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Rager JB, Schmidt KK, Schwartz PH. Discordant Care and Decision Quality: Patients' Reasons for Not Receiving Their Initial Test of Choice in Colorectal Cancer Screening. Med Decis Making 2024; 44:705-714. [PMID: 39056287 DOI: 10.1177/0272989x241262278] [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] [Indexed: 07/28/2024]
Abstract
BACKGROUND Concordance between a person's values and the test or treatment they ultimately receive is widely considered to be an essential outcome for good decision quality. There is little research, however, on why patients receive "discordant" care. A large, randomized trial of decision aids for colorectal cancer (CRC) screening provided an opportunity to assess why some patients received a different test than the one they preferred at an earlier time point. METHODS Of 688 patients who participated in the trial, 43 received a different CRC screening test than the one they selected after viewing a decision aid 6 mo prior. These patients answered 2 brief, open-ended questions about the reasons for this discordance. The research team analyzed their answers using qualitative description. RESULTS Patient responses reflected 6 major categories: barriers or risks of initially favored test, benefits of alternative test, costs or health insurance coverage, discussion with family or friends, provider factors or recommendation, and health issues. CONCLUSIONS Some of the patients' explanations fit well with the informed concordance approach, which infers poor decision quality from the existence of discordant care, since in these cases it appears that the patient's values and preferences were not adequately respected. Other statements suggest that the patient had an informed rationale for changing their mind about which test to undergo. These cases may reflect high-quality decision making, despite the existence of discordance as measured in the trial. This analysis highlights a major challenge to a popular approach for assessing decision quality, the difficulty of normatively assessing the quality of decision making when apparent discordant care has been provided, and the need to assess patient values and preference over time. HIGHLIGHTS Value-choice concordance is an accepted measure for assessing decision quality in decision aid trials, but greater exploration of apparently discordant care challenges key assumptions of this method; this study provides evidence that discordance as typically measured may not always reflect low-quality patient decision making.Researchers evaluating decision aids and assessing decision quality should consider the use of qualitative methods to supplement measures of decision quality and consider assessing patient preferences at multiple time points.
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Affiliation(s)
- Joshua B Rager
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs HSR&D, Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karen K Schmidt
- Indiana University Center for Bioethics, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Indiana University Center for Bioethics, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Philosophy Department, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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2
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Yi H, Trivedi MS, Crew KD, Schechter I, Appelbaum P, Chung WK, Allegrante JP, Kukafka R. Understanding Social, Cultural, and Religious Factors Influencing Medical Decision-Making on BRCA1/2 Genetic Testing in the Orthodox Jewish Community. Public Health Genomics 2024; 27:57-67. [PMID: 38402864 DOI: 10.1159/000536391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/10/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Although the prevalence of a pathogenic variant in the BRCA1 and BRCA2 genes is about 1:400 (0.25%) in the general population, the prevalence is as high as 1:40 (2.5%) among the Ashkenazi Jewish population. Despite cost-effective preventive measures for mutation carriers, Orthodox Jews constitute a cultural and religious group that requires different approaches to BRCA1 and BRCA2 genetic testing relative to other groups. This study analyzed a dialog of key stakeholders and community members to explore factors that influence decision-making about BRCA1 and BRCA2 genetic testing in the New York Orthodox Jewish community. METHODS Qualitative research methods, based on Grounded Theory and Narrative Research, were utilized to analyze the narrative data collected from 49 key stakeholders and community members. A content analysis was conducted to identify themes; inter-rater reliability was 71%. RESULTS Facilitators of genetic testing were a desire for preventive interventions and education, while barriers to genetic testing included negative emotions, feared impact on family/romantic relationships, cost, and stigma. Views differed on the role of religious leaders and healthcare professionals in medical decision-making. Education, health, and community were discussed as influential factors, and concerns were expressed about disclosure, implementation, and information needs. CONCLUSION This study elicited the opinions of Orthodox Jewish women (decision-makers) and key stakeholders (influencers) who play critical roles in the medical decision-making process. The findings have broad implications for engaging community stakeholders within faith-based or culturally distinct groups to ensure better utilization of healthcare services for cancer screening and prevention designed to improve population health.
