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Brown RCC, Keating SE, Jegatheesan DK, Mayr HL, Barnett A, Conley MM, Webb L, Kelly JT, Snoswell CL, Staudacher HM, Macdonald GA, Burton NW, Coombes JS, Campbell KL, Isbel NM, Hickman IJ. Utilizing technology for diet and exercise change in complex chronic conditions across diverse environments (U-DECIDE): feasibility randomised controlled trial. BMC Health Serv Res 2024; 24:935. [PMID: 39148084 PMCID: PMC11325816 DOI: 10.1186/s12913-024-11383-4] [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: 11/16/2023] [Accepted: 07/31/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Diet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service. METHODS U-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes. RESULTS Of 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41-58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent. CONCLUSIONS Digital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option. TRIAL REGISTRATION Australia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020.
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Dev K Jegatheesan
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Healthcare Excellence and Innovation, Metro North Health, Brisbane, Australia
| | - Nicole M Isbel
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia.
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Vomhof M, Boersma AC, Hertroijs DFL, Kaltheuner M, Krichbaum M, Kulzer B, Icks A, Hiligsmann M. Preferences of people with diabetes for diabetes care in Germany: a discrete choice experiment. Expert Rev Pharmacoecon Outcomes Res 2024:1-11. [PMID: 38874180 DOI: 10.1080/14737167.2024.2369293] [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: 06/13/2023] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES The objective of this study is to elicit health care preferences of people with diabetes and identify classes of people with different preferences. METHODS A discrete choice experiment was conducted among people with diabetes in Germany comprising attributes of role division in daily diabetes care planning, type of lifestyle education, support for correct medication intake, consultation frequency, emotional support, and time spent on self-management. A conditional logit model and a latent class model were used to elicit preferences toward diabetes care and analyze preference heterogeneity. RESULTS A total of 76 people with diabetes, recruited in two specialized diabetes care centers in Germany (mean age 51.9 years, 37.3% women, 49.1% type 2 diabetes mellitus, 50.9% type 1 diabetes mellitus), completed the discrete choice experiment. The most important attributes were consultation frequency, division in daily diabetes care planning, and correct medication intake. The latent class model detected preference heterogeneity by identifying two latent classes which differ mainly with respect to lifestyle education and medication intake. CONCLUSION While the majority of people with diabetes showed preferences in line with current health care provision in Germany, a relevant subgroup wished to strengthen lifestyle education and medication intake support with an aid or website.
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Affiliation(s)
- Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medicine and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Anna C Boersma
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Dorijn F L Hertroijs
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Michael Krichbaum
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology, University of Bamberg, Bamberg, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medicine and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, München-Neuherberg, Germany
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Adhiyaman A, Jay M, Chung UYR, Gronda AN, Tseng CH, Wylie-Rosett J, Wittleder S, Wali S, Ladapo JA, Orstad SL. Low-Income Participants' Preference Between Financial Incentives for Behavioral Goals vs Weight Loss Targets and Associations With Behavioral Goal Adherence. Am J Health Promot 2024:8901171241254366. [PMID: 38748662 DOI: 10.1177/08901171241254366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
PURPOSE Examine associations between whether participants' were matched to their preferred financial incentive design and behavioral goal adherence in a weight management intervention. DESIGN Secondary quantitative analysis incorporating qualitative survey data. SETTING Primary care clinics in socioeconomically disadvantaged communities in New York City and Los Angeles. SUBJECTS 668 participants (mean age 47.7 years, 81.0% female, 72.6% Hispanic) with obesity were enrolled in the Financial Incentives foR Weight Reduction (FIReWoRk) intervention. MEASURES We explored qualitatively participant's reasons for hypothetically choosing a behavioral goal-directed vs a weight loss outcome-based financial incentive program. Additionally, behavioral adherence to different goals was collected at the 6-month timepoint, categorized by match to preferred financial incentive design. ANALYSIS Logistic regression was used to examine if participants with certain demographic and higher psychosocial factors were more likely to choose goal-directed over outcome-based incentives. Additionally, logistic regression was used to test for associations between preference and behavioral adherence, using incentive type as an interaction term. RESULTS 60.2% of participants preferred the goal-directed incentive, with the majority stating that it was more structured. Married participants were more likely to prefer goal-directed incentives (OR = 1.57, CI = 1.06-2.33, P = .025). Moderation analysis revealed that participants who preferred goal-directed and were matched to goal-directed had greater rates of behavioral adherence for program attendance and self-weighing, but not dietary tracking and physical activity tracking, compared to those who preferred outcome-based and were matched to outcome-based. CONCLUSION Receiving one's preferred incentive design may not play a strong role in behavioral goal adherence during financially incentivized weight loss interventions.
