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Philpott SE, Witteman HO, Jones KM, Sonderman DS, Julien AS, Politi MC. Clinical trainees' responses to parents who question evidence-based recommendations. PATIENT EDUCATION AND COUNSELING 2017; 100:1701-1708. [PMID: 28495389 DOI: 10.1016/j.pec.2017.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/03/2017] [Accepted: 05/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary). RESULTS 132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions. CONCLUSION Clinicians' attitudes may impact conversations when patients question evidence-based recommendations. PRACTICE IMPLICATIONS Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.
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Affiliation(s)
- Sydney E Philpott
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada; Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Katherine M Jones
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - David S Sonderman
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Anne-Sophie Julien
- Research Centre, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Mary C Politi
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Adsul P, Wray R, Boyd D, Weaver N, Siddiqui S. Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:580-588. [PMID: 27029194 DOI: 10.1007/s13187-016-1025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists' perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30-60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members' involvement in discussions about treatment, especially patients' spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient's condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient's practical, emotional, and social experiences. Their styles to elicit the patient's preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists' routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.
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Affiliation(s)
- Prajakta Adsul
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA.
| | - Ricardo Wray
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
| | - Danielle Boyd
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Nancy Weaver
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA
| | - Sameer Siddiqui
- Department of Surgery, School of Medicine, Saint Louis University, 3635 Vista Ave, St. Louis, MO, 63110, USA
- Center for Cancer Prevention, Research and Outreach, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Rm 329, St. Louis, MO, 63104, USA
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203
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Nyborg I, Danbolt LJ, Kirkevold M. Few opportunities to influence decisions regarding the care and treatment of an older hospitalized family member: a qualitative study among family members. BMC Health Serv Res 2017; 17:619. [PMID: 28859659 PMCID: PMC5579919 DOI: 10.1186/s12913-017-2563-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The drive towards patient involvement in health services has been increasingly promoted. The World Health Organisation emphasizes the family's perspective in comprehensive care. Internationally there is an increased emphasis on what patients and their family tell about the hospital experiences. However, current literature does not adequately address the question of participation experiences among relatives of older hospitalized family members. There is a paucity of research with a generational perspective on relatives' opportunities to exert influence. The aim of the study was to explore relatives' experiences of opportunities to participate in decisions about the care and treatment of older hospitalized family members and whether there are different experiences of influence to the relatives' age. METHODS This was an explorative study applying individual qualitative interviews. The interviews were analysed following hermeneutic methodological principles. Two Norwegian geriatric wards participated: one at a university hospital and one at a local hospital. Twelve participants, six women and six men, were purposively selected. The relatives were aged from 36 to 88 (mean age 62) and were spouses, children and/or children-in-law of patients. RESULTS The relatives' experienced opportunities to exert influence were distributed along a continuum ranging from older relatives being reactive waiting for an initiative from health professionals, to younger adults being proactive securing influence. Older "invisible" carers appeared to go unnoticed by the health professionals, establishing few opportunities to influence decisions. The middle-aged relatives also experienced limited influence, but participated when the hospital needed it. However, limited participation seemed to have less impact on their lives than in the older relatives. Middle-aged relatives and younger adults identified strategies in which visibility was the key to increasing the odds of gaining participation. The exceptional case seemed to be some older carers' experiences of influencing decisions with the help of professionals. CONCLUSIONS Our findings suggest that experiences of influence were limited regardless of age. However, the results indicated that participation among relatives decrease with age while vulnerability for not having influence seemed to increase with age. The problem of patient choice most clearly manifested among the older carers, which might indicate that the relatives' age sets terms for opportunities to participate.
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Affiliation(s)
- Ingrid Nyborg
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
- Innlandet Hospital Trust, Kyrre Grepps gate 11, NO-2819 Gjøvik, Norway
| | - Lars Johan Danbolt
- Norwegian School of Theology, Majorstuen, P.O. Box 5144, NO-0302 Oslo, Norway
- Director of The Center for the Psychology of Religion, Innlandet Hospital Trust, P.O. Box 68, NO-2312 Ottestad, Norway
| | - Marit Kirkevold
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
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Piat M, Sofouli E, Sabetti J, Lambrou A, Chodos H, Briand C, Vachon B, Curran J. Protocol for a mixed studies systematic review on the implementation of the recovery approach in adult mental health services. BMJ Open 2017; 7:e017080. [PMID: 28855202 PMCID: PMC5724147 DOI: 10.1136/bmjopen-2017-017080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Recovery is integral to mental health planning in G-8 countries including Canada. A recovery-oriented approach to care aims to promote personal empowerment, illness self-management and a life beyond services for people with serious mental illness (SMI), while reducing the financial burden associated with mental illness. Although there is a growing body of literature on recovery, no synthesis of research on the implementation of recovery into mental health services exists. OBJECTIVES The objective is to conduct a mixed studies systematic review on the operationalisation of recovery into mental health services for adults with SMI. It will inform the transformation of Canadian services to a recovery orientation, but may be applicable to other countries. METHODS AND ANALYSIS Seven databases including PubMed, Ovid Medline, Ovid Embase, Ovid PsycInfo, CINAHL, the Cochrane Library and Scopus will be searched for peer-reviewed empirical studies published from 1998 to December 2016. Systematic reviews and studies using quantitative, qualitative and mixed methodologies will be included. Secondary searches will be conducted in reference lists of all selected full text articles. Handsearches will also be performed in the tables of contents of three recovery-focused journals for the last 5 years. International experts in the field will be contacted for comments and advice. Data extraction will include identification and methodological synthesis of each study; definition of recovery; information on recovery implementation; facilitators and barriers and study outcomes. A quality assessment will be conducted on each study. The data will be synthesised and a stepwise thematic analysis performed. ETHICS AND DISSEMINATION Ethics approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) a 1-day symposium; (2) presentations in national and international conferences and to local stakeholders; (3) publications in peer-reviewed journals; (4) posts on the organisational websites.
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Judith Sabetti
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Angella Lambrou
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Quebec, Canada
| | - Howard Chodos
- Mental Health Commission of Canada-Ottawa, Ottawa, Ontario, Canada
| | - Catherine Briand
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Brigitte Vachon
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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Scalia P, Elwyn G, Durand MA. "Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'. BMC Med Inform Decis Mak 2017; 17:124. [PMID: 28821256 PMCID: PMC5562992 DOI: 10.1186/s12911-017-0517-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. Results ‘Coherent’ motivations were guided by financial incentives at CapitalCare, and by a ‘champion’ physician at HealthPartners. Nurses worked ‘collectively’ at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Conclusion Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0517-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
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Baldwin PK, Pope ND, Marks AD. Cultural implications of filial obligation and the Asian Indian American family caregiver. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2017. [DOI: 10.4081/qrmh.2017.6618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Family caregivers in young adulthood from different racial/ethnic groups represent an understudied population. Of this group, Asian Indians are a diverse and fast-growing immigrant population in the US and present unique challenges for health care providers. To illustrate factors influencing a young family caregiver from an under-represented racial/ethnic population, we report on the case of a 33 year-old American from an Asian Indian background who was a caregiver for his father with Normal Pressure Hydrocephalus (NPH). With this case report, we illustrate that medical providers should attend to cultural norms of the family system, including family communication patterns, filial obligation, and decision-making.
