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Aghdam HD, Zarei F, Mohammadi SF. Development of a web-based patient decision aid for myopia laser correction method. BMC Med Inform Decis Mak 2024; 24:156. [PMID: 38840124 PMCID: PMC11151511 DOI: 10.1186/s12911-024-02559-3] [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: 03/04/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In the context of healthcare centered on the patient, Patient Decision Aids (PtDAs) acts as an essential instrument, promoting shared decision-making (SDM). Considering the prevalent occurrence of myopia, the objective of this study is to furnish exhaustive and easily comprehensible information to assist patients in making well-informed decisions about their options for myopia laser correction. METHOD The research team developed a decision guide for myopia patients considering laser correction, aiming to facilitate informed decisions. The study followed the first four stages of the IPDAS process model: "scope/scoping," "design," "prototype development," and "alpha testing." Ten semi-structured interviews with patients (n = 6) and corneal specialist ophthalmologists (n = 4) were conducted to understand the challenges in selecting a laser correction method. Online meetings with 4 corneal specialists were held to discuss challenging cases. A comparison table of harms and benefits was created. The initial prototype was developed and uploaded on the internet portal. User feedback on software and text aspects was incorporated into the final web software, which was reviewed by a health education expert for user-friendliness and effectiveness. RESULT Educational needs assessment revealed concerns such as pain, daily life activities, return to work, the potential need for glasses ('number return'), eye prescription stability, and possible complications. These shaped the decision aid tool's content. Expert consensus was achieved in several areas, with some items added or extended. In areas lacking consensus, comments were added for clarity. Five clients assessed the web app (PDAIN), rating it 46/50 in user-centricity, 47/50 in usability, and 45/50 in accuracy and reliability, totaling 138/150. Post-piloting, software errors were documented and rectified. During the trial phase, five myopic users interacted with the software, leading to modifications. User feedback indicated the tool effectively enhanced understanding and influenced decision-making. CONCLUSION PDAIN, serves as a facilitative tool in the process of selecting a corneal laser correction method for myopic patients. It enabling Nearsighted patients to make informed decisions.
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Affiliation(s)
- Hanieh Delshad Aghdam
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Jalal AleAhmad Nasr, P.O.Box: 14115-111, Teharn, Iran
| | - Fatemeh Zarei
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran Jalal AleAhmad Nasr, P.O.Box: 14115-111, Teharn, Iran.
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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2
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Naye F, Toupin-April K, de Wit M, LeBlanc A, Dubois O, Boonen A, Barton JL, Fraenkel L, Li LC, Stacey D, March L, Barber CEH, Hazlewood GS, Guillemin F, Bartlett SJ, Berthelsen DB, Mather K, Arnaud L, Akpabio A, Adebajo A, Schultz G, Sloan VS, Gill TK, Sharma S, Scholte-Voshaar M, Caso F, Nikiphorou E, Nasef SI, Campbell W, Meara A, Christensen R, Suarez-Almazor ME, Jull JE, Alten R, Morgan EM, El-Miedany Y, Singh JA, Burt J, Jayatilleke A, Hmamouchi I, Blanco FJ, Fernandez AP, Mackie S, Jones A, Strand V, Monti S, Stones SR, Lee RR, Nielsen SM, Evans V, Srinivasalu H, Gérard T, Demers JL, Bouchard R, Stefan T, Dugas M, Bergeron F, Beaton D, Maxwell LJ, Tugwell P, Décary S. OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments. Semin Arthritis Rheum 2024; 65:152344. [PMID: 38232625 DOI: 10.1016/j.semarthrit.2023.152344] [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: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada; VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Olivia Dubois
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lyn March
- Department of Medicine, The University of Sydney, Sydney, Australia; Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Canada; Research Institute - McGill University Health Centre, Canada; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, Odense & Department of Rehabilitation, Municipality of Guldborgsund, Odense University Hospital, University of Southern Denmark, Nykoebing, Denmark
| | | | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, France
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | | | - Victor S Sloan
- Sheng Consulting LLC, Flemington, NJ, USA; The Peace Corps, Washington, DC, USA
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Marieke Scholte-Voshaar
- Patient Research Partner, Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Willemina Campbell
- Patient research partner, Toronto Western Hospital, University Health Network, Canada
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Denmark
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Simon R Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Demark, Copenhagen, Denmark
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital, Washington DC, USA; GW School of Medicine, Washington DC, USA
| | - Thomas Gérard
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | | | - Roxanne Bouchard
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Théo Stefan
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Michèle Dugas
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | | | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Morrison T, Foster E, Dougherty J, Barton J. Shared Decision Making in Rheumatology: A Scoping Review. Semin Arthritis Rheum 2022; 56:152041. [DOI: 10.1016/j.semarthrit.2022.152041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
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Fagni F, Knitza J, Krusche M, Kleyer A, Tascilar K, Simon D. Digital Approaches for a Reliable Early Diagnosis of Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:718922. [PMID: 34458293 PMCID: PMC8385754 DOI: 10.3389/fmed.2021.718922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that develops in up to 30% of patients with psoriasis. In the vast majority of cases, cutaneous symptoms precede musculoskeletal complaints. Progression from psoriasis to PsA is characterized by subclinical synovio-entheseal inflammation and often non-specific musculoskeletal symptoms that are frequently unreported or overlooked. With the development of increasingly effective therapies and a broad drug armamentarium, prevention of arthritis development through careful clinical monitoring has become priority. Identifying high-risk psoriasis patients before PsA onset would ensure early diagnosis, increased treatment efficacy, and ultimately better outcomes; ideally, PsA development could even be averted. However, the current model of care for PsA offers only limited possibilities of early intervention. This is attributable to the large pool of patients to be monitored and the limited resources of the health care system in comparison. The use of digital technologies for health (eHealth) could help close this gap in care by enabling faster, more targeted and more streamlined access to rheumatological care for patients with psoriasis. eHealth solutions particularly include telemedicine, mobile technologies, and symptom checkers. Telemedicine enables rheumatological visits and consultations at a distance while mobile technologies can improve monitoring by allowing patients to self-report symptoms and disease-related parameters continuously. Symptom checkers have the potential to direct patients to medical attention at an earlier point of their disease and therefore minimizing diagnostic delay. Overall, these interventions could lead to earlier diagnoses of arthritis, improved monitoring, and better disease control while simultaneously increasing the capacity of referral centers.
