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Murugesu L, Fransen MP, Timmermans DR, Pieterse AH, Smets EM, Damman OC. Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care. PEC INNOVATION 2024; 4:100278. [PMID: 38596600 PMCID: PMC11002297 DOI: 10.1016/j.pecinn.2024.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Background Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care. Methods The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5). Results In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level. Conclusion and innovation The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mirjam P. Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Danielle R.M. Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Arwen H. Pieterse
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, the Netherlands
| | - Ellen M.A. Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Olga C. Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
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Wieringa TH, León-García M, Espinoza Suárez NR, Hernández-Leal MJ, Jacome CS, Zisman-Ilani Y, Otten RHJ, Montori VM, Pieterse AH. The role of time in involving patients with cancer in treatment decision making: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 125:108285. [PMID: 38701622 DOI: 10.1016/j.pec.2024.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized. OBJECTIVE This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers. METHODS Seven databases were searched for any publications on patient involvement in cancer treatment decisions, focusing on how time is used to involve patients, the association between time and patient involvement, and/or strategies to overcome time-related barriers. Reviewers worked independently and in duplicate to select publications and extract data. One coder thematically analyzed data, a second coder checked these analyses. RESULTS The analysis of 26 eligible publications revealed four themes. Time was a resource 1) to process the diagnosis, 2) to obtain/process/consider information, 3) for patients and clinicians to spend together, and 4) for patient involvement in making decisions. DISCUSSION Time is a resource throughout the treatment decision-making process, and generic strategies have been proposed to overcome time constraints. PRACTICE VALUE Clinicians could co-create decision-making timelines with patients, spread decisions across several consultations, share written information with patients, and support healthcare redesigns that allocate the necessary time.
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Affiliation(s)
- Thomas H Wieringa
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - María José Hernández-Leal
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Economics, Rovira i Virgili University, Tarragona, Spain; University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; Millennium Nucleus on Sociomedicine, 750908 Santiago, Chile
| | - Cristian Soto Jacome
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Internal Medicine, Department of Medicine, Norwalk Hospital, Norwalk, CT, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - René H J Otten
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
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Thompson JH, Thompson J, Bailey S. Shared decision-making in advanced physiotherapy and first contact physiotherapy management of adults with musculoskeletal disorders in the United Kingdom: An online cross-sectional survey. J Eval Clin Pract 2024. [PMID: 38881399 DOI: 10.1111/jep.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024]
Abstract
RATIONALE Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient-centred care. AIM To evaluate the current knowledge, views and use of shared decision-making in MSK advanced physiotherapy practice in the United Kingdom. METHODS A cross-sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self-reported use of shared decision-making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom. RESULTS Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient-led approach to decision-making compared to APPs who favoured collaborative decision-making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions. CONCLUSIONS The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient-led decision-making approaches.
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Hriberšek M, Eibensteiner F, Bukowski N, Yeung AWK, Atanasov AG, Schaden E. Research areas and trends in family-centered care in the 21st century: a bibliometric review. Front Med (Lausanne) 2024; 11:1401577. [PMID: 38933103 PMCID: PMC11201138 DOI: 10.3389/fmed.2024.1401577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Family-centered care (FCC) is a model of care provision that sees a patient's loved ones as essential partners to the health care team and positively influences the psychological safety of patients and loved ones. Objectives This review aims to present an overview of impactful publications, authors, institutions, journals, countries, fields of application and trends of FCC in the 21st century as well as suggestions on further research. Methods The Web of Science Database was searched for publications on FCC between January 2000 and Dezember 2023. After screening for duplicates, VOS Viewer and CiteSpace were used to analyze and visualize the data. Results Scientific interest in FCC has grown and resulted in the scientific output of 4,836 publications originating from 103 different countries. Based on the frequent author keywords, FCC was of greatest interest in neonatology and pediatrics, nursing, critical and intensive care, end-of-life and palliative care, and patient-related outcomes. The recent research hotspots are "patient engagement," "qualitative study," and "health literacy." Conclusion FCC has gained recognition and spread from the pediatric to the adult palliative, intensive, end-of-life and geriatric care settings. This is a very reassuring development since adults, especially when older, want and need the assistance of their social support systems. Recent research directions include the involvement of patients in the development of FCC strategies, health literacy interventions and the uptake of telemedicine solutions.
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Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Clinical Department of Pediatric Nephrology and Gastroenterology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nils Bukowski
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Andy Wai Kan Yeung
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Institute of Genetics and Animal Biotechnology, Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Björk J, Hirsch A. An "ethics of strangers"? On knowing the patient in clinical ethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024:10.1007/s11019-024-10213-y. [PMID: 38850498 DOI: 10.1007/s11019-024-10213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
The shape and function of ethical imperatives may vary if the context is an interaction between strangers, or those who are well acquainted. This idea, taken up from Stephen Toulmin's distinction between an "ethics of strangers" and an "ethics of intimacy", can be applied to encounters in healthcare. There are situations where healthcare personnel (HCP) know their patients (corresponding to an "ethics of intimacy") and situations where HCP do not know their patients (corresponding to "an ethics of strangers"). Does it make a difference for normative imperatives that follow from central concepts and principles in medical ethics whether HCP know their patients or not? In our view, this question has not yet been answered satisfactorily. Once we have clarified what is meant by "knowing the patient", we will show that the distinction is particularly relevant with regard to some thorny questions of autonomy in healthcare (e.g., regarding advance directives or paternalism in the name of autonomy), whereas the differences with regard to imperatives following from the principles of justice and beneficence seem to be smaller. We provide a detailed argument for why knowing the patient is ethically valuable in encounters in healthcare. Consequently, healthcare systems should provide fertile ground for HCP to get to know their patients, and structures that foster therapeutic continuity. For this to succeed, a number of questions still need to be clarified, which is an important task for medical ethics.
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Affiliation(s)
- Joar Björk
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
- Department of Research and Development, Region Kronoberg, Sweden.
| | - Anna Hirsch
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Munich, Germany
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Berkhout-Byrne NC, Voorend CGN, Meuleman Y, Mooijaart SP, Brunsveld-Reinders AH, Bos WJW, Van Buren M. Nephrology-tailored geriatric assessment as decision-making tool in kidney failure. J Ren Care 2024; 50:112-127. [PMID: 37031361 DOI: 10.1111/jorc.12466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/26/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients. OBJECTIVE We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure. DESIGN In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis. PARTICIPANTS AND MEASUREMENTS Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis. RESULTS Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics. CONCLUSIONS nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.
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Affiliation(s)
- Noeleen C Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Carlijn G N Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn Van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
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Mandhana DM, Jacome CS, Ballard DI, Tesfai Y, Johnson SB, Gionfriddo MR, Espinoza Suarez NR, Perneth SA, Su L, Montori VM. Developing and validating the Unhurried Conversations Assessment Tool (UCAT). PATIENT EDUCATION AND COUNSELING 2024; 123:108237. [PMID: 38461793 DOI: 10.1016/j.pec.2024.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. METHODS In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. RESULTS UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). CONCLUSION UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. PRACTICE IMPLICATIONS UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, Villanova University, Villanova, PA, USA; Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Cristian Soto Jacome
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Norwalk Hospital, Department of Internal Medicine, Nuvance Health, Norwalk, CT, USA
| | - Dawna I Ballard
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Yohanna Tesfai
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Sarah B Johnson
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Division of Pharmaceutical, Administrative, and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nataly R Espinoza Suarez
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sandra Algarin Perneth
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lillian Su
- Division of Cardiovascular Intensive Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor M Montori
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
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Coylewright M, Otero D, Lindman BR, Levack MM, Horne A, Ngo LH, Beaudry M, Col HV, Col NF. An interactive, online decision aid assessing patient goals and preferences for treatment of aortic stenosis to support physician-led shared decision-making: Early feasibility pilot study. PLoS One 2024; 19:e0302378. [PMID: 38771808 PMCID: PMC11108138 DOI: 10.1371/journal.pone.0302378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Guidelines recommend shared decision making when choosing treatment for severe aortic stenosis but implementation has lagged. We assessed the feasibility and impact of a novel decision aid for severe aortic stenosis at point-of-care. METHODS This prospective multi-site pilot cohort study included adults with severe aortic stenosis and their clinicians. Patients were referred by their heart team when scheduled to discuss treatment options. Outcomes included shared decision-making processes, communication quality, decision-making confidence, decisional conflict, knowledge, stage of decision making, decision quality, and perceptions of the tool. Patients were assessed at baseline (T0), after using the intervention (T1), and after the clinical encounter (T2); clinicians were assessed at T2. Before the encounter, patients reviewed the intervention, Aortic Valve Improved Treatment Approaches (AVITA), an interactive, online decision aid. AVITA presents options, frames decisions, clarifies patient goals and values, and generates a summary to use with clinicians during the encounter. RESULTS 30 patients (9 women [30.0%]; mean [SD] age 70.4 years [11.0]) and 14 clinicians (4 women [28.6%], 7 cardiothoracic surgeons [50%]) comprised 28 clinical encounters Most patients [85.7%] and clinicians [84.6%] endorsed AVITA. Patients reported AVITA easy to use [89.3%] and helped them choose treatment [95.5%]. Clinicians reported the AVITA summary helped them understand their patients' values [80.8%] and make values-aligned recommendations [61.5%]. Patient knowledge significantly improved at T1 and T2 (p = 0.004). Decisional conflict, decision-making stage, and decision quality improved at T2 (p = 0.0001, 0.0005, and 0.083, respectively). Most patients [60%] changed treatment preference between T0 and T2. Initial treatment preferences were associated with low knowledge, high decisional conflict, and poor decision quality; final preferences were associated with high knowledge, low conflict, and high quality. CONCLUSIONS AVITA was endorsed by patients and clinicians, easy to use, improved shared decision-making quality and helped patients and clinicians arrive at a treatment that reflected patients' values. TRIAL REGISTRATION Trial ID: NCT04755426, Clinicaltrials.gov/ct2/show/NCT04755426.