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Affiliation(s)
- Haeseung Yi
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA,
| | - Meghna S Trivedi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Isaac Schechter
- Achieve Behavioral Health, Monsey, New York, USA
- Institute for Applied Research and Community Collaboration (ARCC), Spring Valley, New York, USA
| | - Paul Appelbaum
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Center for Law, Ethics and Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Wendy K Chung
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - John P Allegrante
- Department of Health Studies and Applied Educational Psychology, Teachers College, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Rita Kukafka
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Hart JL, Summer AE, Ogunduyile L, Lapite FC, Hong D, Whitman C, Blette BS, Harhay MO, Halpern SD. Accuracy of Expected Symptoms and Subsequent Quality of Life Measures Among Adults With COPD. JAMA Netw Open 2023; 6:e2344030. [PMID: 37988080 PMCID: PMC10663971 DOI: 10.1001/jamanetworkopen.2023.44030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Patients' expectations for future health guide their decisions and enable them to prepare, adapt, and cope. However, little is known about how inaccurate expectations may affect patients' illness outcomes. Objective To assess the association between patients' expectation inaccuracies and health-related quality of life. Design, Setting, and Participants This cohort study of patients with severe chronic obstructive pulmonary disease (COPD) was conducted from 2017 to 2021, which included a 24-month follow-up period. Eligible participants received outpatient primary care at pulmonary clinics of a single large US health system. Data were analyzed between 2021 and 2023. Exposure Expectation accuracy, measured by comparing patients' self-reported expectations of their symptom burden with their actual physical and emotional symptoms 3, 12, and 24 months in the future. Main Outcome and Measure Health-related quality of life, measured by the St George's Respiratory Questionnaire-COPD at 3, 12, and 24 months. Results A total of 207 participants were included (median age, 65.5 years [range, 42.0-86.0 years]; 120 women [58.0%]; 118 Black [57.0%], 79 White [38.2%]). The consent rate among approached patients was 80.0%. Most patients reported no or only limited discussions of future health and symptom burdens with their clinicians. Across physical and emotional symptoms and all 3 time points, patients' expectations were more optimistic than their experiences. There were no consistent patterns of measured demographic or behavioral characteristics associated with expectation accuracy. Regression models revealed that overoptimistic expectations of future burdens of dyspnea (linear regression estimate, 4.68; 95% CI, 2.68 to 6.68) and negative emotions (linear regression estimate, -3.04; 95% CI, -4.78 to 1.29) were associated with lower health-related quality of life at 3 months after adjustment for baseline health-related quality of life, forced expiratory volume over 1 second, and interval clinical events (P < .001 for both). Similar patterns were observed at 12 months (dyspnea: linear regression estimate, 2.41; 95% CI, 0.45 to 4.37) and 24 months (negative emotions: linear regression estimate, -2.39; 95% CI, -4.67 to 0.12; dyspnea: linear regression estimate, 3.21; 95% CI, 0.82 to 5.60), although there was no statistically significant association between expectation of negative emotions and quality of life at 12 months. Conclusions and Relevance In this cohort study of patients with COPD, we found that patients are overoptimistic in their expectations about future negative symptom burdens, and such inaccuracies were independently associated with worse well-being over time. Developing and implementing strategies to improve patients' symptom expectations may improve patient-centered outcomes.
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Affiliation(s)
- Joanna L. Hart
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Amy E. Summer
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
| | - Lon Ogunduyile
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
| | | | - David Hong
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
| | - Casey Whitman
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
| | - Bryan S. Blette
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Michael O. Harhay
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
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Menon M, Huber R, West DD, Scott S, Russell RB, Berns SD. Community-based approaches to infant safe sleep and breastfeeding promotion: a qualitative study. BMC Public Health 2023; 23:437. [PMID: 36882767 PMCID: PMC9989577 DOI: 10.1186/s12889-023-15227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In the U.S., sudden unexpected infant deaths (SUID) due to accidental suffocation and strangulation in bed (ASSB) are increasing, with disparities by race/ethnicity. While breastfeeding is a protective factor against infant mortality, racial/ethnic disparities are present in its uptake, and motivations to breastfeed are also often coupled with non-recommended infant sleep practices that are associated with infant sleep deaths. Combining infant safe sleep (ISS) and breastfeeding promotion on the community level presents opportunities to address racial/ethnic disparities and associated socioeconomic, cultural, and psychosocial influences. METHODS We completed a descriptive qualitative hermeneutical phenomenology using thematic analysis of focus group data. We examined the phenomenon of community-level providers promoting ISS and breastfeeding in communities vulnerable to ISS and breastfeeding disparities. We asked eighteen informants participating in a national quality improvement collaborative about i.) areas requiring additional support to meet community needs around ISS and breastfeeding, and ii.) recommendations on tools to improve their work promoting ISS and breastfeeding. RESULTS We identified four themes: i.) education and dissemination, ii.) relationship building and social support, iii.) working with clients' personal circumstances and considerations, and iv.) tools and systems. CONCLUSIONS Our findings support embedding risk-mitigation approaches in ISS education; relationship building between providers, clients, and peers; and the provision of ISS and breastfeeding supportive material resources with educational opportunities. These findings may be used to inform community-level provider approaches to ISS and breastfeeding promotion.