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Affiliation(s)
- Filippo Fagni
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum fuer Immuntherapie, FAU Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Lopez‐Olivo MA, des Bordes JK, Lin H, Volk RJ, Rizvi T, Suarez‐Almazor ME. A Randomized Controlled Trial Comparing Two Self-Administered Educational Strategies for Patients With Knee Osteoarthritis. ACR Open Rheumatol 2021; 3:185-195. [PMID: 33590950 PMCID: PMC7966878 DOI: 10.1002/acr2.11222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of self-administered patient educational tools in improving knowledge and behaviors for the management of knee osteoarthritis. METHODS We conducted a randomized clinical trial in patients with knee osteoarthritis to assess the efficacy of providing a video for entertainment education, in combination with two booklets, compared with providing the booklets alone. We evaluated changes in scores on a patient knowledge questionnaire, the Decisional Conflict Scale, the Arthritis Self-Efficacy Scale, and the Effective Consumer Scale between baseline and same day, 3 months, and 6 months post intervention. We used linear regression models to explore associations between demographic characteristics and outcomes, testing for interactions. RESULTS Two hundred nineteen participants were randomly assigned to receive the video + booklets (n = 109) or the booklets alone (n = 110). The mean age of participants was 64.6 (±8.3) years. At 6 months, statistically significant improvements were observed in knowledge and decisional conflict scores for both groups, and statistically significant improvements in the behavior to participate in their health care were observed in the video + booklets group. The video + booklets group was more knowledgeable immediately post intervention than the booklet group (mean difference 0.39 [95% confidence interval 0.02-0.76]). No other significant changes in outcomes were observed at 6 months between the two groups. The video + booklets combination was associated with decreased decisional conflict in Spanish speakers and increased self-efficacy in those with less than a high school education. CONCLUSION Although both education strategies were associated with improved knowledge and reduced decisional conflict at 6 months, receiving the video + booklets in combination, compared with receiving the booklets alone, proved to be more effective in changing behaviors and appeared to have some advantages for Spanish speakers and those who were less educated.
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Affiliation(s)
| | - Jude K. des Bordes
- McGovern Medical SchoolThe University of Texas Health Science Center at Houston
| | - Heather Lin
- The University of Texas MD Anderson Cancer CenterHouston
| | - Robert J. Volk
- The University of Texas MD Anderson Cancer CenterHouston
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7
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Umaefulam V, Fox TL, Barnabe C. Decision Needs and Preferred Strategies for Shared Decision Making in Rheumatoid Arthritis: Perspectives of Canadian Urban Indigenous Women. Arthritis Care Res (Hoboken) 2021; 74:1325-1331. [PMID: 33571403 PMCID: PMC9546336 DOI: 10.1002/acr.24579] [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: 11/16/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Decision making for treatment of rheumatoid arthritis (RA) is complex, with multiple beneficial medication options available, but with the potential for treatment-related adverse effects and significant economic considerations. Indigenous patients make treatment decisions informed by an interplay of clinical, family, and societal factors. Shared decision-making (SDM) may represent an approach to support treatment decisions in a culturally congruent manner. The study identified aspects of arthritis care that Indigenous participants found relevant for SDM and explored preferences for SDM strategies. METHODS A purposive sampling from rheumatology clinics that provide services to Indigenous patients in a Canadian urban centre was used to recruit participants for interviews. Seven participants were recruited to reach content saturation. Interview content was coded by two individuals, including an Indigenous patient with RA, and the data were analyzed via thematic analysis. RESULTS Participants were all women aged 37-61 years living with RA. Participants supported that SDM would be beneficial, primarily to support decisions around treatment plans and medication changes. SDM approaches would need to reflect Indigenous-specific content areas, such as benefits and risks of therapy informed by data from Indigenous patient populations and inclusion of traditional modes of healing. All participants were interested in having a decision coach and preferred that decision aids be in both paper and electronic formats for accessibility. CONCLUSIONS This study advances knowledge in the priority areas and specific content needed in the SDM process, and the preferences of SDM strategies relevant and appropriate for urban Indigenous women living with RA in Canada.
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Affiliation(s)
- Valerie Umaefulam
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Terri-Lynn Fox
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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8
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Roodenrijs NMT, Hamar A, Kedves M, Nagy G, van Laar JM, van der Heijde D, Welsing PMJ. Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open 2021; 7:e001512. [PMID: 33419871 PMCID: PMC7798678 DOI: 10.1136/rmdopen-2020-001512] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA. METHODS PubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised. RESULTS Two hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias. CONCLUSIONS This SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.
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Affiliation(s)
- Nadia M T Roodenrijs
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Attila Hamar
- Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Melinda Kedves
- Rheumatology, Bacs-Kiskun Megyei Korhaz, Kecskemet, Hungary
| | - György Nagy
- Genetics, Cell- and Immunobiology & Rheumatology & Clinical Rheumatology, Semmelweis University, Budapest, Hungary
| | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paco M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Schmale-Grede R, Faubel U. [The patient at the center of health services research]. Z Rheumatol 2020; 79:996-1002. [PMID: 33258977 DOI: 10.1007/s00393-020-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
The article gives an overview of how health services research helps to plan and optimize patient-centered health services. The decision-making processes on the micro-level (individual treatment decisions) and the macro-level (decisions about structuring of the healthcare system) are examined. Examples from the field of rheumatology illustrate how results of health services research can help to improve decisions about treatment by providing relevant information about quality of health services which helps in the joint decision-making process. Furthermore, it becomes clear that political decisions to improve health care service structures can be better achieved if scientific proof of deficits in existing health service structures can be provided. The article also shows how health services research helps to describe and redefine the roles of patients and patient-doctor communication. Additionally, the active role of patients in (health services) research is addressed.