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Affiliation(s)
- Megan Coylewright
- Department of Cardiovascular Medicine, University of Tennessee Health Science Center College of Medicine-Chattanooga, Chattanooga, Tennessee, United States of America
| | - Diana Otero
- Department of Cardiovascular Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Brian R. Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melissa M. Levack
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Aaron Horne
- Department of Medicine, Summit Health, Berkeley Heights, NJ, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa Beaudry
- Central Vermont Medical Center, Berlin, Vermont, United States of America
| | - Hannah V. Col
- Shared Decision Making Resources, Georgetown, ME and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Nananda F. Col
- Shared Decision Making Resources, Georgetown, ME and University of New England, Biddeford, Maine, United States of America
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Makoul G, Noble L, Gulbrandsen P, van Dulmen S. Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters. PATIENT EDUCATION AND COUNSELING 2024; 122:108158. [PMID: 38330705 DOI: 10.1016/j.pec.2024.108158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Contemporary healthcare is characterized by multidisciplinary teamwork across a vast array of primary, secondary and tertiary services, augmented by progressively more technology and data. While these developments aim to improve care, they have also created obstacles and new challenges for both patients and health professionals. Indeed, the increasingly fragmented and transactional nature of clinical encounters can dehumanize the care experience across disciplines and specialties. Effective communication plays a pivotal role in reinforcing the humanity of healthcare through the delivery of person-centered care - compassionate, collaborative care that focuses on the needs of each patient as a whole person. After convening at the International Conference on Communication in Healthcare (Glasgow, 2022), an interdisciplinary group of researchers, educators and health professionals worked together to develop a framework for effective communication that both acknowledges critical challenges in contemporary health services and reinforces the humanity of healthcare. The Glasgow Consensus Statement is intended to function as a useful international touchstone for the training and practice of health professionals, fully recognizing and respecting that different countries are at different stages when it comes to teaching, assessment and policy. It also provides a vocabulary for monitoring the impact of system-level challenges. While effective communication may not change the structure of healthcare, it can improve the process if health professionals are supported in infusing the system with their own innate humanity and applying the framework offered within this consensus statement to reinforce the humanity in everyday practice.
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Affiliation(s)
- Gregory Makoul
- Department of Medicine, Yale School of Medicine, New Haven, USA; Human Understanding Institute, NRC Health, Lincoln, USA.
| | - Lorraine Noble
- UCL Medical School, University College London, London, UK; EACH: International Association for Communication in Healthcare, Salisbury, UK
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Akershus University Hospital, Nordbyhagen, Norway
| | - Sandra van Dulmen
- NIVEL - Netherlands Institute for Health Services Research, Utrecht, Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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10
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Paganini A, Westesson LM, Hansson E, Karlsson SA. Women's decision process when actively choosing to 'go flat' after breast cancer: a constructivist grounded theory study. BMC Womens Health 2024; 24:178. [PMID: 38491353 PMCID: PMC10941362 DOI: 10.1186/s12905-024-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE This study aims to describe a conceptual model that could illuminate the decision process women go through when choosing to go flat on one or both sides due to breast cancer. METHODS A qualitative design, with constructivist grounded theory was used. Eighteen women were individually interviewed, digitally or by telephone, until saturation was reached. Data were analysed using a constant comparative iterative method in accordance with grounded theory. By examining the text data to identify the decision process for going flat and rejecting reconstructive surgery open coding was obtained. As the study proceeded patterns were explored and categories developed into a core category. RESULTS The overall decision process for women choosing to go flat on one or both sides emerged in three phases: Phase 1, where the women are forced to "Face the cancer", Phase 2 comprising "Reflections on health and motivation" and Phase 3, described as "Hobson's choice". The fundament of the decision process was found in the core category "Establishing and safeguarding the chosen self". CONCLUSIONS The decision process involved in actively going flat and rejecting reconstructive surgery is founded in the individual woman's motivations, such as view of femininity and apprehensions about the offered reconstructive surgery.
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Affiliation(s)
- Anna Paganini
- Region Västra Götaland, Department of Plastic and Reconstructive Surgery, Sahlgrenska University hospital, Gothenburg, Sweden.
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden.
- Sahlgrenska Academy, Institution for Clinical Sciences at Gothenburg University, Gothenburg, Sweden.
| | - Linda Myrin Westesson
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
- Region Västra Götaland, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Region Västra Götaland, Department of Plastic and Reconstructive Surgery, Sahlgrenska University hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institution for Clinical Sciences at Gothenburg University, Gothenburg, Sweden
| | - Susanne Ahlstedt Karlsson
- Sahlgrenska Academy, Institution for Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
- Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Gans EA, Pieterse AH, Klapwijk MS, van Stiphout F, van Steenbergen IJ, Portielje JEA, de Groot JF, van Munster BC, van den Bos F. Shared decision-making with older adults with cancer: Adaptation of a model through literature review and expert opinion. Psychooncology 2024; 33:e6291. [PMID: 38282224 DOI: 10.1002/pon.6291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To provide a literature overview of characteristics of Shared Decision Making (SDM) with specific importance to the older adult population with cancer and to tailor an existing model of SDM in patients with cancer to the needs of older adults. METHODS A systematic search of several databases was conducted. Eligible studies described factors influencing SDM concerning cancer treatment with adults aged 65 years or above, with any type of cancer. We included qualitative or mixed-methods studies. Themes were identified and discussed in an expert panel, including a patient-representative, until consensus was reached on an adjusted model. RESULTS Overall 29 studies were included and nine themes were identified from the literature. The themes related to the importance of goal setting, need for tailored information provision, the role of significant others, uncertainty of evidence, the importance of time during and outside of consultations, the possible ill-informed preconceptions that health care professionals (HCPs) might have about older adults and the specific competencies they need to engage in the SDM process with older adults. No new themes emerged from discussion with expert panel. This study presents a visual model of SDM with older patients with cancer based on the identified themes. CONCLUSIONS Our model shows key elements that are specific to SDM with older adults. Further research needs to focus on how to educate HCPs on the competencies needed to engage in SDM with older patients, and how to implement the model into everyday practice.
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Affiliation(s)
- Emma A Gans
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Feikje van Stiphout
- Department of Geriatric Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Irma J van Steenbergen
- Department of Gerontology and Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Janke F de Groot
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Barbara C van Munster
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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12
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Koopman WJ, LaDonna KA, Kinsella EA, Venance SL, Watling CJ. Archetypes of incomplete stories in chronic illness medical encounters. PATIENT EDUCATION AND COUNSELING 2023; 117:107973. [PMID: 37734249 DOI: 10.1016/j.pec.2023.107973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE During encounters, patients and practitioners engage in conversations to address health concerns. Because these interactions are time-pressured events, it may be inevitable that any story exchanged during these encounters will be incomplete in some way, potentially jeopardizing how quality and safety of care is delivered. In this study, we explored how and why incomplete stories might arise in health interactions. METHODS Constructivist grounded theory methodology was used to explore how patients and practitioners approach their interactions during encounters. In this two-phase study, we interviewed patients (n = 21) then practitioners (n = 12). RESULTS We identified three distinct archetypes of incomplete storytelling - the hidden story, the interpreted story, and the tailored story. Measured information sharing, triadic encounters and pre-planned agendas influenced these storylines, respectively. CONCLUSION Both patient and practitioner participants focused on what each considered important, appropriate, and useful for productive encounters. While incomplete stories may be a reality, educating practitioners about how incomplete stories come about from both sides of the conversation creates new opportunities to optimize interactions at medical encounters for in-depth patient practitioner storytelling.
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Affiliation(s)
- Wilma J Koopman
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario N6A 3K7, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada; Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada.
| | - K A LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario K1G 5Z3, Canada
| | - E A Kinsella
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada; Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - S L Venance
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
| | - C J Watling
- Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 3K7, Canada
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Fang MT, Germani F, Spitale G, Wäscher S, Kunz L, Biller-Andorno N. Women's experiences with non-invasive prenatal testing in Switzerland: a qualitative analysis. BMC Med Ethics 2023; 24:85. [PMID: 37872496 PMCID: PMC10594794 DOI: 10.1186/s12910-023-00964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Prenatal genetic testing, in particular non-invasive prenatal testing (NIPT), as well as screening for risks associated with pregnancy, and counseling, play pivotal roles in reproductive healthcare, offering valuable information about the health of the fetus to expectant parents. This study aims to delve into the perspectives and experiences of women considering genetic testing and screening during pregnancy, focusing on their decision-making processes and the implications for informed consent. METHODS A nationwide qualitative study was conducted in Switzerland, involving in-depth interviews with women who were 1 to 2 years post-partum, covered by basic compulsory Swiss insurance, including women with a migration background. Thematic analysis was employed to identify key themes and patterns in the data. RESULTS The findings underscore the significance of effective communication during prenatal counseling, suggesting that healthcare providers could not only convey technical information but also support women in their decision-making processes. Women need comprehensive information about genetic testing and its implications, as well as the reasons for screening during pregnancy, as there might be a need to bridge knowledge gaps and clarify misconceptions. Furthermore, the study highlights the multifaceted nature of decision-making, with women considering factors such as uncertainty, values, emotional responses, and societal support systems. The concept of acceptance emerged as a crucial theme, with some women expressing their readiness to love and accept their child, regardless of genetic anomalies or disabilities. CONCLUSION This study offers valuable insights into the perspectives and needs of women regarding prenatal genetic testing, screening, and counseling in Switzerland. It underscores the importance of enhancing the clinical interaction and informed consent process by providing comprehensive information, addressing misconceptions, and supporting women in decision-making about pregnancy management and the management of the child's health, following prenatal genetic testing, including NIPT. These findings can inform healthcare providers and policymakers in improving the quality of prenatal counseling, ensuring informed consent, and supporting women in making well-informed and meaningful decisions about genetic testing, and on the use of screening during pregnancy.