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Affiliation(s)
- Meera Menon
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Rebecca Huber
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA.
| | - Dana D West
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Stacy Scott
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Rebecca B Russell
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA
| | - Scott D Berns
- The National Institute for Children's Health Quality (NICHQ), 308 Congress Street, 5th Floor, Boston, MA, 02210, USA.,Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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5
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Housten AJ, Kozower BD, Engelhardt KE, Robinson C, Puri V, Samson P, Cooksey K, Politi MC. Developing an Educational and Decision Support Tool for Stage I Lung Cancer Using Decision Science. Ann Thorac Surg 2023; 115:299-308. [PMID: 35926640 DOI: 10.1016/j.athoracsur.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines recommend shared decision-making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision-making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities. METHODS The purpose of this review is to reflect on the process of tool development; identify the challenges associated with meeting the needs of patients, clinicians from multiple disciplines, and institutional workflow during implementation; and propose recommendations for future clinicians who wish to develop, refine, or implement similar tools into routine care. RESULTS In this review, we: (1) discuss guidelines for decision aid development; (2) describe how we applied those to create an education and decision support tool for patients with clinical stage I lung cancer deciding between radiation therapy and surgical resection; and (3) highlight challenges in implementing and evaluating the tool. CONCLUSIONS We provide recommendations for those seeking to develop, refine, or implement similar tools into routine care.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Krista Cooksey
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri.
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6
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Nakayama K, Yonekura Y, Danya H, Hagiwara K. Associations between health literacy and information-evaluation and decision-making skills in Japanese adults. BMC Public Health 2022; 22:1473. [PMID: 35918675 PMCID: PMC9344668 DOI: 10.1186/s12889-022-13892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Health literacy among Japanese is often low, making it difficult for them to evaluate health information and make informed decisions. However, the health literacy scales applied measure the perceived difficulty of health-related tasks; they do not directly assess the specific skills needed to perform the tasks: the skills to judge the reliability of diverse information using evaluation criteria and implement rational decision-making. Therefore, the study objectives were to investigate the following issues using a nationwide survey in Japan. (1) When obtaining information, to what extent do people apply criteria for evaluating information to confirm its reliability; when making decisions, to what extent do they seek out available options and compare pros and cons based on their own values? (2) How strongly are such skills associated with health literacy and demographic characteristics? (3) What opportunities are available to learn these skills? Methods We conducted an online questionnaire survey using a Japanese Internet research company; 3,914 valid responses were received. The measures comprised health literacy (European Health Literacy Survey Questionnaire), five items on information evaluation, four items on decision-making, and items on the availability and location of learning opportunities. We calculated Pearson correlations to explore the association of health literacy with information-evaluation and decision-making skills. Multivariate analyses were also conducted using these factors as dependent variables. Results Fewer than half (30%–50%) of respondents reported always or often evaluating information and engaging in decision-making. Health literacy was significantly and positively correlated with the specific skills of information evaluation and decision-making (r = .26 and .30, respectively) as were multivariate analyses (beta = .15 and .22, respectively). Over 40% of respondents had never learned those skills. The most common resources for learning the skills were the Internet and television; less-used resources were schools and workplaces. Conclusions Both information-evaluation and decision-making skills were associated with health literacy. However, these skills are not sufficiently widespread in Japan because there are few opportunities to acquire them. More research is needed to raise awareness of the importance of such skills for improving health literacy and providing learning opportunities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13892-5.
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Affiliation(s)
- Kazuhiro Nakayama
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.
| | - Yuki Yonekura
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Hitomi Danya
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Kanako Hagiwara
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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Shepherd V. (Re)Conceptualising 'good' proxy decision-making for research: the implications for proxy consent decision quality. BMC Med Ethics 2022; 23:75. [PMID: 35850682 PMCID: PMC9294776 DOI: 10.1186/s12910-022-00809-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes 'good' proxy decision-making for research has remained unexplored. Interventions are needed to improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of 'good' proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients' values and preferences.
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Affiliation(s)
- Victoria Shepherd
- Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 0GB, UK.