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207
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Henton M, Gaglio B, Cynkin L, Feuer EJ, Rabin BA. Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool-Surveillance, Epidemiology, and End Results Cancer Survival Calculator. JMIR Cancer 2017; 3:e9. [PMID: 28729232 PMCID: PMC5544898 DOI: 10.2196/cancer.7120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/30/2017] [Accepted: 05/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information. OBJECTIVE The aim of this study was to develop, test, and implement SEER*CSC. METHODS An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from 4 health care delivery systems were recruited to do formal usability testing of SEER*CSC. A revised version of SEER*CSC was then implemented in two health care delivery sites using a real-world clinical implementation approach, and usage data were collected. Post-implementation follow-up interviews were conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. RESULTS Overall feedback of SEER*CSC from both providers and patients was positive, with providers noting that the tool was professional and reliable, and patients finding it to be informational and helpful to use when discussing their diagnosis with their provider. However, use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. CONCLUSIONS The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real-world clinical setting faced significant challenges. As a result of these findings, SEER*CSC is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision-making pathway. The continued development and eventual release of prognostic tools should include feedback from multidisciplinary health care teams, various stakeholder groups, patients, and caregivers.
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Affiliation(s)
- Michelle Henton
- Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Bridget Gaglio
- Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Laurie Cynkin
- Office of Advocacy Relations, Office of the Director, National Cancer Institute, Bethesda, MD, United States
| | - Eric J Feuer
- Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Borsika A Rabin
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, United States
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Wolf A, Moore L, Lydahl D, Naldemirci Ö, Elam M, Britten N. The realities of partnership in person-centred care: a qualitative interview study with patients and professionals. BMJ Open 2017; 7:e016491. [PMID: 28716793 PMCID: PMC5726073 DOI: 10.1136/bmjopen-2017-016491] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Although conceptual definitions of person-centred care (PCC) vary, most models value the involvement of patients through patient-professional partnerships. While this may increase patients' sense of responsibility and control, research is needed to further understand how this partnership is created and perceived. This study aims to explore the realities of partnership as perceived by patients and health professionals in everyday PCC practice. DESIGN Qualitative study employing a thematic analysis of semistructured interviews with professionals and patients. SETTING Four internal medicine wards and two primary care centres in western Sweden. PARTICIPANTS 16 health professionals based at hospital wards or primary care centres delivering person-centred care, and 20 patients admitted to one of the hospital wards. RESULTS Our findings identified both informal and formal aspects of partnership. Informal aspects, emerging during the interaction between healthcare professionals and patients, without any prior guidelines or regulations, incorporated proximity and receptiveness of professionals and building a close connection and confidence. This epitomised a caring, respectful relationship congruent across accounts. Formal aspects, including structured ways of sustaining partnership were experienced differently. Professionals described collaborating with patients to encourage participation, capture personal goals, plan and document care. However, although patients felt listened to and informed, they were content to ask questions and felt less involved in care planning, documentation or exploring lifeworld goals. They commonly perceived participation as informed discussion and agreement, deferring to professional knowledge and expertise in the presence of an empathetic and trusting relationship. CONCLUSIONS In our study, patients appear to value a process of human connectedness above and beyond formalised aspects of documenting agreed goals and care planning. PCC increases patients' confidence in professionals who are competent and able to make them feel safe and secure. Informal elements of partnership provide the conditions for communication and cooperation on which formal relations of partnership can be constructed.
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Affiliation(s)
- Axel Wolf
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothenburg Centre for Person Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lucy Moore
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Doris Lydahl
- Department of Sociology and Work Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Öncel Naldemirci
- Department of Sociology and Work Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Mark Elam
- Department of Sociology and Work Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Nicky Britten
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Qu H, Shewchuk RM, Alarcón G, Fraenkel L, Leong A, Dall'Era M, Yazdany J, Singh JA. Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context. Arthritis Care Res (Hoboken) 2017; 68:1787-1794. [PMID: 27059939 DOI: 10.1002/acr.22904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/13/2016] [Accepted: 03/29/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Numerous factors can impede or facilitate patients' medication decision-making and adherence to physicians' recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach. METHODS We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis. RESULTS A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders' perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for "me," 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics. CONCLUSION Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication.
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Affiliation(s)
| | | | | | - Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut
| | - Amye Leong
- Healthy Motivation, Santa Barbara, California
| | | | | | - Jasvinder A Singh
- Birmingham VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic College of Medicine, Rochester, Minnesota
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210
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Munce SEP, Graham ID, Salbach NM, Jaglal SB, Richards CL, Eng JJ, Desrosiers J, MacKay-Lyons M, Wood-Dauphinee S, Korner-Bitensky N, Mayo NE, Teasell RW, Zwarenstein M, Mokry J, Black S, Bayley MT. Perspectives of health care professionals on the facilitators and barriers to the implementation of a stroke rehabilitation guidelines cluster randomized controlled trial. BMC Health Serv Res 2017. [PMID: 28651530 PMCID: PMC5485614 DOI: 10.1186/s12913-017-2389-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The Stroke Canada Optimization of Rehabilitation by Evidence Implementation Trial (SCORE-IT) was a cluster randomized controlled trial that evaluated two knowledge translation (KT) interventions for the promotion of the uptake of best practice recommendations for interventions targeting upper and lower extremity function, postural control, and mobility. Twenty rehabilitation centers across Canada were randomly assigned to either the facilitated or passive KT intervention. The objective of the current study was to understand the factors influencing the implementation of the recommended treatments and KT interventions from the perspective of nurses, occupational therapists and physical therapists, and clinical managers following completion of the trial. Methods A qualitative descriptive approach involving focus groups was used. Thematic analysis was used to understand the factors influencing the implementation of the recommended treatments and KT interventions. The Clinical Practice Guidelines Framework for Improvement guided the analysis. Results Thirty-three participants were interviewed from 11 of the 20 study sites (6 sites from the facilitated KT arm and 5 sites from the passive KT arm). The following factors influencing the implementation of the recommended treatments and KT interventions emerged: facilitation, agreement with the intervention – practical, familiarity with the recommended treatments, and environmental factors, including time and resources. Each of these themes includes the sub-themes of facilitator and/or barrier. Improved team communication and interdisciplinary collaboration emerged as an unintended outcome of the trial across both arms in addition to a facilitator to the implementation of the treatment recommendations. Facilitation was identified as a facilitator to implementation of the KT interventions in the passive KT intervention arm despite the lack of formally instituted facilitators in this arm of the trial. Conclusions This is one of the first studies to examine the factors influencing the implementation of stroke recommendations and associated KT interventions within the context of a trial. Findings highlight the important role of self-selected facilitators to implementation efforts. Future research should seek to better understand the specific characteristics of facilitators that are associated with successful implementation and clinical outcomes, especially within the context of stroke rehabilitation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2389-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah E P Munce
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
| | - Ian D Graham
- Centre for Practice-Changing Research, The Ottawa Hospital Research Institute, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec City, Quebec, Canada.,Institut de Réadaptation en Déficience Physique de Québec (IRDPQ) Site Hamel, 525 Boul. Wilfrid-Hamel Est, Québec City, Quebec, G1M 2S8, Canada
| | - Janice J Eng
- University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Johanne Desrosiers
- Université de Sherbrooke, Faculty of Medicine and Health Sciences, 3001, 12e avenue nord, Bureau FM-2208, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marilyn MacKay-Lyons