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Affiliation(s)
- Mirriam Tyebally Fang
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Federico Germani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Giovanni Spitale
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Sebastian Wäscher
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Ladina Kunz
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
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14
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Durand MA, Bannier M, Aim MA, Mancini J. Adaptation and Implementation of Pictorial Conversation Aids for Early-Stage Breast Cancer Surgery and Reconstruction: A Quality Improvement Study. Patient Prefer Adherence 2023; 17:2463-2474. [PMID: 37817892 PMCID: PMC10560627 DOI: 10.2147/ppa.s421695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population. Patients and Methods In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons. Results In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future. Conclusion It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Lebanon, Lebanon, NH, USA
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | | | - Marie-Anastasie Aim
- AP-HM, Délégation à la Recherche Clinique et à l’Innovation, Marseille, France
- Aix-Marseille Univ, LPS, Aix-en-Provence, France
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, ISSPAM, SESSTIM, “Cancer, Biomedicine & Society” Group, Equipe Labellisée LIGUE, Hop Timone, Marseille, France
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15
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Lin KB, Wei Y, Liu Y, Hong FP, Yang YM, Lu P. An opponent model for agent-based shared decision-making via a genetic algorithm. Front Psychol 2023; 14:1124734. [PMID: 37854140 PMCID: PMC10580805 DOI: 10.3389/fpsyg.2023.1124734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/30/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Shared decision-making (SDM) has received a great deal of attention as an effective way to achieve patient-centered medical care. SDM aims to bring doctors and patients together to develop treatment plans through negotiation. However, time pressure and subjective factors such as medical illiteracy and inadequate communication skills prevent doctors and patients from accurately expressing and obtaining their opponent's preferences. This problem leads to SDM being in an incomplete information environment, which significantly reduces the efficiency of the negotiation and even leads to failure. Methods In this study, we integrated a negotiation strategy that predicts opponent preference using a genetic algorithm with an SDM auto-negotiation model constructed based on fuzzy constraints, thereby enhancing the effectiveness of SDM by addressing the problems posed by incomplete information environments and rapidly generating treatment plans with high mutual satisfaction. Results A variety of negotiation scenarios are simulated in experiments and the proposed model is compared with other excellent negotiation models. The results indicated that the proposed model better adapts to multivariate scenarios and maintains higher mutual satisfaction. Discussion The agent negotiation framework supports SDM participants in accessing treatment plans that fit individual preferences, thereby increasing treatment satisfaction. Adding GA opponent preference prediction to the SDM negotiation framework can effectively improve negotiation performance in incomplete information environments.
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Affiliation(s)
- Kai-Biao Lin
- School of Computer and Information Engineering, Xiamen University of Technology, Xiamen, China
| | - Ying Wei
- School of Computer and Information Engineering, Xiamen University of Technology, Xiamen, China
| | - Yong Liu
- School of Data Science and Intelligent Engineering, Xiamen Institute of Technology, Xiamen, China
| | - Fei-Ping Hong
- Department of Neonates, Xiamen Humanity Hospital, Xiamen, China
| | - Yi-Min Yang
- Department of Pediatrics, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Ping Lu
- School of Economics and Management, Xiamen University of Technology, Xiamen, China
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16
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Traeger MW, Krakower DS, Mayer KH, Marcus JL. Prioritising the values of potential users to promote uptake of HIV pre-exposure prophylaxis. Lancet HIV 2023; 10:e690-e692. [PMID: 37573870 DOI: 10.1016/s2352-3018(23)00171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/15/2023]
Abstract
Benefits of pre-exposure prophylaxis (PrEP) extend beyond HIV risk reduction. Users report a range of physical, emotional, and social effects, including reduced anxiety, increased intimacy, and greater sexual satisfaction. For some people, these benefits are the primary motivation for using PrEP. To successfully engage in shared decision making about HIV prevention methods, clinicians need to be able to discuss all potential risks and benefits of PrEP. These risks and benefits include not only those related to HIV risk reduction and other clinical outcomes, but also those related to experiences and relationships that people value. However, national and international clinical resources on the provision of PrEP do not include user-reported outcomes that are values-based or reflect positive effects on personal, social, or sexual wellbeing. To better integrate the values of potential users into discussions about PrEP, clinician training programmes and clinical guidelines need to be guided by community-driven frameworks and expanded to include user-reported outcomes of PrEP use, including beneficial effects. Achieving PrEP uptake and equity goals will require an approach to PrEP provision that centres the values and desired experiences of potential users, particularly those from populations with the greatest unmet need for PrEP.
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Affiliation(s)
- Michael W Traeger
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Burnet Institute, Melbourne, VIC, Australia.
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
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17
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Tseng Y, Lin Y, Hsu W, Kang Y, Su H, Cheng S, Tsai J, Chiu T, Huang H. Shared decision making with Oncologists and Palliative care specialists (SOP) model help advanced pancreatic cancer patients reaching goal concordant care: A prospective cohort study. Cancer Med 2023; 12:20119-20128. [PMID: 37740620 PMCID: PMC10587919 DOI: 10.1002/cam4.6590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Pancreatic cancer is often diagnosed at a late stage with a poor prognosis due to insidious symptoms and lack of evidence-based screening in general population. Palliative care's acceptance in Asian cultures is hindered by misconceptions and ineffective communication about management that improve quality of life other than cancer directed treatment. Our study aimed to determine the effect of the Shared decision-making with Oncologists and Palliative care specialists (SOP) model developed from the traditional shared decision-making (SDM) model on the palliative care acceptance rate and medical resource utilization. METHODS This is a prospective cohort study implementing the SOP model at the National Taiwan University Hospital from January 2018 to December 2019 for patients with advanced pancreatic cancer. Medical resource utilization was defined and recorded as the rate of hospitalization, emergency room (ER), and intensive care unit admissions. We compared the results between two groups: patients who received the SOP model in 2019 and patients who did not receive it in 2018. RESULTS 137 patients with advanced pancreatic cancer were included in our study. The result showed that the acceptance rate of palliative care significantly increased from 50% to 78.69% after the SOP model (p = 0.01). The hospitalization rate did not show a significant difference between 2018 (93.42%, 95% CI: 0.88-0.99) and 2019 (93.44%, 95% CI: 0.87-1.00). 83.61% (95% CI: 0.74-0.93) of our patients in 2019 had at least one ER visit; the rate was 81.5% (95% CI: 0.73-0.91) in 2018 (p = 0.28). The percentage of patients admitted to the ICU increased from 3.95% in 2018 to 8.2% (95% CI: -0.05-0.08) in 2019 (95% CI: 0.11-0.15) (p = 0.00). The hospitalization and ER visit showed no statistically difference between 2 years. CONCLUSIONS The modified SOP model markedly augmented palliative care's acceptance of patients with advanced pancreatic cancer. Adoption of the SOP model would provide these patients a more proactive and systematic approach to deliver needed healthcare.
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Affiliation(s)
- Yung‐Ling Tseng
- Department of EducationKuang Tien General HospitalTaichungTaiwan
| | - Yun‐Ching Lin
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Wan‐Ju Hsu
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
- Department of NursingNational Taiwan University HospitalTaipei cityTaiwan
| | - Ya‐Chun Kang
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsin‐Yin Su
- Cancer Administration and Coordination centerNational Taiwan University HospitalTaipei cityTaiwan
| | - Shao‐Yi Cheng
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Jaw‐Shiun Tsai
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Tai‐Yuan Chiu
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
| | - Hsien‐Liang Huang
- Department of Family MedicineNational Taiwan University HospitalTaipei cityTaiwan
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18
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Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
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Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Wheless M, Lee JJ, Domenico HJ, Martin BJ, Bennett ML, Martin SF, Berlin J, Green JK, Agarwal R. Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality. JCO Oncol Pract 2023; 19:767-776. [PMID: 37390380 PMCID: PMC10538893 DOI: 10.1200/op.23.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care. METHODS We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors. RESULTS For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death (P < .001), as were those with longer therapeutic relationships (P < .001). Inpatient oncologists were more likely to correctly anticipate patient death (P = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs (P = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%). CONCLUSION Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.
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Affiliation(s)
- Margaret Wheless
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Julie J. Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Barbara J. Martin
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Marc L. Bennett
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sara F. Martin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jordan Berlin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jennifer K. Green
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Rajiv Agarwal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
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20
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Gerritse MB, de Swart E, de Vries M, Kluivers KB. Identifying Womens' Needs in Making a Treatment Decision for Stress Urinary Incontinence: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:358-366. [PMID: 37476608 PMCID: PMC10354721 DOI: 10.1089/whr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
Background Choosing a treatment option for female stress urinary incontinence (SUI) is a preference-sensitive decision. Nowadays, shared decision making (SDM) is the preferred way of decision making. SDM considers the needs patients have regarding the decision-making process. The aim of this study was to identify decisional needs of women who are making a treatment decision for SUI. Materials and Methods Semistructured interviews were planned with women who had been seeking treatment for SUI. Patients were recruited in two teaching hospitals in the Netherlands. Interviewers used a topic list based on the Ottawa decision support framework. The interviews were transcribed and coded. Themes and subthemes of factors relating to the treatment decision-making process were identified and described. Results We interviewed a total of 16 women. Four major themes of SUI patients' needs were identified: information on disorder and treatment, SDM, personalized health care, and consideration for social context. Within these themes, specific needs varied between individuals. In addition to the provision of objective information, other important identified needs were subjective, such as acknowledgment of symptoms and feeling understood by a physician. It was important for patients that they had a sufficient amount of time to make their decision. Conclusions To ensure a good quality treatment decision in female SUI, several topics need to be addressed in an SDM process. The themes of decisional needs identified in this study can help improve the decision-making process.