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Affiliation(s)
- R Schmale-Grede
- Deutsche Rheuma-Liga Bundesverband e. V., Welschnonnenstr. 7, 53111, Bonn, Deutschland.
| | - U Faubel
- Deutsche Rheuma-Liga Bundesverband e. V., Welschnonnenstr. 7, 53111, Bonn, Deutschland
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10
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Chen A, Tenhunen H, Torkki P, Heinonen S, Lillrank P, Stefanovic V. Women's decisional conflict in the pathway of prenatal screening and testing: an explorative study within Finnish public maternity care. J Perinat Med 2020; 48:527-537. [PMID: 32304311 DOI: 10.1515/jpm-2019-0450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Objectives To explore women's decisional conflict in the pathway of prenatal screening and testing (PreST) in Finland and to evaluate a counseling service. Methods Self-completion surveys were conducted at two medical settings (screening and further testing) of PreST. Decisional Conflict Scale (DCS) was the main measure. Different types of statistical tests were used to compare women's decisional conflict at different medical settings of PreST, and before-after pre-test counseling. Multivariable linear regressions analyzed the influences of the medical settings and other factors on women's decisional conflict. Results Compared to women in population-based screening, women in further testing (before pre-test counseling) were more likely to feel well informed (P < 0.001), had increased values clarity (P < 0.001), but more likely experienced uncertainty (P = 0.040). Besides medical settings, maternal age, gravidity and previous experience of fetal aneuploidy significantly influenced decisional conflict. After counseling, screen-positive women felt better informed (P < 0.001), had increased values clarity (P < 0.001), perceived more support (P < 0.001), and had better decision certainty (P < 0.001) than before counseling. Conclusions Medical settings influence women's decisional conflict during PreST. Individual counseling is effective in improving screen-positive women's decisional conflict. This research adds knowledge and experience on developing decision-making supports across the pathway of PreST.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Henni Tenhunen
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland.,Department of Public Health, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Seppo Heinonen
- Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paul Lillrank
- Institute of Healthcare Engineering, Management and Architecture (HEMA Institute), Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Vedran Stefanovic
- Professor of Obstetrics, Gynecology and Fetal Medicine, Senior Consultant, Senior Lecturer, Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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11
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Shared Decision Making and Choice for Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244966. [PMID: 31817804 PMCID: PMC6950179 DOI: 10.3390/ijerph16244966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 01/14/2023]
Abstract
: The number of people undergoing bariatric surgery is increasing every year, and their expectations for surgery often differ greatly. The purpose of this study was to develop a patient-centered decision-making aid to help people define their weight loss goals and assist them in discussing their surgical treatment with surgeons. Before the operation, the patients were asked to read the shared decision-making text and conduct a self-assessment. After the operation, we evaluated the program using survey questionnaires. A total of 103 patients were formally included in this study. The results show that patients were very satisfied with the use of patient decision aids (PDAs), with a score of 4.3 points (±0.6), and the postoperative decision-making satisfaction was also very high, at 4.4 points (±0.5), while the postoperative regret score was low, at 1.6 points (±0.6). Their satisfaction with surgical decision making and decision regret were statistically significantly negatively correlated (r = -0.711, p < 0.001). The experience of using PDAs was statistically significantly negatively correlated with decision regret (r = -0.451, p < 0.001); the experience of PDA use was statistically positively correlated with decision satisfaction (r = 0.522, p < 0.001). Patient decision aids are a means of helping patients make informed choices before they seek to undergo bariatric surgery.
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12
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Patient Decision Aid (PDA) for Patients with Rheumatoid Arthritis Reduces Decisional Conflict and Improves Readiness for Treatment Decision Making. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:57-69. [PMID: 31410723 PMCID: PMC6957559 DOI: 10.1007/s40271-019-00381-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives The aim of this study was to develop and assess the effectiveness of a patient decision aid (PDA) to support treatment decision making in Spanish patients with moderate-to-severe rheumatoid arthritis (RA) who fail to achieve the therapeutic goal with the current disease-modifying antirheumatic treatment strategy. Methods The PDA was developed in accordance with the International Patient Decision Aids Standards recommendations. A steering group led the project. Three literature reviews and two focus groups were performed to develop the PDA prototype. To check its comprehensibility, acceptability, and feasibility, alpha-testing was performed using the Decision Support Acceptability Scale (DSAS). Beta-testing was conducted to assess preliminary evidence of PDA efficacy using the Decisional Conflict Scale (DCS) before and after PDA use. Readiness was evaluated using the Preparation for Decision Making Scale (PDMS). Results The PDA included (1) a brief description of RA, (2) treatment information, and (3) a values clarification section. Alpha-testing revealed that most patients considered that the information was presented in a good or excellent way and it could help clarify their values and facilitate treatment decision making. Most rheumatologists agreed that the PDA was easy to understand, to use, and allowed them to reach a shared decision. Beta-testing showed that PDA significantly reduced overall patients’ decisional conflict [33.2 (DE: 21.4) vs 24.6 (23.5); p < 0.001] and prepared the patient for decision making [PDMS: 67.5 (21.0)]. Conclusions We developed a PDA for Spanish patients with moderate-to-severe RA that reduces patients’ decisional conflict and increases their readiness for decision making. The use of this PDA in routine clinical practice may improve the quality of the decision-making process and the quality of the choices made. Electronic supplementary material The online version of this article (10.1007/s40271-019-00381-y) contains supplementary material, which is available to authorized users.