- Office 405 Forrest Building, School of Physiotherapy, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Sharon Wood-Dauphinee
- McGill University, School of Physical and Occupational Therapy, 3630 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Nicol Korner-Bitensky
- McGill University, School of Physical and Occupational Therapy, 3630 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Nancy E Mayo
- Division of Clinical Epidemiology, Division of Geriatrics, McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion R4.29, 687 Pine Ave West, Montreal, Quebec, H3A 1A1, Canada
| | - Robert W Teasell
- Parkwood Institute, 550 Wellington Road, London, Ontario, N6C 0A7, Canada
| | - Merrick Zwarenstein
- Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Jennifer Mokry
- Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada
| | - Sandra Black
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A4 21, Toronto, Ontario, M4N 3M5, Canada
| | - Mark T Bayley
- Neuro Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, room 3-131 (3-East) 3rd Floor University Wing, Toronto, ON, M5G 2A2, Canada
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Ahmadian L, Dorosti N, Khajouei R, Gohari SH. Challenges of using Hospital Information Systems by nurses: comparing academic and non-academic hospitals. Electron Physician 2017; 9:4625-4630. [PMID: 28848639 PMCID: PMC5557144 DOI: 10.19082/4625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 02/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background and aim Hospital Information Systems (HIS) are used for easy access to information, improvement of documentation and reducing errors. Nonetheless, using these systems is faced with some barriers and obstacles. This study identifies the challenges and the obstacles of using these systems in the academic and non-academic hospitals in Kerman. Methods This is a cross-sectional study which was carried out in 2015. The statistical population in this study consisted of the nurses who had been working in the academic and non-academic hospitals in Kerman. A questionnaire consisting of two sections was used. The first section consisted of the demographic information of the participants and the second section comprised 34 questions about the challenges of HIS use. Data were analyzed by the descriptive and statistical analysis (t-test, and ANOVA) using SPSS 19 software. Results The most common and important challenges in the academic hospitals were about human environment factors, particularly “negative attitude of society toward using HIS”. In the non-academic hospitals, the most common and important challenges were related to human factors, and among them, “no incentive to use system” was the main factor. The results of the t-test method revealed that there was a significant relationship between gender and the mean score of challenges related to the organizational environment category in the academic hospitals and between familiarity with HIS and mean score of human environment factors (p<0.05). The results of the ANOVA test also revealed that the educational degree and work experience in the healthcare environment (years) in the academic hospitals have a significant relationship with the mean score related to the hardware challenges, as well, experience with HIS has a significant relationship, with the mean score related to the human challenges (p<0.05). Conclusion The most important challenges in using the information systems are the factors related to the human environment and the human factors. The results of this study can bring a good perspective to the policy makers and the managers regarding obstacles of using HISs from the nurses’ perspective, so that they can solve their problems and can successfully implement these systems.
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Affiliation(s)
- Leila Ahmadian
- Ph.D. in Medical Informatics, Associate Professor of Medical Informatics, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nafise Dorosti
- B.Sc. in Health Information Technology, School of Management and Health Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Ph.D. in Medical Informatics, Associate Professor of Medical Informatics, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadrieh Hajesmaeel Gohari
- M.Sc. in Health Information Technology, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Durand MA, Yen R, Barr PJ, Cochran N, Aarts J, Légaré F, Reed M, James O’Malley A, Scalia P, Guérard GP, Elwyn G. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis. BMJ Open 2017; 7:e015945. [PMID: 28645974 PMCID: PMC5541622 DOI: 10.1136/bmjopen-2017-015945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. METHODS AND ANALYSIS The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. ETHICS AND DISSEMINATION The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Malcolm Reed
- Department of Brighton and Sussex Medical School, Dean’s Office, Brighton, UK
| | - A James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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Adams RC, Levy SE. Shared Decision-Making and Children With Disabilities: Pathways to Consensus. Pediatrics 2017; 139:peds.2017-0956. [PMID: 28562298 DOI: 10.1542/peds.2017-0956] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.
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Affiliation(s)
- Richard C. Adams
- aUniversity of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Susan E. Levy
- bCenter for Autism Research, Division Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cPerelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Coylewright M, O'Neill ES, Dick S, Grande SW. PCI Choice: Cardiovascular clinicians' perceptions of shared decision making in stable coronary artery disease. PATIENT EDUCATION AND COUNSELING 2017; 100:1136-1143. [PMID: 28110953 DOI: 10.1016/j.pec.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Describe cardiovascular clinicians' perceptions of Shared Decision Making following use of a decision aid (DA) for stable coronary artery disease (CAD) "PCI Choice", in a randomized controlled trial. METHODS We conducted a semi-structured qualitative interview study with cardiologists and physician extenders (n=13) after using PCI Choice in practice. Interviews were transcribed then coded. Codes were organized into salient themes. Final themes were determined by consensus with all authors. RESULTS Most clinicians (70%) had no prior knowledge of SDM or DAs. Mixed views about the role of the DA in the visit were related to misconceptions of how patient education differed from SDM. Qualitative assessment of clinician perceptions generated three themes: 1) Gaps exist in clinician knowledge around SDM; 2) Clinicians are often uncomfortable with modifying baseline practice; and 3) Clinicians express interest in using DAs after initial exposure within a research setting. CONCLUSIONS Use of DAs by clinicians during clinic visits may improve understanding of SDM. Initial use is marked by a reluctance to modify established practice patterns. PRACTICE IMPLICATIONS As clinicians explore new approaches to benefit their patients, there is an opportunity for DAs that provide clinician instruction on core elements of SDM to lead to enhanced SDM in clinical practice.
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Affiliation(s)
- Megan Coylewright
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA; Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, USA.
| | - Elizabeth S O'Neill
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Stuart W Grande
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA
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Iaccarino JM, Simmons J, Gould MK, Slatore CG, Woloshin S, Schwartz LM, Wiener RS. Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians. Ann Am Thorac Soc 2017; 14:968-975. [PMID: 28278389 PMCID: PMC5566306 DOI: 10.1513/annalsats.201609-727oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/14/2017] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Guidelines for pulmonary nodule evaluation suggest a variety of strategies, reflecting the lack of high-quality evidence demonstrating the superiority of any one approach. It is unclear whether clinicians agree that multiple management options are appropriate at different levels of risk and whether this impacts their decision-making approaches with patients. OBJECTIVES To assess clinicians' perceptions of the appropriateness of various diagnostic strategies, approach to decision-making, and perceived clinical equipoise in pulmonary nodule evaluation. METHODS We developed and administered a web-based survey in March and April, 2014 to clinician members of the American Thoracic Society. The primary outcome was perceived appropriateness of pulmonary nodule evaluation strategies in three clinical vignettes with different malignancy risk. We compared responses to guideline recommendations and analyzed clinician characteristics associated with a reported shared decision-making approach. We also assessed clinicians' likelihood to enroll patients in hypothetical randomized trials comparing nodule evaluation strategies. RESULTS Of 5,872 American Thoracic Society members e-mailed, 1,444 opened the e-mail and 428 eligible clinicians participated in the survey (response rate, 30.0% among those who opened the invitation; 7% overall). The mean number of options considered appropriate increased with pretest probability of cancer, ranging from 1.8 (SD, 1.2) for the low-risk case to 3.5 (1.1) for the high-risk case (P < 0.0001). As recommended by guidelines, the proportion that deemed surgical resection as an appropriate option also increased with cancer risk (P < 0.0001). One-half of clinicians (50.4%) reported engaging in shared decision-making with patients for pulmonary nodule management; this was more commonly reported by clinicians with more years of experience (P = 0.01) and those who reported greater comfort in managing pulmonary nodules (P = 0.005). Although one-half (49.9%) deemed the evidence for pulmonary nodule evaluation to be strong, most clinicians were willing to enroll patients in randomized trials to compare nodule management strategies in all risk categories (low risk, 87.6%; moderate risk, 89.7%; high risk, 63.0%). CONCLUSIONS Consistent with guideline recommendations, clinicians embrace multiple options for pulmonary nodule evaluation and many are open to shared decision-making. Clinicians support the need for randomized clinical trials to strengthen the evidence for nodule evaluation, which will further improve decision-making.