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Affiliation(s)
- Maria B.E. Gerritse
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Ellis de Swart
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Kirsten B. Kluivers
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Witkam RL, Kragt EAM, Arnts IJJ, Bronkhorst EM, van Dongen R, Kurt E, Steegers MAH, van Haren FGAM, Maandag NJG, Gort C, Henssen DJHA, Wegener JT, Vissers KCP. Spinal Cord Stimulation for Failed Back Surgery Syndrome: to Trial or Not to Trial? THE JOURNAL OF PAIN 2023; 24:1298-1306. [PMID: 36878384 DOI: 10.1016/j.jpain.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Spinal cord stimulation (SCS) is a recommended therapy to treat failed back surgery syndrome (FBSS). A trial period is practiced to enhance patient selection. However, its fundamental evidence is limited, especially concerning long-term benefit and therapy safety. We compared the long-term (5.3 ± 4.0 years) clinical outcome and therapy safety of a trialed and nontrialed implantation strategy, including multidimensional variables and pain intensity fluctuations over time. A multicenter cohort analysis was performed in 2 comparable groups of FBSS patients. Regarding eligibility, patients had to be treated with SCS for at least 3 months. While the Trial group comprised patients who underwent an SCS implantation after a successful trial, the No-Trial group encompassed patients who underwent complete implantation within 1 session. The primary outcome measures were pain intensity scores and complications. The Trial and No-Trial groups consisted of 194 and 376 patients (N = 570), respectively. A statistically but not clinically significant difference in pain intensity (P = .003; effect = 0.506 (.172-.839)) was found in favor of the Trial group. No interaction between a time dependency effect and pain intensity was noted. Whereas trialed SCS patients were more likely to cease opioid usage (P = .003; OR = .509 (.326-.792)), patients in the No-Trial group endured fewer infections (P = .006; proportion difference = .43 (.007-.083)). Although the clinical relevance of our findings should be proven in future studies, this long-term real-world data study indicates that patient-centered assessments on whether an SCS trial should be performed have to be investigated. According to the current ambiguous evidence, SCS trials should be considered on a case-by-case basis. PERSPECTIVE: The currently available comparative evidence, together with our results, remains ambiguous on which SCS implantation strategy might be deemed superior. An SCS trial should be considered on a case-by-case basis, for which further investigation of its clinical utility in certain patient populations or character traits is warranted.
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Affiliation(s)
- Richard L Witkam
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Elisabeth A M Kragt
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge J J Arnts
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert van Dongen
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erkan Kurt
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique A H Steegers
- Department of Anaesthesiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frank G A M van Haren
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natasja J G Maandag
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Cees Gort
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Dylan J H A Henssen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica T Wegener
- Department of Anaesthesiology, Sint Maartenskliniek, Ubbergen, The Netherlands
| | - Kris C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Arends SAM, Thodé M, Pasman HRW, Francke AL, Jongerden IP. How physicians see nurses' role in decision-making about life-prolonging treatments in patients with a short life expectancy: An interview study. PATIENT EDUCATION AND COUNSELING 2023; 114:107863. [PMID: 37356117 DOI: 10.1016/j.pec.2023.107863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Exploring physicians' views on hospital nurses' role in decision-making about potentially life-prolonging treatments in patients with a short life expectancy. METHODS A qualitative study using semi-structured interviews with hospital physicians. Data were collected from May to September 2019 and analyzed following principles of thematic analysis. RESULTS Fifteen physicians working in different hospitals and specialisms participated. Physicians stated that they are responsible for the final decision about potentially life-prolonging treatments. They considered nurses' role in decision-making to be complementary to the roles of both patients and the physicians themselves, especially when there are doubts or complex situations. Physicians varied in how important they found nurses' involvement in the decision-making process: some physicians saw the involvement of nurses as "situation-dependent", while others viewed nurses' involvement as standard practice. Furthermore, physicians mentioned practical obstacles to involving nurses, like the limited time available to both nurses and physicians themselves. CONCLUSION Physicians recognize a complementary role for nurses in decision-making about potentially life-prolonging treatment, especially in cases with doubts or complex situations. PRACTICE IMPLICATIONS Physicians and nurses should engage with each other to make nurses' involvement less situation-dependent. This inter-professional collaboration regarding decision-making about life-prolonging treatments should be stimulated, supported and maintained.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands.
| | - Maureen Thodé
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Section General Internal Medicine, Department of Internal Medicine, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands; Netherlands Institute for Health Services Research - Nivel, Utrecht, the Netherlands
| | - Irene P Jongerden
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, the Netherlands; Expertise Center for Palliative Care, Amsterdam, the Netherlands
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23
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Sandholdt CT, Jønsson ABR, Reventlow S, Bach-Holm D, Line K, Kolko M, Jacobsen MH, Mathiesen OH, Waldorff FB. DETECT: DEveloping and testing a model to identify preventive vision loss among older paTients in gEneral praCTice - protocol for a complex intervention in Denmark. BMJ Open 2023; 13:e069974. [PMID: 37247966 DOI: 10.1136/bmjopen-2022-069974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The number of people living with visual impairment is increasing. Visual impairment causes loss in quality of life and reduce self-care abilities. The burden of disease is heavy for people experiencing visual impairment and their relatives. The severity and progression of age-related eye diseases are dependent on the time of detection and treatment options, making timely access to healthcare critical in reducing visual impairment. General practice plays a key role in public health by managing preventive healthcare, diagnostics and treatment of chronic conditions. General practitioners (GPs) coordinate services from other healthcare professionals. More involvement of the primary sector could potentially be valuable in detecting visual impairment. METHODS We apply the Medical Research Council framework for complex interventions to develop a primary care intervention with the GP as a key actor, aimed at identifying and coordinating care for patients with low vision. The development process will engage patients, relatives and relevant health professional stakeholders. We will pilot test the feasibility of the intervention in a real-world general practice setting. The intervention model will be developed through a participatory approach using qualitative and creative methods such as graphical facilitation. We aim to explore the potentials and limitations of general practice in relation to detection of preventable vision loss. ETHICS AND DISSEMINATION Ethics approval is obtained from local authority and the study meets the requirements from the Declaration of Helsinki. Dissemination is undertaken through research papers and to the broader public through podcasts and patient organisations.
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Affiliation(s)
- Catharina Thiel Sandholdt
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Susanne Reventlow
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kessel Line
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Miriam Kolko
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Kobenhavn, Denmark
| | - Marie Honoré Jacobsen
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | | | - Frans Boch Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
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24
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Sun Y, Zhou W, Zuo S, Chen C, Zhang Q, Chen Y. Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:1261-1270. [PMID: 37214556 PMCID: PMC10199703 DOI: 10.2147/ppa.s411274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To explore the level of participation in shared decision-making by patients with glaucoma and identify influencing factors, to subsequently provide references to promote shared decision-making in ophthalmology, and achieve patient-centered care. Patients and Methods A questionnaire was completed by 148 patients with glaucoma who had been admitted to a specialized ophthalmic hospital in China, between October 2021 and January 2022. The participants' responses to the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) and a general information survey were analyzed to determine their level of participation in shared decision-making and influencing factors. Multiple linear regression was used to identify factors that influence shared decision-making at the time of clinical practice. Results The mean score of SDM-Q-9 was 71.73±21.27 (n=140). Multiple linear regression analysis showed that patients with negative attitudes towards participation in decision-making (P=0.023) and those who had rural insurance (P=0.017) had significantly lower SDM-Q-9 scores than those with positive attitudes and those with medical insurance. Patients who were more satisfied with their medical service had higher SDM-Q-9 scores (P<0.05). Conclusion Patients with glaucoma presented a high level of shared decision-making. Patients' attitudes towards participating in decision-making, the payment method of medical expenses, and the level of satisfaction with medical services are factors that influence their level of participation in shared decision-making.
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Affiliation(s)
- Yiwen Sun
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Wenzhe Zhou
- Glaucoma Clinical Center, the Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, People’s Republic of China
| | - Shushu Zuo
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Chen Chen
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Qiqi Zhang
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yanyan Chen
- Nursing Department, the Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, People’s Republic of China
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25
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Mai A, Voigt K, Schübel J, Gräßer F. A drug recommender system for the treatment of hypertension. BMC Med Inform Decis Mak 2023; 23:89. [PMID: 37161441 PMCID: PMC10170737 DOI: 10.1186/s12911-023-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND One third (20% to 30%) of patients suffering from hypertension show increased blood pressure resistant to treatment. This resistance often has multifactorial causes, like therapeutic inertia and inappropriate medication but also poor patient adherence. Evidence-based guidelines aim to support appropriate health care decisions. However, (i) research and appraisal of clinical guidelines is often not practicable in daily routine care and (ii) guidelines alone are often insufficient to make suitable and personalized treatment decisions. Shared decision-making (SDM) can significantly improve patient adherence, but is also difficult to implement in routine care due to time constraints. METHODS Clinical Decision Support Systems (CDSSs), designed to support clinical decision-making by providing explainable and personalized treatment recommendations, are expected to remedy the aforementioned issues. In this work we describe a digital recommendation system for the pharmaceutical treatment of hypertension and compare its recommendations with clinical experts. The proposed therapy recommender algorithm combines external evidence (knowledge-based) - derived from clinical guidelines and drugs' professional information - with information stored in routine care data (data-based) - derived from 298 medical records and 900 doctor-patient contacts from 7 general practitioners practices. The developed Graphical User Interface (GUI) visualizes recommendations along with personalized treatment information and intents to support SDM. The CDSS was evaluated on 23 artificial test patients (case vignettes), by comparing its output with recommendations from five specialized physicians. RESULTS The results show that the proposed algorithm provides personalized treatment recommendations with large agreement with clinical experts. This is true for agreement with all experts (agree_all), with any expert (agree_any), and with the majority vote of all experts (agree_majority). The performance of a solely data-based approach can be additionally improved by applying evidence-based rules (external evidence). When comparing the achieved results (agree_all) with the inter-rater agreement among experts, the CDSS's recommendations partly agree more often with the experts than the experts among each other. CONCLUSION Overall, the feasibility and performance of medication recommendation systems for the treatment of hypertension could be shown. The major challenges when developing such a CDSS arise from (i) the availability of sufficient and appropriate training and evaluation data and (ii) the absence of standardized medical knowledge such as computerized guidelines. If these challenges are solved, such treatment recommender systems can support physicians with exploiting knowledge stored in routine care data, help to comply with the best available clinical evidence and increase the adherence of the patient by reducing site-effects and individualizing therapies.