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8
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Brown SL, Fisher PL, Morgan A, Davies C, Olabi Y, Hope-Stone L, Heimann H, Hussain R, Cherry MG. 'I Don't Like Uncertainty, I Like to Know': How and why uveal melanoma patients consent to life expectancy prognostication. Health Expect 2022; 25:1498-1507. [PMID: 35474381 PMCID: PMC9327814 DOI: 10.1111/hex.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Technological advances have led to cancer prognostication that is increasingly accurate but often unalterable. However, a reliable prognosis of limited life expectancy can cause psychological distress. People should carefully consider offers of prognostication, but little is known about how and why they decide on prognostication. Using uveal melanoma (UM) patients, we aimed to identify (i) how and why do people with UM decide to accept prognostication and (ii) alignment and divergence of their decision-making from conceptualizations of a 'well-considered' decision. METHODS UM provides a paradigm to elucidate clinical and ethical perspectives on prognostication, because prognostication is reliable but prognoses are largely nonameliorable. We used qualitative methods to examine how and why 20 UM people with UM chose prognostication. We compared findings to a template of 'well-considered' decision-making, where 'well-considered' decisions involve consideration of all likely outcomes. RESULTS Participants wanted prognostication to reduce future worry about uncertain life expectancy. They spontaneously spoke of hoping for a good prognosis when making their decisions, but largely did not consider the 50% possibility of a poor prognosis. When pressed, they argued that a poor outcome at least brings certainty. CONCLUSIONS While respecting decisions as valid expressions of participants' wishes, we are concerned that they did not explicitly consider the realistic possibility of a poor outcome and how this would affect them. Thus, it is difficult to see their decisions as 'well-considered'. We propose that nondirective preference exploration techniques could help people to consider the possibility of a poor outcome. PATIENT OR PUBLIC CONTRIBUTION This paper is a direct response to a patient-identified and defined problem that arose in therapeutic and conversational discourse. The research was informed by the responses of patient participants, as we used the material from interviews to dynamically shape the interview guide. Thus, participants' ideas drove the analysis and shaped the interviews to come.
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Affiliation(s)
| | - Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Andrew Morgan
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Cari Davies
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Yasmin Olabi
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Laura Hope-Stone
- School of Psychology, University of Plymouth, Plymouth, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Heinrich Heimann
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rumana Hussain
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Yung KK, Ardern CL, Serpiello FR, Robertson S. A Framework for Clinicians to Improve the Decision-Making Process in Return to Sport. SPORTS MEDICINE - OPEN 2022; 8:52. [PMID: 35416633 PMCID: PMC9008084 DOI: 10.1186/s40798-022-00440-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the sports organisation. RTS decision-making is a complex process, which relies on evaluating multiple biopsychosocial factors, and is influenced by contextual factors. In this narrative review, we outline how RTS decision-making of clinicians could be evaluated from a decision analysis perspective. To begin with, the RTS decision could be explained as a sequence of steps, with a decision basis as the core component. We first elucidate the methodological considerations in gathering information from RTS tests. Second, we identify how decision-making frameworks have evolved and adapt decision-making theories to the RTS context. Third, we discuss the preferences and perspectives of the athlete, performance coach and manager. We conclude by proposing a framework for clinicians to improve the quality of RTS decisions and make recommendations for daily practice and research.
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Affiliation(s)
- Kate K Yung
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Clare L Ardern
- Musculoskeletal and Sports Injury Epidemiology Centre, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Fabio R Serpiello
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sam Robertson
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Oman K, Durand MA, Elwyn G, Yen RW, Marx C, Politi MC. Unexpected Outcomes of Measuring Decision Regret: Using a Breast Cancer Decision-Making Case Example. THE PATIENT 2022; 15:151-155. [PMID: 34337674 PMCID: PMC10599632 DOI: 10.1007/s40271-021-00543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Shared decision making can help patients feel supported and empowered when deciding between healthcare options. Decision regret can be a meaningful measure of the quality of that encounter. However, in a patient-engaged research study examining shared decision making for breast cancer surgery, decision regret was a difficult construct to assess, and asking questions about decision regret caused the patient to experience that emotion upon reflection. In this article, we consider the complexity of decision regret, and discuss the difficulty of measuring that emotion through existing instruments. We call for clarity in definitions of decision regret and offer suggestions for developing a set of questions that can capture regret in a more meaningful way.
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Affiliation(s)
- Kelly Oman
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA.
| | - Marie-Anne Durand
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- UM1295, CERPOP, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Glyn Elwyn
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Renata West Yen
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Christine Marx
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA
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11
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Chang DS, Chen WL, Wang R. Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior. BMC Health Serv Res 2022; 22:199. [PMID: 35164761 PMCID: PMC8845262 DOI: 10.1186/s12913-022-07575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. Methods A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. Results The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. Conclusions This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. Trial registration CRREC104107. Date: 22/01/2016. Prospectively Registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07575-5.