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Affiliation(s)
| | - James Simmons
- Division of Pulmonary, Critical Care, and Sleep Medicine, Brown University, Providence, Rhode Island
| | - Michael K. Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Steven Woloshin
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
| | - Lisa M. Schwartz
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; and
| | - Renda Soylemez Wiener
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1199] [Impact Index Per Article: 171.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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Dispositional differences in seeking autonomy- or dependency-oriented help: Conceptual development and scale validation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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218
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Petzold T, Eberlein-Gonska M, Schmitt Mph J. [Not Available]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2017; 121:52-53. [PMID: 28410830 DOI: 10.1016/j.zefq.2017.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Thomas Petzold
- Medizinischer Dienst der Krankenversicherung im Freistaat Sachsen e.V., Am Schießhaus 1, 01067 Dresden Gesundheitsökonomisches Zentrum, Technische Universität Dresden.
| | - Maria Eberlein-Gonska
- Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307 Dresden.
| | - Jochen Schmitt Mph
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307 Dresden.
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Thomas A, Han L, Osler BP, Turnbull EA, Douglas E. Students' attitudes and perceptions of teaching and assessment of evidence-based practice in an occupational therapy professional Master's curriculum: a mixed methods study. BMC MEDICAL EDUCATION 2017; 17:64. [PMID: 28347300 PMCID: PMC5368912 DOI: 10.1186/s12909-017-0895-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/08/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Most health professions, including occupational therapy, have made the application of evidence-based practice a desired competency and professional responsibility. Despite the increasing emphasis on evidence-based practice for improving patient outcomes, there are numerous research-practice gaps in the health professions. In addition to efforts aimed at promoting evidence-based practice with clinicians, there is a strong impetus for university programs to design curricula that will support the development of the knowledge, attitudes, skills and behaviours associated with evidence-based practice. Though occupational therapy curricula in North America are becoming increasingly focused on evidence-based practice, research on students' attitudes towards evidence-based practice, their perceptions regarding the integration and impact of this content within the curricula, and the impact of the curriculum on their readiness for evidence-based practice is scarce. The present study examined occupational therapy students' perceptions towards the teaching and assessment of evidence-based practice within a professional master's curriculum and their self-efficacy for evidence-based practice. METHODS The study used a mixed methods explanatory sequential design. The quantitative phase included a cross-sectional questionnaire exploring attitudes towards evidence-based practice, perceptions of the teaching and assessment of evidence-based practice and evidence-based practice self-efficacy for four cohorts of students enrolled in the program and a cohort of new graduates. The questionnaire was followed by a focus group of senior students aimed at further exploring the quantitative findings. RESULTS All student cohorts held favourable attitudes towards evidence-based practice; there was no difference across cohorts. There were significant differences with regards to perceptions of the teaching and assessment of evidence-based practice within the curriculum; junior cohorts and students with previous education had less favourable perceptions. Students' self-efficacy for evidence-based practice was significantly higher across cohorts. Four main themes emerged from the focus group data: (a) Having mixed feelings about the value of evidence-based practice (b) Barriers to the application of evidence-based practice; (c) Opposing worlds and (d) Vital and imperfect role of the curriculum. CONCLUSION This study provides important data to support the design and revision of evidence-based practice curricula within professional rehabilitation programs.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
- Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec Canada
| | - Lu Han
- School of Physical and Occupational Therapy, 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
- Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec Canada
| | - Brittony P. Osler
- School of Physical and Occupational Therapy, 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
- Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec Canada
| | - Emily A. Turnbull
- School of Physical and Occupational Therapy, 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
- Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec Canada
| | - Erin Douglas
- School of Physical and Occupational Therapy, 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
- Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec Canada
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Tong WT, Lee YK, Ng CJ, Lee PY. Factors influencing implementation of a patient decision aid in a developing country: an exploratory study. Implement Sci 2017; 12:40. [PMID: 28327157 PMCID: PMC5361724 DOI: 10.1186/s13012-017-0569-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies on barriers and facilitators to implementation of patient decision aids (PDAs) are conducted in the west; hence, the findings may not be transferable to developing countries. This study aims to use a locally developed insulin PDA as an exemplar to explore the barriers and facilitators to implementing PDAs in Malaysia, an upper middle-income country in Asia. METHODS Qualitative methodology was adopted. Nine in-depth interviews (IDIs) and three focus group discussions (FGDs) were conducted with policymakers (n = 6), medical officers (n = 13), diabetes educators (n = 5) and a nurse, who were involved in insulin initiation management at an academic primary care clinic. The interviews were conducted with the aid of a semi-structured interview guide based on the Theoretical Domains Framework. The interviews were audio-recorded, transcribed verbatim and analyzed using a thematic approach. RESULTS Five themes emerged, and they were lack of shared decision-making (SDM) culture, role boundary, lack of continuity of care, impact on consultation time and reminder network. Healthcare providers' (HCPs) paternalistic attitude, patients' passivity and patient trust in physicians rendered SDM challenging which affected the implementation of the PDA. Clear role boundaries between the doctors and nurses made collaborative implementation of the PDA challenging, as nurses may not view the use of insulin PDA to be part of their job scope. The lack of continuity of care might cause difficulties for doctors to follow up on insulin PDA use with their patient. While time was the most commonly cited barrier for PDA implementation, use of the PDA might reduce consultation time. A reminder network was suggested to address the issue of forgetfulness as well as to trigger interest in using the PDA. The suggested reminders were peer reminders (i.e. HCPs reminding one another to use the PDA) and system reminders (e.g. incorporating electronic medical record prompts, displaying posters/notices, making the insulin PDA available and visible in the consultation rooms). CONCLUSIONS When implementing PDAs, it is crucial to consider the healthcare culture and system, particularly in developing countries such as Malaysia where concepts of SDM and PDAs are still novel.
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Affiliation(s)
- Wen Ting Tong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
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Sepucha KR, Simmons LH, Barry MJ, Edgman-Levitan S, Licurse AM, Chaguturu SK. Ten Years, Forty Decision Aids, And Thousands Of Patient Uses: Shared Decision Making At Massachusetts General Hospital. Health Aff (Millwood) 2017; 35:630-6. [PMID: 27044963 DOI: 10.1377/hlthaff.2015.1376] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Shared decision making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital's integration of shared decision making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, shared decision making conversations; using patient decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of shared decision making in practice. In the period 2005-15, more than 900 clinicians and other staff members were trained in shared decision making, and more than 28,000 orders for one of about forty patient decision aids were placed to support informed patient-centered decisions. We profile two different implementation initiatives that increased the use of patient decision aids at the hospital's eighteen adult primary care practices, and we summarize key elements of the shared decision making program.