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Affiliation(s)
- Arthur Mai
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, TU Dresden, Dresden, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, TU Dresden, Dresden, Germany.
| | - Jeannine Schübel
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, TU Dresden, Dresden, Germany
| | - Felix Gräßer
- Institute of Biomedical Engineering, TU Dresden, Dresden, Germany
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26
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Thomas KL, Al-Khatib SM, Kosinski AS, Sears SF, Allen LaPointe NM, Jackson LR, Matlock DD, Haithcock D, Colley BJ, Hirsh DS, Peterson ED. Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical Trial. Ann Intern Med 2023; 176:615-623. [PMID: 37011387 PMCID: PMC10354526 DOI: 10.7326/m22-2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Racial disparities in implantable cardioverter-defibrillator (ICD) implantation are multifactorial and are partly explained by higher refusal rates. OBJECTIVE To assess the effectiveness of a video decision support tool for Black patients eligible for an ICD. DESIGN Multicenter, randomized clinical trial conducted between September 2016 and April 2020. (ClinicalTrials.gov: NCT02819973). SETTING Fourteen academic and community-based electrophysiology clinics in the United States. PARTICIPANTS Black adults with heart failure who were eligible for a primary prevention ICD. INTERVENTION An encounter-based video decision support tool or usual care. MEASUREMENTS The primary outcome was the decision regarding ICD implantation. Additional outcomes included patient knowledge, decisional conflict, ICD implantation within 90 days, the effect of racial concordance on outcomes, and the time patients spent with clinicians. RESULTS Of the 330 randomly assigned patients, 311 contributed data for the primary outcome. Among those randomly assigned to the video group, assent to ICD implantation was 58.6% compared with 59.4% in the usual care group (difference, -0.8 percentage point [95% CI, -13.2 to 11.1 percentage points]). Compared with usual care, participants in the video group had a higher mean knowledge score (difference, 0.7 [CI, 0.2 to 1.1]) and a similar decisional conflict score (difference, -2.6 [CI, -5.7 to 0.4]). The ICD implantation rate within 90 days was 65.7%, with no differences by intervention. Participants randomly assigned to the video group spent less time with their clinician than those in the usual care group (mean, 22.1 vs. 27.0 minutes; difference, -4.9 minutes [CI, -9.4 to -0.3 minutes]). Racial concordance between video and study participants did not affect study outcomes. LIMITATION The Centers for Medicare & Medicaid Services implemented a requirement for shared decision making for ICD implantation during the study. CONCLUSION A video-based decision support tool increased patient knowledge but did not increase assent to ICD implantation. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Kevin L Thomas
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | - Sana M Al-Khatib
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | | | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina (S.F.S.)
| | - Nancy M Allen LaPointe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (N.M.A.L.)
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina (L.R.J.)
| | - Daniel D Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado (D.D.M.)
| | | | | | - David S Hirsh
- Department of Medicine, Emory University, Atlanta, Georgia (D.S.H.)
| | - Eric D Peterson
- Department of Medicine, University of Texas Southwestern, Dallas, Texas (E.D.P.)
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27
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López-Cano M, Adell-Trapé M, Verdaguer-Tremolosa M, Rodrigues-Gonçalves V, Badia-Closa J, Serra-Aracil X. Parastomal hernia prevention with permanent mesh in end colostomy: failure with late follow-up of cohorts in three randomized trials. Hernia 2023; 27:657-664. [PMID: 36966221 DOI: 10.1007/s10029-023-02781-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/14/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Short-term results have been reported regarding parastomal hernia (PH) prevention with a permanent mesh. Long-term results are scarce. The objective was to assess the long-term PH occurrence after a prophylactic synthetic non-absorbable mesh. METHODS Long-term data of three randomized controlled trials (RCTs) were collected. The primary outcome was the detection of PH based exclusively on a radiological diagnosis by computed tomography (CT) performed during the long-term follow-up. The Kaplan-Meier method was used for the comparison of time to diagnosis of PH according to the presence of mesh vs. no-mesh and the technique of mesh insertion: open retromuscular, laparoscopic keyhole, and laparoscopic modified Sugarbaker. RESULTS We studied 121 patients (87 men, median age 70 years), 82 (67.8%) of which developed a PH. The median overall length of follow-up was 48.5 months [interquartile range (IQR) 14.4-104.9], with a median time until PH diagnosis of 17.7 months (IQR 9.3-49.0). The survival analysis did not show significant differences in the time to development of a PH according to the presence or absence of a prophylactic mesh neither in the overall study population (log-rank, P = 0.094) nor in the groups of each technique of mesh insertion, although according to the surgical technique, a higher reduction in the appearance of PH for the open retromuscular technique was found (log-rank, P = 0.001). CONCLUSION In the long-term follow-up placement of a non-absorbable synthetic prophylactic mesh in the context of an elective end colostomy does not seem effective for preventing PH.
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Affiliation(s)
- M López-Cano
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - M Adell-Trapé
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Verdaguer-Tremolosa
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Rodrigues-Gonçalves
- Abdominal Wall Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Badia-Closa
- Department of General and Digestive Surgery, Colorectal Unit, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - X Serra-Aracil
- Department of General and Digestive Surgery, Colorectal Unit, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
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Geisler A, Hedegaard S, Bucknall TK. Piloting a Nurse-Led Critical Care Outreach Service to Pre-Empt Medical Emergency Team Calls and Facilitate Staff Learning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4214. [PMID: 36901225 PMCID: PMC10001841 DOI: 10.3390/ijerph20054214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
A nurse-led critical care outreach service (NLCCOS) can support staff education and decision making in the wards, managing at-risk patients with ward nurses to avoid further deterioration. We aimed to investigate the characteristics of patients identified as at-risk, the types of treatments they required to prevent deterioration, the education initiated by the NLCCOS, and the perceived experiences of ward nurses. This prospective observational pilot study using mixed methods took place in one medical and one surgical ward at a university hospital in Denmark. Participants were patients nominated as at-risk by head nurses in each ward, the ward nurses, and nurses from the NLCCOS. In total, 100 patients were reviewed, 51 medical and 49 surgical patients, over a six-month period. Most patients (70%) visited by the NLCCOS had a compromised respiratory status, and ward nurses received teaching and advice regarding interventions. Sixty-one surveys were collected from ward nurses on their learning experience. Over 90% (n = 55) of nurses believed they had learned from, and were more confident with, managing patients following the experience. The main educational areas were respiratory therapy, invasive procedures, medications, and benefits of mobilization. Further research needs to measure the impact of the intervention on patient outcomes and MET call frequency over time in larger samples.
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Affiliation(s)
- Anja Geisler
- Department of Anesthesiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Susanne Hedegaard
- Department of Anesthesiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | - Tracey K. Bucknall
- School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Centre for Quality and Patient Safety—Alfred Health Partnership, Institute of Health Transformation, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004, Australia
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Zisman-Ilani Y, Thompson KD, Siegel LS, Mackenzie T, Crate DJ, Korzenik JR, Melmed GY, Kozuch P, Sands BE, Rubin DT, Regueiro MD, Cross R, Wolf DC, Hanson JS, Schwartz RM, Vrabie R, Kreines MD, Scherer T, Dubinsky MC, Siegel CA. Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial. Aliment Pharmacol Ther 2023; 57:205-214. [PMID: 36377259 PMCID: PMC9790033 DOI: 10.1111/apt.17286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Crohn's disease requires effective patient-clinician communication for successful illness and medication management. Shared decision making (SDM) has been suggested to improve communication around early intensive therapy. However, effective evidence-based SDM interventions for Crohn's disease are lacking, and the impact of SDM on Crohn's disease decision making and choice of therapy is unclear. AIM To test the impact of SDM on choice of therapy, quality of the decision and provider trust compared to standard Crohn's disease care. METHODS We conducted a multi-site cluster randomised controlled trial in 14 diverse gastroenterology practices in the US. RESULTS A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, participated in the study. Among these, 99 received the intervention and 59 received standard care. Demographics were similar between groups, although there were more women assigned to standard care, and a slightly shorter disease duration among those in the intervention group. Participants in the intervention group more frequently chose combination therapy (25% versus 5% control, p < 0.001), had a significantly lower decisional conflict (p < 0.05) and had greater trust in their provider (p < 0.05). CONCLUSIONS With rapidly expanding medication choices for Crohn's disease and slow uptake of early intensive therapy, SDM can personalise treatment strategies and has the potential to move the field of Crohn's disease management forward with an ultimate goal of consistently treating this disease early and intensively in appropriate patients. TRIAL REGISTRATION Evaluating a Shared Decision Making Program for Crohn's Disease, ClinicalTrials.gov Identifier NCT02084290 https://clinicaltrials.gov/ct2/show/NCT02084290.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Kimberly D. Thompson
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Todd Mackenzie
- Geisel School of Medicine at Dartmouth, Biomedical Data Science, Hanover, New Hampshire, USA
| | - Damara J. Crate
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joshua R. Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Gil Y. Melmed
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patricia Kozuch
- Inflammatory Bowel Disease Program, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David T. Rubin
- Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Raymond Cross
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - John S. Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, North Carolina, USA
| | | | - Raluca Vrabie
- Gastroenterology Division, New York University, New York City, New York, USA
| | | | | | - Marla C. Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Center, Icahn School of Medicine Mount Sinai, New York City, New York, USA
| | - Corey A. Siegel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Abstract
Clinical decisions are optimally made collaboratively, with patients and clinicians working together to review all available information and treatment options. A comprehensive dialogue that identifies and brings into focus individual patient goals within the context of the evidence base is the ideal approach. Shared decision-making (SDM) is essential to making choices about treatment preferences and characterizes the optimal practice of evidence-based medicine and good patient care. By supporting patient autonomy and engagement, the patient and family become partners in their health care. Decisions surrounding whether or not to proceed with diagnostic and therapeutic procedures after fully discussing appropriate alternatives are best made considering both the evidence base and patient goals. The central feature of SDM is that a clinician and a patient engage in a dialogue to jointly make decisions, with reciprocated sharing of information that both find beneficial to reach the best decision. SDM entails much more than patient education or informed consent: there must be bidirectional transfer of knowledge, discussion of patient preference, and a process of deliberation reaching consensus. Patient decision aids have been shown to improve patient understanding of options and risks, enhance the patient's involvement, and focus their comprehension of treatment preferences. Patient decision aids also may be of value in strengthening the physician-patient relationship. The need to emphasize SDM should be integrated into the quality process at every level to make it meaningful, not an apparently arbitrary obstacle that requires discovery of a shrewd work-around. A more patient-oriented consideration of the benefits of symptom relief and improved quality of life, in addition to survival and freedom from adverse events, could only be beneficial.