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Affiliation(s)
- Dong-Shang Chang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| | - Wil-Lie Chen
- School of Nursing, China Medical University, Taichung, Taiwan.
| | - Rouwen Wang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
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12
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Ferrer RA, Ellis EM, Orehek E, Klein WMP. Fear increases likelihood of seeking decisional support from others when making decisions involving ambiguity. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca A. Ferrer
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Erin M. Ellis
- Basic Biobehavioral and Psychological Sciences Branch National Cancer Institute Rockville Maryland USA
| | - Edward Orehek
- Department of Psychology San Diego State University San Diego California USA
| | - William M. P. Klein
- Behavioral Research Program, National Cancer Institute Rockville Maryland USA
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13
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Trenaman L, Jansen J, Blumenthal-Barby J, Körner M, Lally J, Matlock DD, Perestelo-Perez L, Ropka M, Stirling C, Valentine K, Vo H, Wills CE, Thomson R, Sepucha K. Are We Improving? Update and Critical Appraisal of the Reporting of Decision Process and Quality Measures in Trials Evaluating Patient Decision Aids. Med Decis Making 2021; 41:954-959. [PMID: 33966534 PMCID: PMC8474325 DOI: 10.1177/0272989x211011120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In 2014, a systematic review found large gaps in the quality of reporting of
measures used in 86 published trials evaluating the effectiveness of patient
decision aids (PtDAs). The purpose of this study was to update that
review. Methods We examined measures of decision making used in 49 randomized controlled
trials included in the 2014 and 2017 Cochrane Collaboration systematic
review of PtDAs. Data on development of the measures, reliability, validity,
responsiveness, precision, interpretability, feasibility, and acceptability
were independently abstracted by 2 paired reviewers. Results Information from 273 measures was abstracted, and 109 of these covered the
core domains of decision processes (n = 55) and decision
quality including informed choice/knowledge (n = 48) and
values-choice concordance (n = 12). Very few studies
reported data on the performance and clinical sensibility of measures, with
reliability (23%) and validity (6%) being the most common. Studies using new
measures were less likely to include information about their psychometric
performance compared with previously published measures. Limitations The review was limited to reporting of measures in studies included in the
Cochrane review and did not consult prior publications. Conclusion There continues to be very little reported about the development or
performance of measures used to evaluate the effectiveness of PtDAs in
published trials. Minimum reporting standards have been published, and
efforts to require investigators to use them are needed.
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Affiliation(s)
- Logan Trenaman
- University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Jesse Jansen
- Maastricht University, Maastricht, The Netherlands
| | | | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs- University, Freiburg, Baden-Wurttemberg, Germany
| | - Joanne Lally
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel D Matlock
- University of Colorado, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | | | - Mary Ropka
- University of Virginia, Charlottesville, VA, USA
| | | | - Kathrene Valentine
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Ha Vo
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Thomson
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Sepucha
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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14
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Haiek LN, LeDrew M, Charette C, Bartick M. Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic. MATERNAL & CHILD NUTRITION 2021; 17:e13129. [PMID: 33404146 PMCID: PMC7883116 DOI: 10.1111/mcn.13129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
Despite decades of research establishing the importance of breastfeeding, skin-to-skin contact and mother-infant closeness, the response to the coronavirus disease 2019 (COVID-19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision-making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence-based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision-making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID-19 pandemic.
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Affiliation(s)
- Laura N. Haiek
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Department of Family Medicine, MontrealMcGill UniversityMontrealQuebecCanada
- Queen Elizabeth Academic Family Medicine GroupMontrealQuebecCanada
| | - Michelle LeDrew
- National BCC Baby‐Friendly ProjectBreastfeeding Committee for CanadaSherwood ParkAlbertaCanada
| | - Christiane Charette
- Direction générale de la santé publiqueMinistère de la Santé et des Services sociauxQuebecQuebecCanada
- Département de pédiatrie, CISSS de la Montérégie‐EstUniversity of SherbrookeSaint‐HyacintheQuebecCanada
| | - Melissa Bartick
- Mount Auburn HospitalCambridgeMassachusetts02138USA
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
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15
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Hadizadeh-Talasaz F, Ghoreyshi F, Mohammadzadeh F, Rahmani R. Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial. BMC Pregnancy Childbirth 2021; 21:144. [PMID: 33596854 PMCID: PMC7890798 DOI: 10.1186/s12884-021-03615-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/03/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section. METHODS This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35-37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher's exact tests. p-value less than 0.05 was considered statistically significant. RESULTS After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007). CONCLUSIONS Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section. TRIAL REGISTRATION IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.