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Affiliation(s)
- Karen R Sepucha
- Karen R. Sepucha is an assistant professor of medicine at Harvard Medical School and Massachusetts General Hospital (MGH), both in Boston
| | | | - Michael J Barry
- Michael J. Barry is a physician and medical director of the John D. Stoeckle Center for Primary Care Innovation at MGH
| | - Susan Edgman-Levitan
- Susan Edgman-Levitan is executive director of the John D. Stoeckle Center for Primary Care Innovation at MGH
| | - Adam M Licurse
- Adam M. Licurse is assistant medical director of the Brigham and Women's Physicians Organization, a physician at Brigham and Women's Hospital, and associate medical director for population health management at Partners HealthCare, all in Boston
| | - Sreekanth K Chaguturu
- Sreekanth K. Chaguturu is vice president for population health management at Partners HealthCare, a staff physician at MGH, and a clinical instructor at Harvard Medical School
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Ortega-Moreno M, Padilla-Garrido N, Huelva-López L, Aguado-Correa F, Bayo-Calero J, Bayo-Lozano E. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions]. ACTA ACUST UNITED AC 2017; 32:141-145. [PMID: 28274548 DOI: 10.1016/j.cali.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/23/2016] [Accepted: 01/14/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. MATERIAL AND METHODS A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. RESULTS More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. CONCLUSIONS The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient.
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Affiliation(s)
- M Ortega-Moreno
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España.
| | - N Padilla-Garrido
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España
| | - L Huelva-López
- Centro de Transfusión Sanguínea de Huelva, Huelva, España
| | - F Aguado-Correa
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España
| | - J Bayo-Calero
- Servicio de Oncología Médica, Hospital Juan Ramón Jiménez, Huelva, España
| | - E Bayo-Lozano
- Servicio de Oncología Radioterápica, Hospital Juan Ramón Jiménez, Huelva, España
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Curtis K, Fry M, Shaban RZ, Considine J. Translating research findings to clinical nursing practice. J Clin Nurs 2017; 26:862-872. [PMID: 27649522 PMCID: PMC5396371 DOI: 10.1111/jocn.13586] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. BACKGROUND There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. DESIGN This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. METHODS This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. CONCLUSIONS Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. RELEVANCE TO PRACTICE Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.
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Affiliation(s)
- Kate Curtis
- Sydney Nursing SchoolUniversity of SydneyCamperdownNSWAustralia
- Trauma ServiceSt George HospitalKogarahNSWAustralia
- St George and Sutherland Clinical SchoolUniversity of New South WalesSt George HospitalKogarahNSWAustralia
| | - Margaret Fry
- Northern Sydney Local Health DistrictRoyal North Shore Hospital CampusSt LeonardsNSWAustralia
- Faculty of HealthUniversity of Technology SydneyUltimoNSWAustralia
| | - Ramon Z Shaban
- School of Nursing and MidwiferyMenzies Health Institute QueenslandGriffith UniversityNathanQldAustralia
- Department of Infection Control and Infectious DiseasesGold Coast University HospitalGold Coast Hospital and Health ServiceSouthportQldAustralia
| | - Julie Considine
- Centre for Quality and Patient Safety ResearchSchool of Nursing and MidwiferyDeakin UniversityBurwoodVicAustralia
- Midwifery Research CentreEastern HealthDeakin University NursingBox HillVicAustralia
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Salyers MP, Fukui S, Bonfils KA, Firmin RL, Luther L, Goscha R, Rapp CA, Holter MC. Consumer Outcomes After Implementing CommonGround as an Approach to Shared Decision Making. Psychiatr Serv 2017; 68:299-302. [PMID: 27903137 PMCID: PMC5658777 DOI: 10.1176/appi.ps.201500468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined consumer outcomes before and after implementing CommonGround, a computer-based shared decision-making program. METHODS Consumers with severe mental illness (N=167) were interviewed prior to implementation and 12 and 18 months later to assess changes in active treatment involvement, symptoms, and recovery-related attitudes. Providers also rated consumers on level of treatment involvement. RESULTS Most consumers used CommonGround at least once (67%), but few used the program regularly. Mixed-effects regression analyses showed improvement in self-reported symptoms and recovery attitudes. Self-reported treatment involvement did not change; however, for a subset of consumers with the same providers over time (N=83), the providers rated consumers as more active in treatment. CONCLUSIONS This study adds to the growing literature on tools to support shared decision making, showing the potential benefits of CommonGround for improving recovery outcomes. More work is needed to better engage consumers in CommonGround and to test the approach with more rigorous methods.
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Affiliation(s)
- Michelle P Salyers
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Sadaaki Fukui
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Kelsey A Bonfils
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Ruth L Firmin
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Lauren Luther
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Rick Goscha
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Charles A Rapp
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
| | - Mark C Holter
- Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis (e-mail: ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was affiliated when this work was done
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Edqvist M, Hildingsson I, Mollberg M, Lundgren I, Lindgren H. Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study. Birth 2017; 44:86-94. [PMID: 27859542 PMCID: PMC5324579 DOI: 10.1111/birt.12267] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women. METHODS An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables. RESULTS A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention. CONCLUSION It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low- and high-risk pregnancies.
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Affiliation(s)
- Malin Edqvist
- Institute of Health and Care SciencesThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Ingegerd Hildingsson
- Department of NursingMid Sweden UniversitySundsvallSweden,Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Margareta Mollberg
- Institute of Health and Care SciencesThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Ingela Lundgren
- Institute of Health and Care SciencesThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Lindgren
- Institute of Health and Care SciencesThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Women's and Children's HealthKarolinska InstituteStockholmSweden
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226
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The Patient Experience With Shared Decision Making: A Qualitative Descriptive Study. JOURNAL OF INFUSION NURSING 2017; 38:407-18. [PMID: 26536328 DOI: 10.1097/nan.0000000000000136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Shared decision making is a process characterized by a partnership between a nurse and a patient. The existence of a relationship does not ensure shared decision making. Little is known about what nurses need to know and do for this experience to take place. A qualitative descriptive study was implemented using Coalizzi's method. Semistructured interviews were held with patients, and 3 themes were uncovered. The findings suggest that a nurse's conduct aimed at drawing patients in and inviting them to participate in a conversation leads toward shared decisions. Infusion nurses may find this information useful as they engage their patients in shared decisions.
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227
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Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know? BIOMED RESEARCH INTERNATIONAL 2016; 2016:6829875. [PMID: 28116302 PMCID: PMC5225325 DOI: 10.1155/2016/6829875] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022]
Abstract
Radiotherapy (RT) for prostate cancer (PC) has steadily evolved over the last decades, with improving biochemical disease-free survival. Recently population based research also revealed an association between overall survival and doses ≥ 75.6 Gray (Gy) in men with intermediate- and high-risk PC. Examples of improved RT techniques are image-guided RT, intensity-modulated RT, volumetric modulated arc therapy, and stereotactic ablative body RT, which could facilitate further dose escalation. Brachytherapy is an internal form of RT that also developed substantially. New devices such as rectum spacers and balloons have been developed to spare rectal structures. Newer techniques like protons and carbon ions have the intrinsic characteristics maximising the dose on the tumour while minimising the effect on the surrounding healthy tissue, but clinical data are needed for confirmation in randomised phase III trials. Furthermore, it provides an overview of an important discussion issue in PC treatment between urologists and radiation oncologists: the comparison between radical prostatectomy and RT. Current literature reveals that all possible treatment modalities have the same cure rate, but a different toxicity pattern. We recommend proposing the possible different treatment modalities with their own advantages and side-effects to the individual patient. Clinicians and patients should make treatment decisions together (shared decision-making) while using patient decision aids.