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Affiliation(s)
- Lloyd W Klein
- From the Cardiology Department, University of California, San Francisco, San Francisco, CA
| | - H Vernon Anderson
- Cardiology Division, Cardiology Department, University of Texas Health Science Center, Houston, TX
| | - Joaquin Cigarroa
- Cardiology Department, Oregon Health and Science University, Portland, OR
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31
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López Cano M, García-Alamino JM. Shared decision making. Patient-centered evidence. Cir Esp 2023; 101:60-62. [PMID: 35809786 DOI: 10.1016/j.cireng.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Manuel López Cano
- Unidad de Cirugía de Pared Abdominal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Josep M García-Alamino
- Grupo de Investigación Salud Global, Género y Sociedad (GHenderS), Blanquerna-Universitat Ramon Llull, Barcelona, Spain; Programme in Evidence Based Health Care, University of Oxford, Oxford, UK
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van Veenendaal H, Peters LJ, van Weele E, Hendriks MP, Schuurman M, Visserman E, Hilders CGJM, Ubbink DT. Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer. Curr Oncol 2022; 30:236-249. [PMID: 36661668 PMCID: PMC9857756 DOI: 10.3390/curroncol30010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Enhancing the application of shared decision-making (SDM) is critical for integrating patient preferences in breast cancer treatment choices. We investigated the effect of an adapted multilevel SDM implementation program in breast cancer care. Methods: Breast cancer patients qualifying for (neo)adjuvant systemic treatment were included in a multicenter before−after study. Consultations were audio recorded between June 2018 and July 2019 and analyzed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to score SDM application by clinicians. The Shared Decision-Making Questionnaire (SDM-Q-9) was used to rate patients’ perceived SDM level. Consultation duration, decision types, number of options discussed and consultations per patient were monitored. Regression analysis was used to investigate the correlated variables and program components. Results: Mean OPTION-5 scores increased from 33.9 (n = 63) before implementation to 54.3 (n = 49) after implementation (p < 0.001). The SDM-Q-9 scores did not change: 91.1 (n = 51) at baseline versus 88.9 (n = 23) after implementation (p = 0.81). Without increasing consultation time, clinicians discussed more options after implementation. The regression analysis showed that exposure to the implementation program, redistribution of tasks and discussing feedback from consultations was associated with a higher level of SDM. Conclusion: The multilevel program helped clinicians achieve clinically relevant improvement in SDM, especially when it is tailored to (individuals in) teams and includes (e-)training, discussing feedback on consultations and redistribution of tasks.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Loes J. Peters
- Department of Surgery, Location University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Esther van Weele
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
- Vestalia, Acaciapark 136, 1213 LD Hilversum, The Netherlands
| | - Mathijs P. Hendriks
- Department of Medical Oncology, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Maaike Schuurman
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Ella Visserman
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Carina G. J. M. Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
- Board of Directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Dirk T. Ubbink
- Department of Surgery, Location University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, Alip A, Sylvia M, Chen MF, Taib NA, Jaganathan M, Ng CJ, Teo SH. Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health Expect 2022; 25:2837-2850. [PMID: 36098241 DOI: 10.1111/hex.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia. METHODS We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. RESULTS Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. CONCLUSION This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design, recruitment and analysis.
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Affiliation(s)
- Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Siu Ching Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Soo Ying Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Adlinda Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - McCarthy Sylvia
- Clinical Service Department, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - May Feng Chen
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Universiti Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Health Services & Systems Research, Duke NUS Medical School, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
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Driever EM, Stiggelbout AM, Brand PLP. Shared Decision-making in Different Types of Decisions in Medical Specialist Consultations. J Gen Intern Med 2022; 37:2966-2972. [PMID: 35037173 PMCID: PMC9485336 DOI: 10.1007/s11606-021-07221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUNDS Research on shared decision-making (SDM) has mainly focused on decisions about treatment (e.g., medication or surgical procedures). Little is known about the decision-making process for the numerous other decisions in consultations. OBJECTIVES We assessed to what extent patients are actively involved in different decision types in medical specialist consultations and to what extent this was affected by medical specialist, patient, and consultation characteristics. DESIGN Analysis of video-recorded encounters between medical specialists and patients at a large teaching hospital in the Netherlands. PARTICIPANTS Forty-one medical specialists (28 male) from 18 specialties, and 781 patients. MAIN MEASURE Two independent raters classified decisions in the consultations in decision type (main or other) and decision category (diagnostic tests, treatment, follow-up, or other advice) and assessed the decision-making behavior for each decision using the Observing Patient Involvement (OPTION)5 instrument, ranging from 0 (no SDM) to 100 (optimal SDM). Scheduled and realized consultation duration were recorded. KEY RESULT In the 727 consultations, the mean (SD) OPTION5 score for the main decision was higher (16.8 (17.1)) than that for the other decisions (5.4 (9.0), p < 0.001). The main decision OPTION5 scores for treatment decisions (n = 535, 19.2 (17.3)) were higher than those for decisions about diagnostic tests (n = 108, 14.6 (16.8)) or follow-up (n = 84, 3.8 (8.1), p < 0.001). This difference remained significant in multilevel analyses. Longer consultation duration was the only other factor significantly associated with higher OPTION5 scores (p < 0.001). CONCLUSION Most of the limited patient involvement was observed in main decisions (versus others) and in treatment decisions (versus diagnostic, follow-up, and advice). SDM was associated with longer consultations. Physicians' SDM training should help clinicians to tailor promotion of patient involvement in different types of decisions. Physicians and policy makers should allow sufficient consultation time to support the application of SDM in clinical practice.
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Affiliation(s)
- Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L P Brand
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands
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35
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Watson J, Whiting PF, Salisbury C, Hamilton WT, Banks J. Blood tests in primary care: A qualitative study of communication and decision-making between doctors and patients. Health Expect 2022; 25:2453-2461. [PMID: 35854666 PMCID: PMC9615068 DOI: 10.1111/hex.13564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Blood tests are commonly used in primary care as a tool to aid diagnosis, and to offer reassurance and validation for patients. If doctors and patients do not have a shared understanding of the reasons for testing and the meaning of results, these aims may not be fulfilled. Shared decision‐making is widely advocated; yet, most research focusses on treatment decisions rather than diagnostic decisions. The aim of this study was to explore communication and decision‐making around diagnostic blood tests in primary care. Methods Qualitative interviews were undertaken with patients and clinicians in UK primary care. Patients were interviewed at the time of blood testing, with a follow‐up interview after they received test results. Interviews with clinicians who requested the tests provided paired data to compare clinicians' and patients' expectations, experiences and understandings of tests. Interviews were analysed thematically using inductive and deductive coding. Results A total of 80 interviews with 28 patients and 19 doctors were completed. We identified a mismatch in expectations and understanding of tests, which led to downstream consequences including frustration, anxiety and uncertainty for patients. There was no evidence of shared decision‐making in consultations preceding the decision to test. Doctors adopted a paternalistic approach, believing that they were protecting patients from anxiety. Conclusion Patients were not able to develop informed preferences and did not perceive that choice is possible in decisions about testing, because they did not have sufficient information and a shared understanding of tests. A lack of shared understanding at the point of decision‐making led to downstream consequences when test results did not fulfil patients' expectations. Although shared decision‐making is recommended as best practice, it does not reflect the reality of doctors' and patients' accounts of testing; a broader model of shared understanding seems to be more relevant to the complexity of primary care diagnosis. Patient or Public Contribution A patient and public involvement group comprising five participants with lived experience of blood testing in primary care met regularly during the study. They contributed to the development of the research objectives, planning recruitment methods, reviewing patient information leaflets and topic guides and also contributed to discussion of emerging themes at an early stage in the analysis process.
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Affiliation(s)
- Jessica Watson
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | - Penny F Whiting
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Jonathan Banks
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), Bristol, UK
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36
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Zegarek M, Brienza R, Quinn N. Twelve Tips for teaching shared decision making. MEDICAL TEACHER 2022; 45:1-7. [PMID: 35793200 DOI: 10.1080/0142159x.2022.2093700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Shared decision making (SDM) is a process in which preference-sensitive decisions are discussed with patients in a collaborative and accessible format so that patients can select an option that integrates their values and preferences into the context of evidence-based medicine. While SDM has been shown to improve some metrics of quality of care and is now included in many competencies developed by accreditation bodies, it can be challenging to successfully incorporate competencies in SDM into clinical teaching. Multiple interventions and curricula that build competency in SDM have been published, but here we aim to suggest ways to integrate teaching competencies in SDM into all forms of clinical teaching. These twelve tips provide strategies to foster trainee development of the relational and risk-benefit communication competencies that are required for successful shared decision making.