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Affiliation(s)
- Fatemeh Hadizadeh-Talasaz
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Faezeh Ghoreyshi
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Mohammadzadeh
- Department of Epidemiology & Biostatistics, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Roghaieh Rahmani
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
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16
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Brooks Holliday S, Hepner KA, Farmer CM, Mahmud A, Kimerling R, Smith BN, Rosen C. Discussing measurement-based care with patients: An analysis of clinician-patient dyads. Psychother Res 2021; 31:211-223. [PMID: 32522100 DOI: 10.1080/10503307.2020.1776413] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 01/07/2023] Open
Abstract
Abstract Measurement-based care (MBC) refers to the use of three integrated strategies to improve effectiveness of behavioral health care: routine outcomes monitoring using symptom measures; regularly sharing these data with patients; and using these data to inform treatment decisions. This study examined how clinicians discuss MBC data with patients, including identifying what aspects of these discussions contribute to clinician-patient agreement on the value of MBC, and how clinicians use MBC data to inform treatment decisions. Twenty-six clinician-patient dyads participated in semi-structured interviews and provided a treatment session recording in which MBC data were discussed. Qualitative data analyses revealed four subtypes of dyads: clinician and patient both valued MBC; clinician valued MBC, patient passively participated in MBC; clinician valued MBC, patient had mixed perceptions of MBC; clinician and patient reported moderate or low value for MBC. In dyads for whom both the clinician and patient valued MBC, the clinician provided clear and repeated rationale for MBC, discussed data with patients at every administration, and connected observed scores to patient skills or strategies. Emerging best practices for discussing MBC include providing a strong rationale, discussing results frequently, actively engaging patients in discussions, and using graphs to visualize progress.
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Affiliation(s)
| | | | | | | | | | | | - Craig Rosen
- VA National Center for PTSD, Boston, MA, USA
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17
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Geddis‐Regan A, Errington L, Abley C, Wassall R, Exley C, Thomson R. Enhancing shared and surrogate decision making for people living with dementia: A systematic review of the effectiveness of interventions. Health Expect 2021; 24:19-32. [PMID: 33248009 PMCID: PMC7879553 DOI: 10.1111/hex.13167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dementia can have a profound impact on decision making. People living with dementia (PLwD) often need to make decisions about health care, and, as dementia progresses, decisions may need to be made on their behalf. Specific interventions may support this process. REVIEW QUESTION What interventions are effective in improving shared decision making or surrogate decision making on the health care of PLwD? METHODS A narrative systematic review of existing literature was conducted. Seven databases, grey literature and key journals were searched. After exclusion by title, abstracts then full texts were reviewed collaboratively to manage any disagreements. RESULTS Eight studies met the inclusion criteria. Two articles, including one RCT, evaluated decision aids regarding the use of enteral feeding in advanced dementia. Six further articles, including five RCTs, were found which evaluated the effectiveness of interventions supporting patients or carers with advance care planning. CONCLUSION Decision-making interventions typically consist of multiple components which aim to establish preferences for future health care. Advance care planning interventions supported aspects of the decision-making processes but their impact on decision quality was rarely evaluated. Interventions did not increase the concordance of decisions with a person's values. The decision-specific interventions are unlikely to produce benefit in other decision contexts. PATIENT INVOLVEMENT Two caregivers, a public stakeholder group and a carer group were consulted in the design of the wider study to which this review relates. Six PLwD refined the research questions addressed in this paper.
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Affiliation(s)
- Andrew Geddis‐Regan
- School of Dental SciencesNewcastle UniversityNewcastle upon TyneUK
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Linda Errington
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Clare Abley
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Rebecca Wassall
- School of Dental SciencesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Catherine Exley
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Richard Thomson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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18
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Gamborg ML, Mehlsen M, Paltved C, Tramm G, Musaeus P. Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine. BMC Emerg Med 2020; 20:73. [PMID: 32928158 PMCID: PMC7489001 DOI: 10.1186/s12873-020-00367-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. OBJECTIVE A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. METHODS A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. RESULTS Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. CONCLUSIONS This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.
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Affiliation(s)
- Maria Louise Gamborg
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark.