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13
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Hsiao B, Binder-Finnema P, Nowell WB, Michel G, Wiedmeyer C, Fraenkel L. Preference Phenotypes in Support of Shared Decision-Making at Point-of-Care for Patients With Rheumatoid Arthritis: A Proof-of-Concept Study. Arthritis Care Res (Hoboken) 2019; 71:629-637. [PMID: 29953733 DOI: 10.1002/acr.23684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In this proof-of-concept study, we sought to evaluate whether a value clarification tool enabling patients to view a set of rheumatoid arthritis (RA) treatment preference phenotypes could be used to support shared decision-making at the point-of-care. METHODS We conducted a pretest/post test study. English-speaking patients with RA presenting to their scheduled outpatient visits were asked to participate. Visits for patients with active RA were transcribed. Shared decision-making components were measured using a quantitative coding scheme based on an established model of shared decision-making. RESULTS Forty-six visits were included in the pretest and 40 in the post test phases. Providers offered more disease-modifying antirheumatic drugs (DMARDs) (2 or more) in the post test visits (60%) compared to the pretest visits (47.8%). Overall, more patients vocalized their values and/or preferences in the post test visits compared to the pretest visits for treatment escalation decisions including a choice of 1 new DMARD (90.9% versus 56.3%), 2 or more new DMARDs (95.8% versus 86.4%), as well as prednisone (87.5% versus 66.7%). Providers were also more likely to base their recommendations on patients' values and/or preferences in the post test (100% of 6 visits) than the pretest (64.3% of 14 visits) phases during visits in which a recommendation was made. The mean ± SD length of the visit was 29.9 ± 11.6 minutes and 25.1 ± 10.7 minutes in the pretest and post test phases, respectively. CONCLUSION This study provides an early indication that a value clarification tool allowing patients to consider a set of preference phenotypes can support shared decision-making at the point-of-care without extending visit time.
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Affiliation(s)
- Betty Hsiao
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - George Michel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
| | | | - Liana Fraenkel
- Yale University School of Medicine, New Haven, and Veterans Administration Connecticut Healthcare System, West Haven, Connecticut
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14
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Grande SW, Longacre MR, Palmblad K, Montan MV, Berquist RP, Hager A, Kotzbauer G. Empowering Young People Living With Juvenile Idiopathic Arthritis to Better Communicate With Families and Care Teams: Content Analysis of Semistructured Interviews. JMIR Mhealth Uhealth 2019; 7:e10401. [PMID: 30794202 PMCID: PMC6406228 DOI: 10.2196/10401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Young people living with juvenile idiopathic arthritis (JIA) face a number of communication barriers for achieving optimal health as they transition from pediatric care into adult care. Despite growing interest in mobile or wireless technologies to support health (mHealth), it is uncertain how these engagement tools might support young people, their families, and care teams to optimize preference-based treatment strategies. Objective This study aims to examine how an mHealth patient support system (mPSS) might foster partnership between young people living with JIA, their families, and care teams. Methods Semistructured interviews with young people (5-15 years old), their families, and JIA care teams were conducted using researcher-developed interviews guides. Transcribed data were qualitatively analyzed using conventional content analysis. Results We conducted semistructured interviews with 15 young people, their parents, and 4 care team members. Content analysis revealed the potential of an mPSS to support productive dialogue between families and care teams. We identified four main themes: (1) young people with JIA face communication challenges, (2) normalizing illness through shared experience may improve adherence, (3) partnership opens windows into illness experiences, and (4) readiness to engage appears critical for clinic implementation. Conclusions A human-centered mPSS design that offers JIA patients the ability to track personally relevant illness concerns and needs can enhance communication, generate consensus-based treatment decisions, and improve efficiency and personalization of care. Technology that supports continuous learning and promotes better understanding of disease management may reduce practice burden while increasing patient engagement and autonomy in fostering lasting treatment decisions and ultimately supporting personalized care and improving outcomes.
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Affiliation(s)
- Stuart W Grande
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Meghan R Longacre
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Karin Palmblad
- Karolinska Institutet, Department of Women and Child Health, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Greg Kotzbauer
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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15
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Rose-Davis B, Curran J, Wright J, Cellucci T, Duffy CM, Tucker LB, Batthish M, Huber AM, Lang B, Levy DM, Rumsey DG, Watanabe Duffy KN, Stringer E. Factors Influencing the Uptake of Canadian Research Findings into the Care of Children with Arthritis: A Healthcare Provider Perspective. J Rheumatol 2018; 46:294-300. [PMID: 30442824 DOI: 10.3899/jrheum.180282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine barriers and facilitators to the uptake of findings from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) study into clinical care by pediatric rheumatologists (PR) and allied health professionals (AHP) caring for children with juvenile idiopathic arthritis (JIA) in Canada. METHODS PR and AHP participated in this qualitative study through telephone interviews. Interview guides were developed using the Theoretical Domains Framework and focused on the use of information from the ReACCh-Out study in the practice of counseling patients and families. A directed content analysis approach was used for coding. RESULTS Nineteen interviews (8 PR and 11 AHP) were completed. All PR had knowledge of the ReACCh-Out study. Three major themes were identified: (1) both groups are motivated to use information from research in clinical care; (2) volume and emotional effect of information on families are barriers; and (3) specific timepoints in care trigger providing this information. AHP had less knowledge of the ReACCh-Out study, did not feel it was their primary role to provide this information, and have a desire for more opportunity to participate in academic forums related to research. CONCLUSION We have described a comprehensive overview of the barriers and facilitators perceived by healthcare providers in the translation of knowledge from JIA research into use in clinical practice. These findings provide a foundation for the development of knowledge translation strategies in the care of children with JIA and other rheumatic diseases.
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Affiliation(s)
- Benjamin Rose-Davis
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Janet Curran
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Julia Wright
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Tania Cellucci
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Ciarån M Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Lori B Tucker
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Michelle Batthish
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Adam M Huber
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Bianca Lang
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Deborah M Levy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Dax G Rumsey
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Karen N Watanabe Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Elizabeth Stringer
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada. .,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre.