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Affiliation(s)
- Matthew Zegarek
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Rebecca Brienza
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Noel Quinn
- Center of Education in Interprofessional Primary Care, VA Connecticut Healthcare System, West Haven, CT, USA
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37
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Friedemann Smith C, Lunn H, Wong G, Nicholson BD. Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care. BMJ Qual Saf 2022; 31:541-554. [PMID: 35354664 PMCID: PMC9234415 DOI: 10.1136/bmjqs-2021-014529] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk. OBJECTIVE To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care. METHODS Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives. RESULTS 95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care. CONCLUSIONS We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.
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Affiliation(s)
| | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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38
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Arends SAM, Steenbergen M, Thodé M, Francke AL, Jongerden IP. Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: A qualitative interview study. PATIENT EDUCATION AND COUNSELING 2022; 105:2531-2536. [PMID: 35123835 DOI: 10.1016/j.pec.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/17/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore whether nurses in hospital settings experience moral distress when involved in potentially life-prolonging treatments in adults with a short life expectancy. METHODS A qualitative study using semi-structured interviews. RESULTS 23 Registered nurses working in inpatient or outpatient hospital settings participated. The nurses stated they were often not involved in decisions regarding life-prolonging treatments. They reported signs of moral distress such as feeling powerless when they when they were not being listened to in the decision-making process and when confronted with negative treatment outcomes. Nurses felt frustrated when their own values were not reflected in the decision-making or when physicians created unrealistic expectations. CONCLUSIONS Hospital nurses experience moral distress when they are involved in life-prolonging treatment because of the patient's advanced condition and their own lack of involvement in the decision-making process about the treatment. In these situations, moral distress is characterised by feelings of powerlessness and frustration. PRACTICE IMPLICATIONS Nurses need to be empowered by training programmes that focus on an active role in the decision-making process. Further research is needed to evaluate effective tools and training programmes that help nurses in shared decision-making processes.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | | | - Maureen Thodé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, Netherlands.
| | - Irene P Jongerden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
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Engineering Education Understanding Expert Decision System Research and Application. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9662301. [PMID: 35548096 PMCID: PMC9085332 DOI: 10.1155/2022/9662301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022]
Abstract
Engineering education is based on technical science and aims at training engineers who can transform science and technology into productive forces. In recent years, due to the emergence of new technology revolution, engineering science and production technology have achieved new development, and higher engineering education is also facing new challenges. Engineering education is to cultivate talents in an international environment and update the traditional engineer training model from the aspects of educational philosophy, mode, goal, approach, and means. The author believes that in the process of exploring the new talent training model, we must first change the educational concept and correctly understand and deal with various relationships in engineering education. To solve various decision-making problems in engineering construction, this study introduces the concept of engineering education certification under the background of new infrastructure and engineering education certification, analyzes the current situation and existing problems of engineering education understanding in recent years, and carries out reform and exploration from different aspects. The achievements in engineering education are analyzed. The engineering education project is analyzed and researched using the engineering decision-making scheme. It can be seen from the experimental analysis that the method has a good effect.
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40
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Wang L. Internet of Things Device Identification Algorithm considering User Privacy. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6173185. [PMID: 35510052 PMCID: PMC9061015 DOI: 10.1155/2022/6173185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
The Internet of Things has become the third wave of the information industry and cloud computing, big data, and Internet technologies. Among the many identification technologies used in the Internet of Things, radiofrequency identification technology is undoubtedly one of the most popular methods today. It is replacing the traditional contact IC card and becoming a new trend of smart cards. At the same time, a large amount of data is generated in the IoT environment. A lot of data involve user privacy, and users do not have good control over these data. Collecting and utilizing these data on the basis of protecting user privacy have become an important problem to be solved urgently. With the implementation of the strategy of rejuvenating the country through science and education, major colleges and universities are developing rapidly through enrollment and expansion, which also brings inconvenience to campus security management. Although the traditional campus all-in-one card system can guarantee the security identity of people entering and leaving, it does not reasonably integrate and utilize this information, resulting in waste of information resources and, to a certain extent, the problem of user privacy leakage. To solve the above problems, a new system was developed to integrate resources to identify users. To protect the privacy data of Internet of Things users, a specific solution using blockchain technology is proposed; for the identity authentication problem of Internet of Things users, the identity authentication based on the public key address of the blockchain is used on the chain, and the group signature is used off the chain. The identity authentication method solves the contradiction between anonymity and traceability in blockchain application scenarios. The simulation results show that the system not only considers user privacy but also has extremely important practical significance for the promotion of Internet of Things and RF applications.
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Affiliation(s)
- Lin Wang
- College of Physics and Engineering Technology, Chengdu Normal College, ChengDu, Sichuan, China
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41
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Jun Z, Li X. Research on the Mining of Intangible Cultural Heritage Digital Resources in the Manual Online Teaching System of Preschool Education. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2136597. [PMID: 35502352 PMCID: PMC9056238 DOI: 10.1155/2022/2136597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
Our country's international status as a cultural power has been further enhanced, and the protection of intangible cultural heritage containing the essence of traditional culture is also gradually being carried out. In addition, with the rapid development of the digital environment, the public's cultural needs continue to grow, and the contradiction between the supply and demand of public digital cultural services continues to intensify. Converting intangible cultural heritage into digital form for protection and providing resource services for the public has become an important trend in the protection and inheritance of intangible cultural heritage at home and abroad, and it is also an inevitable requirement to solve the contradiction between supply and demand. Improving public cultural services is one of the key projects. At present, our country's research and practice of intangible cultural heritage digitization and services are also in progress, but there is no research on intangible cultural heritage digital resource services and system construction from the perspective of information service elements. Based on the digital resource service of intangible cultural heritage, the manual course is one of the main skill courses for preschool education majors. At this stage, the short class hours of manual courses, the lack of class hours, the low utilization rate of teaching materials, and the disconnection between the content and the needs of the kindergarten are all problems that need to be solved at present. Just relying on cross-references between schools, the manual knowledge and skills mastered by graduates are not comprehensive enough to complete the manual tasks assigned by the kindergarten. This paper implements the concept of intangible cultural heritage and hopes that by studying the manual knowledge and skills that today's kindergarten teachers need to possess, the content of existing manual courses can be adjusted in a targeted manner, so that the electronic culture dissemination of manual curriculum resources for preschool education is more reasonable, meeting the requirements of kindergarten teachers in terms of manual knowledge and skills.
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Affiliation(s)
- Zhao Jun
- Ganzhou Teachers College, Jiangxi 341000, China
| | - Xingping Li
- Ganzhou Teachers College, Jiangxi 341000, China
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Santos ROMD, Abreu MMD, Migowski A, Engstrom EM. Decision aid for prostate cancer screening in Brazil. Rev Saude Publica 2022; 56:19. [PMID: 35416845 PMCID: PMC8973024 DOI: 10.11606/s1518-8787.2022056003467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To present the development and validation processes of a decision aid for prostate cancer screening in Brazil. METHODS Study with qualitative-participatory design for the elaboration of a decision aid for prostate cancer screening, with the participation of a group of men and physicians inserted in primary health care in 11 Brazilian states. Evidence synthesis, field testing, and use in clinical scenarios were performed to adapt the content, format, language, and applicability towards the needs of the target audience in the years 2018 and 2019. The versions were subsequently evaluated by the participants and modified based on the data obtained. RESULTS We elaborated an unprecedented tool in Brazil, with information about the tests used in the screening, comparison of their possible benefits and harms and a numerical infographic with the consequences of this practice. We verified the decision aid usability to assist in the communication between the doctor and the man in the context of primary health care, besides identifying the need for greater discussion about sharing decisions in clinical scenarios. CONCLUSION The tool was easy to use, objective, and has little interference in consultation time. It is a technical-scientific material, produced by research, with the participation of its main target audience and which is available free of charge for use in Brazilian clinical scenarios.
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Affiliation(s)
| | - Mirhelen Mendes de Abreu
- Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica da Faculdade de Medicina. Rio de Janeiro, RJ, Brasil
| | - Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva. Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
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A Method for Prediction the Trajectory of Table Tennis in Multirotation State Based on Binocular Vision. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8274202. [PMID: 35463267 PMCID: PMC9023219 DOI: 10.1155/2022/8274202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/19/2022] [Accepted: 03/26/2022] [Indexed: 11/18/2022]
Abstract
The research on the space trajectory of high-speed moving and flying objects has very important research significance and application value in the fields of sports, military, aerospace, and industry. Table tennis has the characteristics of small size, fast flight speed, and complex motion model. It is very suitable as an experimental object for the study of flying object trajectory. This study takes table tennis as the research object to carry out research on the trajectory prediction of flying objects and builds a trajectory prediction system based on the trajectory prediction model, combining the constraints of the simple physical motion model and the deviation correction of the double LSTM neural network. Aiming at the problem of trajectory extraction of flying table tennis balls, a high-speed industrial camera was used to build a table tennis trajectory extraction system based on binocular vision. A multicamera information fusion method based on dynamic weights is proposed for the prediction of the trajectory of flying table tennis. In order to solve the problems that some model parameters are difficult to measure and the model is too complicated in the traditional physical motion model of table tennis trajectory, a method combining simple physics is proposed. This paper proposes a trajectory prediction model with motion model constraints and dual LSTM neural network bias correction. Experiments show that the proposed method can greatly improve the accuracy of the trajectory extraction and prediction system and can achieve a certain success rate of hitting.