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Abstract
Shared decision-making is a paradigm of patient engagement that is assuming greater importance in the era of value-based health care. The basic tenets include patient engagement on clinical decisions, taking into account multiple factors that influence physician and patient decision-making. Understanding and reconciling diametrically opposed views of care are important tenets of shared decision-making. Because many decisions are made preoperatively, the applicability of these principles may be useful especially in the situation of a higher risk surgical candidate. Many patients with Do-Not-Resuscitate (DNR) orders are undergoing procedures to improve quality of life. This article explores shared decision-making and DNR.
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Affiliation(s)
- Arvind Chandrakantan
- Department of Anesthesiology, Institutional Ethics Committee, Stony Brook University Medical Center, HSC Level 4, Room # 060, Stony Brook, NY 11794, USA.
| | - Tracie Saunders
- Department of Anesthesiology, Institutional Ethics Committee, Stony Brook University Medical Center, HSC Level 4, Room # 060, Stony Brook, NY 11794, USA
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Laue J, Melbye H, Halvorsen PA, Andreeva EA, Godycki-Cwirko M, Wollny A, Francis NA, Spigt M, Kung K, Risør MB. How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study. Int J Chron Obstruct Pulmon Dis 2016; 11:3109-3119. [PMID: 27994450 PMCID: PMC5153277 DOI: 10.2147/copd.s118856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations. METHODS Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong. RESULTS Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients' perspective: the GPs considered patients' experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients' perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of "wrong decisions" and concerning the negotiation of responsibilities. CONCLUSION Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs' management decisions. GPs consider a holistic understanding of illness and the patients' own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs' decisions depend on the availability and reliability of other formal and informal carers, and the health care systems' organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients' social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations.
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Affiliation(s)
- Johanna Laue
- Department of Community Medicine, General Practice Research Unit, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
| | - Hasse Melbye
- Department of Community Medicine, General Practice Research Unit, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
| | - Peder A Halvorsen
- Department of Community Medicine, General Practice Research Unit, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
| | - Elena A Andreeva
- Department of Family Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Maciek Godycki-Cwirko
- Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Anja Wollny
- Institute of General Practice, University Medical Center Rostock, Rostock, Germany
| | - Nick A Francis
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Mark Spigt
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Kenny Kung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Mette Bech Risør
- Department of Community Medicine, General Practice Research Unit, University of Tromsø – The Arctic University of Norway, Tromsø, Norway
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Wielaert S, van de Sandt-Koenderman MW, Dammers N, Sage K. ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings. Disabil Rehabil 2016; 40:76-89. [DOI: 10.1080/09638288.2016.1243160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Nina Dammers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Gondek D, Edbrooke-Childs J, Velikonja T, Chapman L, Saunders F, Hayes D, Wolpert M. Facilitators and Barriers to Person-centred Care in Child and Young People Mental Health Services: A Systematic Review. Clin Psychol Psychother 2016; 24:870-886. [DOI: 10.1002/cpp.2052] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Dawid Gondek
- Evidence Based Practice Unit, UCL and Anna Freud Centre; London UK
| | | | - Tjasa Velikonja
- Evidence Based Practice Unit, UCL and Anna Freud Centre; London UK
| | - Louise Chapman
- Evidence Based Practice Unit, UCL and Anna Freud Centre; London UK
| | | | - Daniel Hayes
- Evidence Based Practice Unit, UCL and Anna Freud Centre; London UK
| | - Miranda Wolpert
- Evidence Based Practice Unit, UCL and Anna Freud Centre; London UK
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Leyva B, Persoskie A, Ottenbacher A, Hamilton JG, Allen JD, Kobrin SC, Taplin SH. Do Men Receive Information Required for Shared Decision Making About PSA Testing? Results from a National Survey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:693-701. [PMID: 26498649 PMCID: PMC5515087 DOI: 10.1007/s13187-015-0870-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Most professional organizations, including the American College of Physicians and U.S. Preventive Services Task Force, emphasize that screening for prostate cancer with the prostate-specific antigen (PSA) test should only occur after a detailed discussion between the health-care provider and patient about the known risks and potential benefits of the test. In fact, guidelines strongly advise health-care providers to involve patients, particularly those at elevated risk of prostate cancer, in a "shared decision making" (SDM) process about PSA testing. We analyzed data from the National Cancer Institute's Health Information National Trends Survey 2011-2012-a nationally representative, cross-sectional survey-to examine the extent to which health professionals provided men with information critical to SDM prior to PSA testing, including (1) that patients had a choice about whether or not to undergo PSA testing, (2) that not all doctors recommend PSA testing, and (3) that no one is sure if PSA testing saves lives. Over half (55 %) of men between the ages of 50 and 74 reported ever having had a PSA test. However, only 10 % of men, regardless of screening status, reported receiving all three pieces of information: 55 % reported being informed that they could choose whether or not to undergo testing, 22 % reported being informed that some doctors recommend PSA testing and others do not, and 14 % reported being informed that no one is sure if PSA testing actually saves lives. Black men and men with lower levels of education were less likely to be provided this information. There is a need to improve patient-provider communication about the uncertainties associated with the PSA test. Interventions directed at patients, providers, and practice settings should be considered.
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Affiliation(s)
- Bryan Leyva
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA.
| | - Alexander Persoskie
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Allison Ottenbacher
- Science of Research and Technology Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer D Allen
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
| | - Sarah C Kobrin
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA
| | - Stephen H Taplin
- Process of Care Research Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr. 3E230, Bethesda, MD, 20892, USA
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Litchfield I, Gale N, Burrows M, Greenfield S. Protocol for using mixed methods and process improvement methodologies to explore primary care receptionist work. BMJ Open 2016; 6:e013240. [PMID: 27852720 PMCID: PMC5129058 DOI: 10.1136/bmjopen-2016-013240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The need to cope with an increasingly ageing and multimorbid population has seen a shift towards preventive health and effective management of chronic disease. This places general practice at the forefront of health service provision with an increased demand that impacts on all members of the practice team. As these pressures grow, systems become more complex and tasks delegated across a broader range of staff groups. These include receptionists who play an essential role in the successful functioning of the surgery and are a major influence on patient satisfaction. However, they do so without formal recognition of the clinical implications of their work or with any requirements for training and qualifications. METHODS AND ANALYSIS Our work consists of three phases. The first will survey receptionists using the validated Work Design Questionnaire to help us understand more precisely the parameters of their role; the second involves the use of iterative focus groups to help define the systems and processes within which they work. The third and final phase will produce recommendations to increase the efficiency and safety of the key practice processes involving receptionists and identify the areas and where receptionists require targeted support. In doing so, we aim to increase job satisfaction of receptionists, improve practice efficiency and produce better outcomes for patients. ETHICS AND DISSEMINATION Our work will be disseminated using conferences, workshops, trade journals, electronic media and through a series of publications in the peer reviewed literature. At the very least, our work will serve to prompt discussion on the clinical role of receptionists and assess the advantages of using value streams in conjunction with related tools for process improvement.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Michael Burrows
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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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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Brodtkorb K, Skisland AVS, Slettebø Å, Skaar R. Preserving dignity in end-of-life nursing home care: Some ethical challenges. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/2057158516674836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A central task in palliative care is meeting the needs of frail, dying patients in nursing homes. The aim of this study was to investigate how healthcare workers are influenced by and deal with ethical challenges in end-of-life care in nursing homes. The study was inspired by clinical application research. Researchers and clinical staff, as co-researchers, collaborated to shed light on clinical situations and create a basis for new practice. The analysis resulted in the main theme, ‘Dignity in end-of-life nursing home care’, and the sub-categories ‘Challenges regarding life-prolonging treatment’ and ‘Uncertainty regarding clarification conversations’. Our findings indicate that nursing homes do not provide necessary organizational frames for the team approach that characterizes good palliation, and therefore struggle to give dignified care. Ethical challenges experienced by healthcare workers are closely connected to inadequate organizational frames.