- Corporate HR MidtSim, Central Region of Denmark & Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Charlotte Paltved
- Corporate HR MidtSim, Central Region of Denmark & Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gitte Tramm
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Peter Musaeus
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark
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19
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D’Agostino TA, Brewster AM, Peterson SK, Bedrosian I, Parker PA. Discussions about contralateral prophylactic mastectomy among surgical oncology providers and women with sporadic breast cancer: a content analysis. Transl Behav Med 2020; 10:347-354. [PMID: 30561744 PMCID: PMC7237543 DOI: 10.1093/tbm/iby098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rates of contralateral prophylactic mastectomy (CPM) have risen substantially, yet little is known about how and to what extent CPM is discussed within surgical oncology visits at the time of treatment decision-making. We examined CPM discussions in naturally occurring interactions between sporadic breast cancer patients and their surgical oncology providers. Women with early-stage unilateral disease were recruited before their first surgical visit and completed brief questionnaires to determine study eligibility and interest in treatment options. After their visits, enrolled patients and their providers completed questionnaires assessing discussion of and interest in CPM. Audio-recorded visits from 36 unique patients were randomly selected, transcribed, and analyzed. A CPM discussion was present in 28 transcripts. Approximately half of CPM discussions were initiated by the patient or the oncology provider. The topic of CPM was most frequently introduced while reviewing available treatment options. Patients were most interested in pursuing CPM to reduce the risk of future breast cancer. Providers most frequently responded by offering information (e.g., about risk of contralateral disease). A high level of agreement was found among patient, provider, and observer ratings of whether or not CPM was discussed. CPM discussions were consistently present within our sample. Results can be used to build providers' skills and bring provider-patient communication more in line with best practices and recommendations from leading professional medical societies.
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Affiliation(s)
- Thomas A D’Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Albany Stratton VA Medical Center, Albany, NY, USA
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Peterson
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Peinado S, Paquin RS, Rini C, Roche M, Butterfield RM, Berg JS, Powell CM, Bailey DB, Lewis MA. Values clarification and parental decision making about newborn genomic sequencing. Health Psychol 2020; 39:335-344. [PMID: 31886693 PMCID: PMC7078054 DOI: 10.1037/hea0000829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Using an online decision aid developed to support parental decision making about newborn genomic sequencing, we tested whether adding a values clarification exercise to educational content would improve decision making outcomes and influence intention to pursue genomic sequencing. We also examined whether the effect of values clarification varied depending on one's health literacy level. METHOD In an online experiment, women and men aged 18 to 44 who were either pregnant or had a pregnant partner, were currently trying to get pregnant, or were preparing for a pregnancy within the next 2 years were randomly assigned to complete either a decision aid with educational information about newborn genomic sequencing or a decision aid with the same educational information and a values clarification exercise. RESULTS Of the 1,000 participants who completed the decision aid, those who completed the values clarification exercise reported less decision regret, F(1, 995) = 6.19, p = .01, and were clearer about their personal values, F(1, 995) = 6.39, p = .01. Moderation analyses revealed that the benefit of values clarification on decisional conflict was particularly evident among participants with lower health literacy, B = -3.94, SE = 1.67, t = -2.36, p = .018. There was not a significant moderation effect of health literacy and decision aid condition on decision regret. CONCLUSIONS Adding a values clarification exercise to decision aids for parents making decisions about genomic sequencing may improve the decision-making experience and provide some benefit to individuals with lower health literacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Susana Peinado
- Center for Communication Science, RTI International,
Research Triangle Park, NC
| | - Ryan S. Paquin
- Center for Communication Science, RTI International,
Research Triangle Park, NC
| | - Christine Rini
- John Theurer Cancer Center, Hackensack University Medical
Center, Hackensack, NJ and Georgetown University School of Medicine, Washington,
DC
| | - Myra Roche
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rita M. Butterfield
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan S. Berg
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cynthia M. Powell
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability
Studies, RTI International, Research Triangle Park, NC, USA
| | - Megan A. Lewis
- Center for Communication Science, RTI International,
Research Triangle Park, NC
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21
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Van Humbeeck L, Malfait S, Holvoet E, Vogelaers D, De Pauw M, Van Den Noortgate N, Van Biesen W. Value discrepancies between nurses and patients: A survey study. Nurs Ethics 2020; 27:1044-1055. [DOI: 10.1177/0969733020906595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.