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Phillips R, Pell B, Grant A, Bowen D, Sanders J, Taylor A, Edwards A, Choy E, Williams D. Identifying the unmet information and support needs of women with autoimmune rheumatic diseases during pregnancy planning, pregnancy and early parenting: mixed-methods study. BMC Rheumatol 2018; 2:21. [PMID: 30886972 PMCID: PMC6390539 DOI: 10.1186/s41927-018-0029-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Autoimmune rheumatic diseases (ARDs) such as inflammatory arthritis and Lupus, and many of the treatments for these diseases, can have a detrimental impact on fertility and pregnancy outcomes. Disease activity and organ damage as a result of ARDs can affect maternal and foetal outcomes. The safety and acceptability of hormonal contraceptives can also be affected. The objective of this study was to identify the information and support needs of women with ARDs during pregnancy planning, pregnancy and early parenting. Methods This mixed methods study included a cross-sectional online survey and qualitative narrative interviews. The survey was completed by 128 women, aged 18–49 in the United Kingdom with an ARD who were thinking of getting pregnant in the next five years, who were pregnant, or had young children (< 5 years old). The survey assessed quality-of-life and information needs (Arthritis Impact Measurement Scale Short Form and Educational Needs Assessment Tool), support received, what women found challenging, what was helpful, and support women would have liked. From the survey participants, a maximum variation sample of 22 women were purposively recruited for qualitative interviews. Interviews used a person-centered participatory approach facilitated by visual methods, which enabled participants to reflect on their experiences. Interviews were also carried out with seven health professionals purposively sampled from primary care, secondary care, maternity, and health visiting services. Results Survey findings indicated an unmet need for information in this population (ENAT total mean 104.85, SD 30.18). Women at the pre-conception stage reported higher needs for information on pregnancy planning, fertility, giving birth, and breastfeeding, whereas those who had children already expressed a higher need for information on pain and mobility. The need for high quality information, and more holistic, multi-disciplinary, collaborative, and integrated care consistently emerged as themes in the survey open text responses and interviews with women and health professionals. Conclusions There is an urgent need to develop and evaluate interventions to better inform, support and empower women of reproductive age who have ARDs as they navigate the complex challenges that they face during pregnancy planning, pregnancy and early parenting. Electronic supplementary material The online version of this article (10.1186/s41927-018-0029-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rhiannon Phillips
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Bethan Pell
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Aimee Grant
- 2Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Daniel Bowen
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- 3School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Ann Taylor
- 4Centre for Medical Education, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ernest Choy
- 5Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Denitza Williams
- 1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Shaw Y, Metes ID, Michaud K, Donohue JM, Roberts MS, Levesque MC, Chang JC. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. Arthritis Care Res (Hoboken) 2018; 70:533-541. [PMID: 28575542 DOI: 10.1002/acr.23301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. METHODS A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. RESULTS In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. CONCLUSION Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process.
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Affiliation(s)
- Yomei Shaw
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ilinca D Metes
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark S Roberts
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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18
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Li LC, Shaw CD, Lacaille D, Yacyshyn E, Jones CA, Koehn C, Hoens AM, Geldman J, Sayre EC, Macdonald GG, Leese J, Bansback N. Effects of a Web-Based Patient Decision Aid on Biologic and Small-Molecule Agents for Rheumatoid Arthritis: Results From a Proof-of-Concept Study. Arthritis Care Res (Hoboken) 2018; 70:343-352. [PMID: 28544648 DOI: 10.1002/acr.23287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the extent to which ANSWER-2, an interactive online patient decision aid, reduces patients' decisional conflict and improves their medication-related knowledge and self-management capacity. METHODS We used a pre-post study design. Eligible participants had a diagnosis of rheumatoid arthritis (RA), had been recommended to start using a biologic agent or small-molecule agent or to switch to a new one, and had internet access. Access to ANSWER-2 was provided immediately after enrollment. Outcome measures included 1) the Decisional Conflict Scale (DCS), 2) the Medication Education Impact Questionnaire (MeiQ), and 3) the Partners in Health Scale (PIHS). A paired t-test was used to assess differences pre- and postintervention. RESULTS The majority of the 50 participants were women (n = 40), and the mean ± SD age of participants was 49.6 ± 12.2 years. The median disease duration was 5 years (25th, 75th percentile: 2, 10 years). The mean ± SD DCS score was 45.9 ± 25.1 preintervention and 25.1 ± 21.8 postintervention (mean change of -21.2 of 100 [95% confidence interval (95% CI) -28.1, -14.4], P < 0.001). Before using ANSWER-2, 20% of participants had a DCS score of <25, compared to 52% of participants after the intervention. Similar results were observed in the PIHS (mean ± SD 25.3 ± 14.8 preintervention and 20.4 ± 13.0 postintervention; mean change of -3.7 of 88 [95% CI -6.3, -1.0], P = 0.009). Findings from the MeiQ were mixed, with statistically significant differences found only in the self-management subscales. CONCLUSION Patients' decisional conflict decreased and perceived self-management capacity improved after using ANSWER-2. Future research comparing the effectiveness of ANSWER-2 with that of educational material on biologic agents will provide further insight into its value in RA management.