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Affiliation(s)
- Kari Brodtkorb
- Center of Care research, South, University of Agder, Grimstad, Norway
| | | | - Åshild Slettebø
- Center of Care research, South, University of Agder, Grimstad, Norway
| | - Ragnhild Skaar
- Center of Care research, South, University of Agder, Grimstad, Norway
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Abstract
BACKGROUND Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. CONCLUSION Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of 'real world' contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants' discretion over resource mobilisation and actors' contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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Affiliation(s)
- Carl R May
- Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton, SO17 1BJ, UK. .,University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK.
| | - Mark Johnson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Tracy Finch
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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237
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Abstract
BACKGROUND Context is a problem in research on health behaviour change, knowledge translation, practice implementation and health improvement. This is because many intervention and evaluation designs seek to eliminate contextual confounders, when these represent the normal conditions into which interventions must be integrated if they are to be workable in practice. DISCUSSION We present an ecological model of the ways that participants in implementation and health improvement processes interact with contexts. The paper addresses the problem of context as it affects processes of implementation, scaling up and diffusion of interventions. We extend our earlier work to develop Normalisation Process Theory and show how these processes involve interactions between mechanisms of resource mobilisation, collective action and negotiations with context. These mechanisms are adaptive. They contribute to self-organisation in complex adaptive systems. CONCLUSION Implementation includes the translational efforts that take healthcare interventions beyond the closed systems of evaluation studies into the open systems of 'real world' contexts. The outcome of these processes depends on interactions and negotiations between their participants and contexts. In these negotiations, the plasticity of intervention components, the degree of participants' discretion over resource mobilisation and actors' contributions, and the elasticity of contexts, all play important parts. Understanding these processes in terms of feedback loops, adaptive mechanisms and the practical compromises that stem from them enables us to see the mechanisms specified by NPT as core elements of self-organisation in complex systems.
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238
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Naehrig DN, Koh ES, Vogiatzis M, Yanagisawa W, Kwong C, Shepherd HL, Milross C, Dhillon HM. Impact of cognitive function on communication in patients with primary or secondary brain tumours. J Neurooncol 2016; 126:299-307. [PMID: 26498590 DOI: 10.1007/s11060-015-1964-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/19/2015] [Indexed: 11/12/2022]
Abstract
Communication support tools (CST) improve patient outcomes in oncology including: knowledge, satisfaction, self-management, and adherence to planned treatment. Little is known about communication support tools use in patients with primary or secondary brain tumours. We aimed to explore cognitive function and communication support tool use in this population. This prospective survey involved patients, caregivers and health professionals. Questionnaires were completed after initial brain radiotherapy consultation and 1-2 weeks later. Patients completed the Montreal Cognitive Assessment (MoCA). Descriptive statistics are reported. Fifty-three patients participated, median age 62 years, ECOG status 0-2 (90 %), with 75 % having secondary brain metastasis. 21/53 (40 %) patients reported needing help reading medical information. Only 28 % patients had normal cognition (MoCA score ≥ 26/30). Initially, 82 % of patients and 87 % of caregivers reported the consultation was 'extremely/quite clear, and 69 % of their health professionals thought consultation 'extremely/quite clear' to patient. At follow-up, fewer patients (75 %) reported health professionals' explanation as 'extremely/quite clear'. Although patients recalled discussed illness and treatment details, 82 % recalled treatment-related side effects and management thereof by 46 %. CST use was reported by 22 % patients, 19 % caregivers, and 27 %health professionals. When used, tools improved understanding according to 92 % patients, 100 % caregivers, and 91 % health professionals. The majority of patients have some level of cognitive impairment. Information discussed appears clear to most patients, but this is not sustained, and recall of treatment toxicity management is poor. Few CSTs are used in consultations, but when used, are reported as helpful by all.
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Hsu C, Liss DT, Frosch DL, Westbrook EO, Arterburn D. Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties. Med Decis Making 2016; 37:113-126. [PMID: 27899745 DOI: 10.1177/0272989x16671933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. DESIGN In-depth, qualitative interviews with specialty care providers in two specialties-orthopedics and cardiology-at two time points during DA implementation. Data were analyzed using a thematic analysis approach. RESULTS We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. LIMITATIONS Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. CONCLUSIONS Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.
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Affiliation(s)
- Clarissa Hsu
- Group Health Research Institute, Seattle, WA (CH, EOW, DA)
| | - David T Liss
- Feinberg School of Medicine, Northwestern University, Chicago, IL (DTL)
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA (DLF).,Department of Medicine, University of California, Los Angeles, CA (DLF)
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Meursinge Reynders R, Ronchi L, Ladu L, Di Girolamo N, de Lange J, Roberts N, Mickan S. Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review. Syst Rev 2016; 5:163. [PMID: 27662827 PMCID: PMC5034676 DOI: 10.1186/s13643-016-0336-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs. METHODS Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information. RESULTS Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias; and (8) additional shortcomings. Meta-analyses were not possible because of these limitations. Two eligible studies found that respectively 56.3 % (952/1691) and 40.16 % (439/1093) of clinicians do not use OMIs. CONCLUSIONS Notwithstanding the limitations of the eligible studies, their findings were important because (1) 17 implementation constructs were identified of which 8 were scored by more than 50 % of the stakeholders; (2) the various shortcomings showed how to improve on future implementation studies; and (3) the underuse of OMIs in the selected studies and in the literature demonstrated the need to identify, quantify, and address implementation constructs. Prioritizing of future research questions on OMIs with all pertinent stakeholders is an important first step and could redirect research studies on OMIs towards implementation issues. Patients, clinicians, researchers, policymakers, insurance companies, implant companies, and research sponsors will all be beneficiaries.