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22
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The Policies of Provision of Assistive and Welfare Technology—A Literature Review. SOCIETIES 2020. [DOI: 10.3390/soc10010022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Due to the increasing ageing population worldwide, humanity is facing global demographic challenges. For many people, their later years are often lived with changed functioning and the need for support in daily living activities. Assistive technology and welfare technology (AT/WT) constitute a partial solution to the demographic challenges. Objectives: The purpose of this literature review is to identify the policy features, such as decision models and guidance for the provision of AT/WT as reported in the current scientific literature. Methods: A literature review with a deductive approach using the structure of the Global Cooperation on Assistive Technology (GATE) model was conducted. The data were searched from the databases: PubMed, Cinahl Plus, and the Web of Science, resulting in nine included articles. Results: The findings are presented according to the structure of the eight domains from the GATE model— policy, assessment, procurement, technology, environment, usability, sustainability and rights— which are further grouped into categories exploring the variations in every domain. Conclusion: The review reveals a nascent and growing interest in the area; however, evidence-based decision models and other guidance on AT/WT are lacking. Recent scholarships and policy reforms can form the basis of stronger guidance to organise complex AT/WT systems, but further and future research is needed.
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23
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Scott IA. Filling the glass of evidence‐based medicine. Intern Med J 2020; 50:15-16. [DOI: 10.1111/imj.14697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ian A. Scott
- Internal Medicine and Clinical EpidemiologyPrincess Alexandra Hospital Brisbane Queensland Australia
- School of Clinical MedicineUniversity of Queensland Brisbane Queensland Australia
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Alexis Ruiz A, Wyszyńska PK, Laudanski K. Narrative Review of Decision-Making Processes in Critical Care. Anesth Analg 2019; 128:962-970. [DOI: 10.1213/ane.0000000000003683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Affiliation(s)
- Aaron M Tannenbaum
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.M.T., S.D.H.)
| | - Scott D Halpern
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.M.T., S.D.H.)
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Acerini CL, Segal D, Criseno S, Takasawa K, Nedjatian N, Röhrich S, Maghnie M. Shared Decision-Making in Growth Hormone Therapy-Implications for Patient Care. Front Endocrinol (Lausanne) 2018; 9:688. [PMID: 30524377 PMCID: PMC6262035 DOI: 10.3389/fendo.2018.00688] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022] Open
Abstract
Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.
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Affiliation(s)
- Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini
| | - David Segal
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherwin Criseno
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kei Takasawa
- Department of Paediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
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Moudi Z, Phanodi Z, Ansari H, Zohour MM. Decisional conflict and regret: shared decision-making about pregnancy affected by β-thalassemia major in Southeast of Iran. J Hum Genet 2017; 63:309-317. [PMID: 29273732 DOI: 10.1038/s10038-017-0379-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/26/2017] [Accepted: 10/08/2017] [Indexed: 11/09/2022]
Abstract
To study the effect of shared decision-making (SDM) on decisional conflict (DC) scores immediately after consultation and to assess the decisional regret (DR) scores in the first 3 months following women's decision regarding termination of pregnancy. This quasi-experimental study was conducted during August 3rd-February 20th, 2016. We included 80 women whose fetuses were diagnosed with β-thalassemia major (β-TM) through chorionic villi sampling and were referred to the only prenatal diagnosis center at Ali-Asghar Hospital, Zahedan, Iran. While the control group went through the routine procedures, the intervention group received a 90-min counseling session based on SDM. The demographic characteristics form and DC scale were filled out immediately after the consultation session. After 3 months, the women were contacted via telephone call to collect data on their level of DR. The mean DC score was significantly (P = < 0.0025) lower in the intervention group (8.47 ± 4.63) compared with the control group (44.10 ± 14.5). Moreover, the mean score of DR was significantly (P = 0.004) lower in the intervention group (9.37 ± 15.44) compared with the control group (24.37 ± 23.42). SDM consultation can help women experience significantly lower levels of DC and DR.
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Affiliation(s)
- Zahra Moudi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Zenab Phanodi
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Izadi S, Pachur T, Wheeler C, McGuire J, Waters EA. Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making. PATIENT EDUCATION AND COUNSELING 2017; 100:1928-1933. [PMID: 28583721 PMCID: PMC5573624 DOI: 10.1016/j.pec.2017.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/17/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." METHODS An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. RESULTS 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). CONCLUSION The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. PRACTICE IMPLICATIONS Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making.
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Affiliation(s)
- Sonya Izadi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Thorsten Pachur
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany
| | - Courtney Wheeler
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Jaclyn McGuire
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Erika A Waters
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA.
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Nigg CR, Jake-Schoffman DE, Janke EA. Motivating future directions of behavioral medicine. J Behav Med 2016; 40:1-5. [PMID: 28028656 DOI: 10.1007/s10865-016-9817-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Claudio R Nigg
- Office of Public Health Studies, University of Hawaii, 1960 East-West Road, Honolulu, HI, 96822, USA.
| | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - E Amy Janke
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, PA, USA
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