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Affiliation(s)
- Linda C Li
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | | | | | - Alison M Hoens
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | | | - Graham G Macdonald
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | - Jenny Leese
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
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19
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Assessing Implementation Readiness and Success of an e-Resource to Improve Prelicensure Physical Therapy Workforce Capacity to Manage Rheumatoid Arthritis. J Orthop Sports Phys Ther 2017; 47:652-663. [PMID: 28859591 DOI: 10.2519/jospt.2017.7281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Prospective within-subject, cross-sectional, between-group, nested qualitative designs within an implementation science framework. Background Physical therapy is recommended for rheumatoid arthritis (RA) care, yet prelicensure RA curriculum time remains limited. Objectives To determine readiness for, and success of, implementing an e-learning tool, Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL), within the prelicensure physical therapy curriculum. Methods All physical therapy students in a 1-year cohort in 2014 had RAP-eL embedded in their curriculum. Rheumatoid Arthritis for Physiotherapists e-Learning is an online platform that delivers RA disease information with translation to clinical practice. Implementation readiness, determined by acceptability of RAP-eL to students, was evaluated using focus groups (n = 23). Implementation success was measured using quantitative data from a previously validated questionnaire, including changes in students' self-reported confidence in knowledge (out of 45) and skills (out of 40) in managing RA after 4 weeks of access to RAP-eL, retention of learning over 14 months, and differences in workforce readiness between students in the cohort who had access to RAP-eL and a historical control cohort. Results Acceptability of RAP-eL was confirmed from qualitative data, demonstrating implementation readiness. Short-term improvements were observed in RA knowledge (mean difference, 16.6; 95% confidence interval [CI]: 15.7, 17.6) and RA skills (mean difference, 14.9; 95% CI: 13.9, 15.9; n = 137). Retention was demonstrated after 14 months (P<.001; n = 62). Students in the 1-year cohort who had RAP-eL embedded in the curriculum scored significantly higher on knowledge (mean difference, 3.6; 95% CI: 1.3, 5.9) and skills (mean difference, 3.3; 95% CI: 0.9, 5.7; n = 62) compared to those without RAP-eL (n = 36). Rheumatoid Arthritis for Physiotherapists e-Learning remains embedded in the curriculum. Conclusion This study demonstrated both readiness and success of the sustainable implementation of RAP-eL within a prelicensure physical therapy curriculum. J Orthop Sports Phys Ther 2017;47(9):652-663. doi:10.2519/jospt.2017.7281.
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Slater H, Dear BF, Merolli MA, Li LC, Briggs AM. Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice. Best Pract Res Clin Rheumatol 2017; 30:483-502. [PMID: 27886943 DOI: 10.1016/j.berh.2016.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/26/2023]
Abstract
Musculoskeletal (MSK) conditions are the second leading cause of morbidity-related burden of disease globally. EHealth is a potentially critical factor that enables the implementation of accessible, sustainable and more integrated MSK models of care (MoCs). MoCs serve as a vehicle to drive evidence into policy and practice through changes at a health system, clinician and patient level. The use of eHealth to implement MoCs is intuitive, given the capacity to scale technologies to deliver system and economic efficiencies, to contribute to sustainability, to adapt to low-resource settings and to mitigate access and care disparities. We follow a practice-oriented approach to describing the 'what' and 'how' to harness eHealth in the implementation of MSK MoCs. We focus on the practical application of eHealth technologies across care settings to those MSK conditions contributing most substantially to the burden of disease, including osteoarthritis and inflammatory arthritis, skeletal fragility-associated conditions and persistent MSK pain.
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Affiliation(s)
- Helen Slater
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
| | - Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, NSW, Australia.
| | - Mark A Merolli
- Health and Biomedical Informatics Centre, The University of Melbourne, VIC, Australia.
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Arthritis Research Canada, Vancouver, British Columbia, Canada.
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
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Hamilton CB, Leese JC, Hoens AM, Li LC. Framework for Advancing the Reporting of Patient Engagement in Rheumatology Research Projects. Curr Rheumatol Rep 2017; 19:38. [PMID: 28631065 PMCID: PMC5750042 DOI: 10.1007/s11926-017-0666-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW The term "patient engagement in research" refers to patients and their surrogates undertaking roles in the research process beyond those of study participants. This paper proposes a new framework for describing patient engagement in research, based on analysis of 30 publications related to patient engagement. RECENT FINDINGS Over the past 15 years, patients' perspectives have been instrumental in broadening the scope of rheumatology research and outcome measurement, such as evaluating fatigue in rheumatoid arthritis. Recent reviews, however, highlight low-quality reporting of patient engagement in research. Until we have more detailed information about patient engagement in rheumatology research, our understanding of how patients' perspectives are being integrated into research projects remains limited. When authors follow our guidance on the important components for describing patients' roles and function as "research partners," researchers and other knowledge users will better understand how patients' perspectives were integrated in their research projects.
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Affiliation(s)
- Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada
| | - Jenny C Leese
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada
| | - Alison M Hoens
- BC SUPPORT Unit, Vancouver, BC, Canada
- Arthritis Patient Advisory Board of Arthritis Research Canada, Richmond, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
- BC SUPPORT Unit, Vancouver, BC, Canada.
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Field testing of decision coaching with a decision aid for parents facing extreme prematurity. J Perinatol 2017; 37:728-734. [PMID: 28358384 DOI: 10.1038/jp.2017.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/21/2016] [Accepted: 02/14/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of this study is to assess and modify an existing decision aid and field-test decision coaching with the modified aid during consultations with parents facing potential delivery at 23 to 24 weeks gestation. STUDY DESIGN International Patient Decision Aid Standards instrument (IPDASi) scoring deficits, multi-stakeholder group feedback and α-testing guided modifications. Feasibility/acceptability were assessed. The Decisional Conflict Scale was used to measure participants' decisional conflict before (T1) and immediately after (T2) the consultation. RESULTS IPDASi assessment of the existing aid (score 11/35) indicated it required updated data, more information and a palliative care description. Following modification, IPDASi score increased to 26/35. Twenty subjects (12 pregnancies) participated in field-testing; 15 completed all questionnaires. Most participants (89%) would definitely recommend this form of consultation. Decisional conflict scores decreased (P<0.001) between T1 (52±25) and T2 (10±16). CONCLUSION Field testing demonstrated that consultations using the aid with decision coaching were feasible, reduced decisional conflict and may facilitate shared decision-making.