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Intelligent Selection Algorithm of Optimal Logistics Distribution Path Based on Supply Chain Technology. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9955726. [PMID: 35463274 PMCID: PMC9023198 DOI: 10.1155/2022/9955726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
Abstract
How to realize the intelligence of logistics distribution is a hot research topic at present. How to reasonably allocate vehicles, optimize driving routes and travel time, deliver goods to customers on time at the lowest cost, and realize efficient and low-cost operation of the logistics distribution system has always been a problem in academia and industry for many years. Logistics enterprises face problems such as low efficiency of logistics operation, lack of scientific rationality of logistics resource planning, and lack of overall optimization of logistics management operation mode. These are severe tests that steel companies must accept. Under the background of logistics supply chain, the integrated service platform of logistics supply chain has become an urgent research topic. This study takes a steel enterprise as the main research background. On this basis, the two core modules of warehousing and distribution in the logistics business of iron and steel enterprises are qualitatively analyzed, the concept of business process reengineering is proposed, and the logistics supply chain of iron and steel enterprises is established. The concept of comprehensive service platform is realized through RFID technology. In addition, this study conducts a comprehensive analysis and research on the logistics distribution path optimization and vehicle scheduling problem, designs and implements a logistics vehicle scheduling management system, and then adopts the multiobjective method to solve the logistics distribution path planning problem, SMEs. Genetic algorithm and a simulation decision-making subsystem suitable for this problem are designed, which can better solve the problem of route optimization and vehicle scheduling in small-scale distribution.
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Research on Keyword Extraction Algorithm in English Text Based on Cluster Analysis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4293102. [PMID: 35387240 PMCID: PMC8979710 DOI: 10.1155/2022/4293102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022]
Abstract
How to facilitate users to quickly and accurately search for the text information they need is a current research hotspot. Text clustering can improve the efficiency of information search and is an effective text retrieval method. Keyword extraction and cluster center point selection are key issues in text clustering research. Common keyword extraction algorithms can be divided into three categories: semantic-based algorithms, machine learning-based algorithms, and statistical model-based algorithms. There are three common methods for selecting cluster centers: randomly selecting the initial cluster center point, manually specifying the cluster center point, and selecting the cluster center point according to the similarity between the points to be clustered. The randomly selected initial cluster center points may contain “outliers,” and the clustering results are locally optimal. Manually specifying the cluster center points will be very subjective because each person’s understanding of the text set is different, and it is not suitable for the case of a large number of text sets. Selecting the cluster center points according to the similarity between the points to be clustered can make the selected cluster center points distributed in each class and be as close as possible to the class center points, but it takes a long time to calculate the cluster centers. Aiming at this problem, this paper proposes a keyword extraction algorithm based on cluster analysis. The results show that the algorithm does not rely on background knowledge bases, dictionaries, etc., and obtains statistical parameters and builds models through training. Experiments show that the keyword extraction algorithm has high accuracy and can quickly extract the subject content of an English translation.
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Arends SAM, Thodé M, De Veer AJE, Pasman HRW, Francke AL, Jongerden IP. Nurses' perspective on their involvement in decision-making about life-prolonging treatments: A quantitative survey study. J Adv Nurs 2022; 78:2884-2893. [PMID: 35307867 PMCID: PMC9541323 DOI: 10.1111/jan.15223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Aims In hospital settings, decisions about potentially life‐prolonging treatments are often made in a dialogue between a patient and their physician, with a focus on active treatment. Nurses can have a valuable contribution in this process, but it seems they are not always involved. Our aim was to explore how hospital nurses perceive their current role and preferred role in shared decision‐making about potentially life‐prolonging treatment in patients in the last phase of life. Design Cross‐sectional quantitative study conducted in the Netherlands in April and May 2019. Methods An online survey, using a questionnaire consisting of 12 statements on nurses' opinion about supporting patients in decisions about potentially life‐prolonging treatments, and 13 statements on nurses' actual involvement in these decisions. Results In total 179 hospital nurses from multiple institutions who care for adult patients in the last phase of life responded. Nurses agreed that they should have a role in shared decision‐making about potentially life‐prolonging treatments, indicating greatest agreement with ‘It is my task to speak up for my patient’ and ‘It is important that my role in supporting patients is clear’. However, nurses also said that in practice they were often not involved in shared decision‐making, with least involvement in ‘active participation in communication about treatment decisions’ and ‘supporting a patient with the decision’. Conclusion There is a discrepancy between nurses' preferred role in decision‐making about potentially life‐prolonging treatment and their actual role. More effort is needed to increase nurses' involvement. Impact Nurses' contribution to decision‐making is increasingly considered to be valuable by the nurses themselves, physicians and patients, though involvement is still not common. Future research should focus on strategies, such as training programs, that empower nurses to take an active role in decision‐making.
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Affiliation(s)
- Susanne A M Arends
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maureen Thodé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anke J E De Veer
- Netherlands Institute for Health Services Research - Nivel, Utrecht, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anneke L Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research - Nivel, Utrecht, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Ries NM, Johnston B, Jansen J. A qualitative interview study of Australian physicians on defensive practice and low value care: "it's easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other". BMC Med Ethics 2022; 23:16. [PMID: 35246129 PMCID: PMC8895622 DOI: 10.1186/s12910-022-00755-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background Defensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour. Methods A qualitative interview study investigated the views and experiences of physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change. Results All participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences. Conclusions The findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00755-2.
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Affiliation(s)
- Nola M Ries
- Faculty of Law, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Briony Johnston
- Faculty of Law, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
| | - Jesse Jansen
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Giachetti L, Cinelli F, Nieri M. Intrasulcular Restorations of Anterior Teeth According to the BAIR Technique: Evaluation of Periodontal Parameters. Dent J (Basel) 2022; 10:dj10030037. [PMID: 35323239 PMCID: PMC8947544 DOI: 10.3390/dj10030037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
Some clinical situations, such as the closure of pronounced diastemas, and the transformation of malformed, small, or peg-shaped teeth, require a rebalancing of dental proportions accompanied by a modification of the gingival contour. A traditional treatment plan can include surgical, prosthetic, and/or orthodontic treatments. In some cases, it can be considered too invasive, and not all patients are willing to undertake long therapies. To overcome these limitations, a possible solution could be the application of the Biologically Active Intrasulcular Restoration (BAIR) technique, which allows us to modify the natural emergence tooth profile using simple intrasulcular direct restorations. The aims of this paper are to investigate possible effects on gingival health, and to assess the patient satisfaction about the aesthetic intervention performed. Periodontal data were collected, and patient satisfaction was registered using the VAS questionnaire. All sites healed without complications, no adverse events were registered or reported by the patients, and no signs of periodontal morbidity were visible. The results show that the patients evaluated the final aesthetics in a positive way, and they perceived a good condition of periodontal health as well. The intervention is felt as almost painless, and patients do not report significant post-operative distress. In conclusion, the BAIR technique can provide a valid therapeutic alternative for patients for whom traditional treatments are not indicated. It is a minimally invasive intervention where both the operating times and the biologic and economic costs are reduced.
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Bokkers K, Vlaming M, Engelhardt EG, Zweemer RP, van Oort IM, Kiemeney LALM, Bleiker EMA, Ausems MGEM. The Feasibility of Implementing Mainstream Germline Genetic Testing in Routine Cancer Care-A Systematic Review. Cancers (Basel) 2022; 14:cancers14041059. [PMID: 35205807 PMCID: PMC8870548 DOI: 10.3390/cancers14041059] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Germline genetic testing for patients with cancer can have important implications for treatment, preventive options, and for family members. In a mainstream genetic testing pathway, pre-test counseling is performed by non-genetic healthcare professionals, thereby making genetic testing more accessible to all patients who might benefit from it. These mainstream genetic testing pathways are being implemented in different hospitals around the world, and for different cancer types. It is important to evaluate how a mainstream genetic testing pathway can be made sustainable and if quality of genetic care is maintained. We show in this systematic review that it is feasible to incorporate a mainstream genetic testing pathway into routine cancer care while maintaining quality of care. A training procedure for non-genetic healthcare professionals and a close collaboration between genetics and other clinical departments are highly recommended to ensure sustainability. Abstract Background: Non-genetic healthcare professionals can provide pre-test counseling and order germline genetic tests themselves, which is called mainstream genetic testing. In this systematic review, we determined whether mainstream genetic testing was feasible in daily practice while maintaining quality of genetic care. Methods: PubMed, Embase, CINAHL, and PsychINFO were searched for articles describing mainstream genetic testing initiatives in cancer care. Results: Seventeen articles, reporting on 15 studies, met the inclusion criteria. Non-genetic healthcare professionals concluded that mainstream genetic testing was possible within the timeframe of a routine consultation. In 14 studies, non-genetic healthcare professionals completed some form of training about genetics. When referral was coordinated by a genetics team, the majority of patients carrying a pathogenic variant were seen for post-test counseling by genetic healthcare professionals. The number of days between cancer diagnosis and test result disclosure was always lower in the mainstream genetic testing pathway than in the standard genetic testing pathway (e.g., pre-test counseling at genetics department). Conclusions: Mainstream genetic testing seems feasible in daily practice with no insurmountable barriers. A structured pathway with a training procedure is desirable, as well as a close collaboration between genetics and other clinical departments.
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Affiliation(s)
- Kyra Bokkers
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
| | - Michiel Vlaming
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
| | - Ellen G. Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (E.G.E.); (E.M.A.B.)
| | - Ronald P. Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Inge M. van Oort
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (L.A.L.M.K.)
| | - Lambertus A. L. M. Kiemeney
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands; (I.M.v.O.); (L.A.L.M.K.)
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 21, 6525 EZ Nijmegen, The Netherlands
| | - Eveline M. A. Bleiker
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (E.G.E.); (E.M.A.B.)
- Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Family Cancer Clinic, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Margreet G. E. M. Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (K.B.); (M.V.)
- Correspondence: ; Tel.: +31-88-75-538-00
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Shared decision-making between older people with multimorbidity and GPs: focus group study. Br J Gen Pract 2022; 72:e609-e618. [PMID: 35379603 PMCID: PMC8999685 DOI: 10.3399/bjgp.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice. Aim To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care. Design and setting Qualitative study. General practices (rural and urban) in Devon, England. Method Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis. Results Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators. Conclusion Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.
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