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Affiliation(s)
- Reint Meursinge Reynders
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,, Via Matteo Bandello 15, 20123, Milan, Italy.
| | | | - Luisa Ladu
- , Via Matteo Bandello 15, 20123, Milan, Italy
| | - Nicola Di Girolamo
- Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academisch Centrum Tandheelkunde Amsterdam (ACTA), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Nia Roberts
- Bodleian Health Care libraries, Cairns Library Level 3, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Sharon Mickan
- Department of Allied Health, Gold Coast Health and Griffith University, Queensland, QLD, 4222, Australia
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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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242
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Lépine J, Leiva Portocarrero ME, Delanoë A, Robitaille H, Lévesque I, Rousseau F, Wilson BJ, Giguère AMC, Légaré F. What factors influence health professionals to use decision aids for Down syndrome prenatal screening? BMC Pregnancy Childbirth 2016; 16:262. [PMID: 27596573 PMCID: PMC5011951 DOI: 10.1186/s12884-016-1053-2] [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] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023] Open
Abstract
Background Health professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up. Methods We planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews. Results Out of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues’ approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a relevant source of information (n = 24, 67 %, motivation and goals domain); and 6) not knowing any PtDAs (n = 23, 64 %, knowledge domain). Conclusions Appraisal, PtDA availability, peer approval, time concerns, evidence and PtDA awareness all affect whether health professionals are likely to use a PtDA to help pregnant women make informed decision about Down syndrome screening. Implementation strategies will need to address these factors. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1053-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Maria Esther Leiva Portocarrero
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Agathe Delanoë
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada
| | - Isabelle Lévesque
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, and MSSS/FRQS/CHUQ Research Chair in Health Technology Assessment and Evidence Based Laboratory Medicine, Quebec, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Anik M C Giguère
- Quebec Centre of Excellence on Aging, CHU de Québec Research Centre, Quebec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation and Research Axis of Population Health and Practice-Changing Research, CHU de Québec Research Centre, Quebec, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada. .,CHU de Québec Research Centre (CRCHUQ), Hôpital Saint-François d'Assise, Université Laval, 10 rue de l'Espinay, Local D6-737, Quebec, QC, G1L 3L5, Canada.
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Nijhuis FA, van Heek J, Bloem BR, Post B, Faber MJ. Choosing an Advanced Therapy in Parkinson’s Disease; is it an Evidence-Based Decision in Current Practice? JOURNAL OF PARKINSONS DISEASE 2016; 6:533-43. [DOI: 10.3233/jpd-160816] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Frouke A.P. Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
- Department of Neurology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Jolien van Heek
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud university medical center, Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud university medical center, Nijmegen, the Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud university medical center, Nijmegen, the Netherlands
| | - Marjan J. Faber
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences., Radboud university medical center, Nijmegen, the Netherlands
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Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, Khan DN, Mbaruku G, Mrisho M, Mugerwa K, Uka S, Gülmezoglu AM, Straus SE. Low- and middle-income countries face many common barriers to implementation of maternal health evidence products. J Clin Epidemiol 2016; 76:229-37. [DOI: 10.1016/j.jclinepi.2016.02.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/16/2015] [Accepted: 02/02/2016] [Indexed: 11/16/2022]
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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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246
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Mosavianpour M, Sarmast HH, Kissoon N, Collet JP. Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review. J Multidiscip Healthc 2016; 9:303-10. [PMID: 27499628 PMCID: PMC4959766 DOI: 10.2147/jmdh.s107796] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Theoretical domains framework (TDF) provides an integrative model for assessing barriers to behavioral changes in order to suggest interventions for improvement in behavior and ultimately outcomes. However, there are other tools that are used to assess barriers. OBJECTIVE The objective of this study is to determine the degree of concordance between domains and constructs identified in two versions of the TDF including original (2005) and refined version (2012) and independent studies of other tools. METHODS We searched six databases for articles that studied barriers to health-related behavior changes of health care professionals or the general public. We reviewed quantitative papers published in English which included their questionnaires in the article. A table including the TDF domains of both original and refined versions and related constructs was developed to serve as a reference to describe the barriers assessed in the independent studies; descriptive statistics were used to express the results. RESULTS Out of 552 papers retrieved, 50 were eligible to review. The barrier domains explored in these articles belonged to two to eleven domains of the refined TDF. Eighteen articles (36%) used constructs outside of the refined version. The spectrum of barrier constructs of the original TDF was broader and could meet the domains studied in 48 studies (96%). Barriers in domains of "environmental context and resources", "beliefs about consequences", and "social influences" were the most frequently explored in 42 (84%), 37 (74%), and 33 (66%) of the 50 articles, respectively. CONCLUSION Both refined and original TDFs cataloged barriers measured by the other studies that did not use TDF as their framework. However, the original version of TDF explored a broader spectrum of barriers than the refined version. From this perspective, the original version of the TDF seems to be a more comprehensive tool for assessing barriers in practice.
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Affiliation(s)
- Mirkaber Mosavianpour
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Hamideh Helen Sarmast
- British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Niranjan Kissoon
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia; British Columbia Children's Hospital; Child and Family Research Institute, Vancouver, BC, Canada
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Farrell R, Agatisa P, Mercer M, Mitchum A, Coleridge M. Expanded indications for noninvasive prenatal genetic testing: Implications for the individual and the public. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jemep.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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248
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Gayer CC, Crowley MJ, Lawrence WF, Gierisch JM, Gaglio B, Williams JW, Myers ER, Kendrick A, Slutsky J, Sanders GD. An overview and discussion of the Patient-Centered Outcomes Research Institute's decision aid portfolio. J Comp Eff Res 2016; 5:407-15. [PMID: 27298206 DOI: 10.2217/cer-2016-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Decision aids (DAs) help patients make informed healthcare decisions in a manner consistent with their values and preferences. Despite their promise, DAs developed with public research dollars are not being implemented and adopted in real-world patient care settings at a rate consistent with which they are being developed. To appraise the sum of the parts of the portfolio and create a strategic imperative surrounding future funding, the Patient-Centered Outcomes Research Institute (PCORI) tasked the Duke Evidence Synthesis Group with evaluating its DA portfolio. This paper describes PCORI's portfolio of DAs according to the Duke Evidence Synthesis Group's analysis in the context of PCORI's mission and the field of decision science. The results revealed a diversity within PCORI's portfolio of funded DA projects. Findings support the movement toward more rigorous DA development, assessment and maintenance. PCORI's funding priorities related to DAs are clarified and comparative questions of interest are posed.
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Affiliation(s)
| | - Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - John W Williams
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Evan R Myers
- Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA.,Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Amy Kendrick
- Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA
| | - Jean Slutsky
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Gillian D Sanders
- Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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249
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van de Pol MHJ, Fluit CRMG, Lagro J, Slaats YHP, Olde Rikkert MGM, Lagro-Janssen ALM. Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. PATIENT EDUCATION AND COUNSELING 2016; 99:1069-1077. [PMID: 26763871 DOI: 10.1016/j.pec.2015.12.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities. METHODS We used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model. RESULTS Consensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). CONCLUSIONS SDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker. PRACTICE IMPLICATIONS The developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients.
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Affiliation(s)
- Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Cornelia R M G Fluit
- Academic Educational Institute, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Joep Lagro
- Department of Internal Medicine, Haga Teaching Hospital, Postbus 40551, 2504 LN The Hague, The Netherlands.
| | - Yvonne H P Slaats
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
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250
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Sharkey S, Lloyd C, Tomlinson R, Thomas E, Martin A, Logan S, Morris C. Communicating with disabled children when inpatients: barriers and facilitators identified by parents and professionals in a qualitative study. Health Expect 2016; 19:738-50. [PMID: 25156078 PMCID: PMC5055242 DOI: 10.1111/hex.12254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children. AIMS To explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients. DESIGN This was an exploratory qualitative study. METHODS We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication. RESULTS Barriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids. CONCLUSIONS Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers.
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Affiliation(s)
- Siobhan Sharkey
- Primary Care Research Group, University of Plymouth Medical School, University of Plymouth, Plymouth, UK
| | - Claire Lloyd
- Peninsula Cerebra Research Unit and PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Alice Martin
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Stuart Logan
- Peninsula Cerebra Research Unit and PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Christopher Morris
- Peninsula Cerebra Research Unit and PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK
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