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Nota I, Drossaert CHC, Melissant HC, Taal E, Vonkeman HE, Haagsma CJ, van de Laar MAFJ. Development of a web-based patient decision aid for initiating disease modifying anti-rheumatic drugs using user-centred design methods. BMC Med Inform Decis Mak 2017; 17:51. [PMID: 28441950 PMCID: PMC5405550 DOI: 10.1186/s12911-017-0433-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/29/2017] [Indexed: 04/05/2023] Open
Abstract
Background A main element of patient-centred care, Patient Decision Aids (PtDAs) facilitate shared decision-making (SDM). A recent update of the International Patient Decision Aids Standards (IPDAS) emphasised patient involvement during PtDA development, but omitted a methodology for doing so. This article reports on the value of user-centred design (UCD) methods for the development of a PtDA that aims to support inflammatory arthritis patients in their choice between disease modifying anti-rheumatic drugs (DMARDs). Methods The IPDAS development process model in combination with UCD methods were applied. The process was overseen by an eight-member multidisciplinary steering group. Patients and health professionals were iteratively consulted. Qualitative in-depth interviews combined with rapid prototyping were conducted with patients to assess their needs for specific functionality, content and design of the PtDA. Group meetings with health professionals were organized to assess patients’ needs and to determine how the PtDA should be integrated into patient pathways. The current literature was reviewed to determine the clinical evidence to include in the PtDA. To evaluate usability among patients, they were observed using the PtDA while thinking aloud and then interviewed. Results The combination of patient interviews with rapid prototyping revealed that patients wanted to compare multiple DMARDs both for their clinical aspects and implications for daily life. Health professionals mainly wanted to refer patients to a reliable, easily adjustable source of information about DMARDs. A web-based PtDA was constructed consisting of four parts: 1) general information about SDM, inflammatory arthritis and DMARDs; 2) an application to compare particular DMARDs; 3) value clarification exercises; and 4) a printed summary of patients’ notes, preferences, worries and questions that they could bring to discuss with their rheumatologist. Conclusions The study demonstrated that UCD methods can be of great value for the development of PtDAs. The early, iterative involvement of patients and health professionals was helpful in developing a novel user-friendly PtDA that allowed patients to choose between DMARDs. The PtDA fits the values of all stakeholders and easily integrates with the patient pathway and daily workflow of health professionals. This collaborative designed PtDA may improve SDM and patient participation in arthritis care. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0433-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands.
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Heleen C Melissant
- Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Erik Taal
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500 KA, Enschede, The Netherlands
| | - Cees J Haagsma
- Department of Rheumatology, Ziekenhuisgroep Twente, PO Box 7600, 7600 SZ, Almelo, The Netherlands
| | - Mart A F J van de Laar
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500 KA, Enschede, The Netherlands
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Blalock SJ. Medication Risk Communication in Rheumatology: Where Are We and Where Do We Go from Here? Curr Rheumatol Rep 2017; 19:7. [PMID: 28164248 DOI: 10.1007/s11926-017-0631-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper reviews findings from recent research examining issues related to the risk communication process within the context of rheumatologic conditions. Five specific questions are addressed. First, to what extent do patients with rheumatic disorders exhibit adequate knowledge relevant to disease and medication risks and risk management? Second, what sources do patients use when attempting to find information about disease and medication risks and risk management? Third, what types of information about disease and medication risks and risk management do rheumatologists provide during routine office visits. Fourth, what governmental regulations attempt to increase consumer access to information about medication risks and risk management? Finally, what other educational resources are available to facilitate patient-provider communication concerning disease and medication risks and risk management? The findings reported identify gaps in patient knowledge concerning medication risks and risk management, highlight areas for improvement, and identify resources that may enhance medication risk communication.
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Affiliation(s)
- Susan J Blalock
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7573, USA.
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25
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Nota I, Drossaert CHC, Taal E, Vonkeman HE, Haagsma CJ, van de Laar MAFJ. Evaluation of a patient decision aid for initiating disease modifying anti-rheumatic drugs. Arthritis Res Ther 2016; 18:252. [PMID: 27793171 PMCID: PMC5086044 DOI: 10.1186/s13075-016-1138-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/27/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND According to international guidelines, treatment of inflammatory arthritis should be based on a shared decision between patient and rheumatologist. Furthermore, patients with inflammatory arthritis have high need of information and want to be more actively involved in medical decision-making. To facilitate shared decision-making and support patients in choosing between disease modifying anti-rheumatic drugs (DMARDs), a web-based patient decision aid (PtDA) was developed. This study evaluated use, appreciation and effect of this PtDA. METHODS A post-test only study with a historical comparison group was conducted. In a two-year period, all patients diagnosed with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, who were deciding whether to start a (different) DMARD were invited to participate. In the first year, patients received standard information (comparison group). In the second year, patients were referred to the PtDA (intervention group). In both groups, a questionnaire was sent four weeks after consulting the rheumatologist. Patient characteristics included sociodemographic, health-related and preference-related variables. Process measures were for use and appraisal of the PtDA (intervention group only). The primary outcome measure was patients' perceived role in medical decision-making. Secondary outcome measures comprised satisfaction with the decision-making process and the decision, beliefs about medication, adherence to medication and trust in the physician. RESULTS We received 158/232 questionnaires (68 %) from the comparison group and 123/200 (61 %) from the intervention group. The PtDA was used by 69/123 patients (57 %) in the intervention group. Patients who used the PtDA highly appreciated it and perceived it as easy to use and helpful. Relative to the comparison group, patients in the intervention group perceived a more active role in medical decision-making and decisions were more in line with patients' personal preferences. Other outcomes showed no significant difference between the two groups. CONCLUSION The web-based PtDA was highly appreciated and perceived as helpful for decision-making. Implementation of the PtDA in rheumatology practice was associated with a significantly larger proportion of patients perceiving an active role in medical decision-making and decisions were more in line with patients' personal preferences. The PtDA can be a valuable aid in improving patient participation in decision-making about DMARDs.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands
| | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Cees J Haagsma
- Department of Rheumatology, Ziekenhuisgroep Twente, PO Box 7600, 7600, SZ, Almelo, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, 7500, AE, Enschede, The Netherlands.,Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
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26
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Palmer D, Miedany YE. Shared decision making for patients living with inflammatory arthritis. ACTA ACUST UNITED AC 2016; 25:31-5. [DOI: 10.12968/bjon.2016.25.1.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Palmer
- Advanced Nurse Practitioner, North Middlesex University Hospital NHS Trust
| | - Yasser El Miedany
- Consultant Rheumatologist, Darent Valley Hospital, Dartford and Gravesham NHS Trust
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27
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Ackerman IN, Ngian GS, Van Doornum S, Briggs AM. A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis. Clin Rheumatol 2015; 35:33-41. [DOI: 10.1007/s10067-015-3131-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 12/16/2022]
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28
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Voshaar MJH, Nota I, van de Laar MAFJ, van den Bemt BJF. Patient-centred care in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29:643-63. [PMID: 26697772 DOI: 10.1016/j.berh.2015.09.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Review of the evidence on patient-centred care (PCC) in rheumatoid arthritis (RA) shows that involving the patient as an individual - with unique needs, concerns and preferences - has a relevant impact on treatment outcomes (safety, effectiveness and costs). This approach empowers patients to take personal responsibility for their treatment. Because clinicians are only able to interact personally with their patients just a few hours per year, patients with a chronic condition such as RA should be actively involved in the management of their disease. To stimulate this active role, five different PCC activities can be distinguished: (1) patient education, (2) patient involvement/shared decision-making, (3) patient empowerment/self-management, (4) involvement of family and friends and (5) physical and emotional support. This article reviews the existing knowledge on these five PCC activities in the context of established RA management, especially focused on opportunities to increase medication adherence in established RA.
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Affiliation(s)
| | - I Nota
- University of Twente, Enschede, The Netherlands.
| | - M A F J van de Laar
- University of Twente, Enschede, The Netherlands; Medisch Spectrum Twente, Enschede, The Netherlands.
| | - B J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
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29
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Zong JY, Leese J, Klemm A, Sayre EC, Memetovic J, Esdaile JM, Li LC. Rheumatologists’ Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice. Arthritis Care Res (Hoboken) 2015; 67:1463-70. [DOI: 10.1002/acr.22605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Jeff Y. Zong
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Jenny Leese
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Alexandria Klemm
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Eric C. Sayre
- Arthritis Research Canada; Vancouver British Columbia Canada
| | | | - John M. Esdaile
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Linda C. Li
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
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30
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Nota I, Drossaert CHC, Taal E, van de Laar MAFJ. Patients' Considerations in the Decision-Making Process of Initiating Disease-Modifying Antirheumatic Drugs. Arthritis Care Res (Hoboken) 2015; 67:956-64. [DOI: 10.1002/acr.22531] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/04/2014] [Accepted: 12/02/2014] [Indexed: 01/27/2023]
Affiliation(s)
- Ingrid Nota
- University of Twente; Enschede The Netherlands
| | | | - Erik Taal
- University of Twente; Enschede The Netherlands
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31
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Hoffman AS, Llewellyn-Thomas HA, Tosteson ANA, O'Connor AM, Volk RJ, Tomek IM, Andrews SB, Bartels SJ. Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform. BMC Med Inform Decis Mak 2014; 14:112. [PMID: 25495552 PMCID: PMC4275953 DOI: 10.1186/s12911-014-0112-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. METHODS An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. RESULTS This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01). CONCLUSIONS Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.
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Affiliation(s)
- Aubri S Hoffman
- Dartmouth Centers for Health and Aging, Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway (HB7250), Lebanon, NH, 03766, USA.
| | - Hilary A Llewellyn-Thomas
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7250), Hanover, NH, 03755, USA.
| | - Anna N A Tosteson
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7250), Hanover, NH, 03755, USA.
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, One Medical Center Drive (HB7505), Lebanon, NH, 03755, USA.
| | - Annette M O'Connor
- Department of Epidemiology, University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
| | - Robert J Volk
- Department of General Internal Medicine, Unit 1465, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77230, USA.
| | - Ivan M Tomek
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03766, USA.
| | - Steven B Andrews
- Collaboratory for Healthcare and Bioinformatics, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 330, Lebanon, NH, 03766, USA.
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, 46 Centerra Parkway (HB7250), Lebanon, NH, 03766, USA.
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Barton JL, Koenig CJ, Evans-Young G, Trupin L, Anderson J, Ragouzeos D, Breslin M, Morse T, Schillinger D, Montori VM, Yelin EH. The design of a low literacy decision aid about rheumatoid arthritis medications developed in three languages for use during the clinical encounter. BMC Med Inform Decis Mak 2014; 14:104. [PMID: 25649726 PMCID: PMC4363399 DOI: 10.1186/s12911-014-0104-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles. METHODS Based on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development. RESULTS Three iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians. CONCLUSIONS The process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.
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Affiliation(s)
- Jennifer L Barton
- Department of Medicine, University of California, San Francisco, CA, USA. .,Division of Hospital & Specialty Medicine, Portland Veterans Affairs Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA.
| | | | - Gina Evans-Young
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | - Laura Trupin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
| | | | | | | | | | - Dean Schillinger
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Edward H Yelin
- Department of Medicine, University of California, San Francisco, CA, USA. .,Phillip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.
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33
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Hirsh JM. Can shared decision making help eliminate disparities in rheumatoid arthritis outcomes? J Rheumatol Suppl 2014; 41:1257-9. [PMID: 24986961 DOI: 10.3899/jrheum.140479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Joel M Hirsh
- Denver Health and Hospital Authority, 777 Bannock St., Mail Code 4000, Denver, Colorado 80204, USA.
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