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Affiliation(s)
- Akshitha Adhiyaman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Melanie Jay
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Un Young Rebecca Chung
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andres N Gronda
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra Wittleder
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Joseph A Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephanie L Orstad
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
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Lodewijks Y, van Ede L, Scheerhoorn J, Bouwman A, Nienhuijs S. Patient's Preference for Same-Day Discharge or Hospitalization After Bariatric Surgery. Obes Surg 2024; 34:716-722. [PMID: 38278982 DOI: 10.1007/s11695-024-07068-w] [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: 07/23/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Enhanced Recovery After Bariatric Surgery protocols have proven to be effective in reducing complication rates and length of stay. Guidelines do not include a recommendation on the length of hospital stay whereas same-day discharge is currently widely investigated on safety and feasibility. However, none of these studies takes patient preferences into account. The study aimed to reveal the patient's preference for outpatient surgery (OS) in patients who underwent primary bariatric surgery. MATERIALS AND METHODS A single-center preference-based randomized trial was performed between March and December of 2021. Adult patients planned for primary bariatric surgery were able to choose their care pathway, either OS with remote heart and respiratory rate monitoring by a wearable data logger or standard care with at least one-night hospitalization. RESULTS Out of the 202 patients, nearly everyone (98.5%) had a preference. Of 199 patients, 99 (49.7%) chose inpatient surgery. Of the 100 with a preference for OS, 23 stayed in the hospital due to medical reasons and 12 patients changed their preference. Based on both initial preference and changed preference, there were no differences between sex, age, body mass index, and co-morbidities such as diabetes mellitus, hypertension, and atrial fibrillation, nor in the use of anticoagulants or type of surgery. CONCLUSION Patients seemed to have a strong preference for their stay after a bariatric procedure. The preference is equally divided between outpatient and inpatient surgery and is not influenced by any patient characteristics.
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Affiliation(s)
- Yentl Lodewijks
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Lisa van Ede
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Jai Scheerhoorn
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven Technical University, De Zaale, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Patil SP, Billings ME, Bourjeily G, Collop NA, Gottlieb DJ, Johnson KG, Kimoff RJ, Pack AI. Long-term health outcomes for patients with obstructive sleep apnea: placing the Agency for Healthcare Research and Quality report in context-a multisociety commentary. J Clin Sleep Med 2024; 20:135-149. [PMID: 37904571 PMCID: PMC10758567 DOI: 10.5664/jcsm.10832] [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: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/01/2023]
Abstract
This multisociety commentary critically examines the Agency for Healthcare Research and Quality (AHRQ) final report and systematic review on long-term health outcomes in obstructive sleep apnea. The AHRQ report was commissioned by the Centers for Medicare & Medicaid Services and particularly focused on the long-term patient-centered outcomes of continuous positive airway pressure, the variability of sleep-disordered breathing metrics, and the validity of these metrics as surrogate outcomes. This commentary raises concerns regarding the AHRQ report conclusions and their potential implications for policy decisions. A major concern expressed in this commentary is that the AHRQ report inadequately acknowledges the benefits of continuous positive airway pressure for several established, long-term clinically important outcomes including excessive sleepiness, motor vehicle accidents, and blood pressure. While acknowledging the limited evidence for the long-term benefits of continuous positive airway pressure treatment, especially cardiovascular outcomes, as summarized by the AHRQ report, this commentary reviews the limitations of recent randomized controlled trials and nonrandomized controlled studies and the challenges of conducting future randomized controlled trials. A research agenda to address these challenges is proposed including study designs that may include both high quality randomized controlled trials and nonrandomized controlled studies. This commentary concludes by highlighting implications for the safety and quality of life for the millions of people living with obstructive sleep apnea if the AHRQ report alone was used by payers to limit coverage for the treatment of obstructive sleep apnea while not considering the totality of available evidence. CITATION Patil SP, Billings ME, Bourjeily G, et al. Long-term health outcomes for patients with obstructive sleep apnea: placing the Agency for Healthcare Research and Quality report in context-a multisociety commentary. J Clin Sleep Med. 2024;20(1):135-149.
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Affiliation(s)
- Susheel P. Patil
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals of Cleveland, Cleveland, Ohio
| | | | - Ghada Bourjeily
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karin G. Johnson
- University of Massachusetts Chan School of Medicine-Baystate, Springfield, Massachusetts
| | - R. John Kimoff
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania
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Wang D, Zhou D, Liu X, Xu Z, Bai T, Hou X. Different dosages of vonoprazan for gastroesophageal reflux disease: study protocol for a pragmatic, crossover-cluster, randomized controlled trial with patient preference arms. Trials 2023; 24:778. [PMID: 38041136 PMCID: PMC10691065 DOI: 10.1186/s13063-023-07760-9] [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: 06/25/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Vonoprazan results in more potent acid suppression for gastroesophageal reflux disease (GERD) than proton pump inhibitors. It has only been approved for treating erosive esophagitis in China, but 30-40% of GERD patients cannot achieve the goal of treatment with vonoprazan 20 mg daily. This study aims to investigate whether vonoprazan could relieve the symptoms of Chinese patients with non-erosive reflux disease (NERD) and whether increased dosage or different times of dosing could increase the response rate of GERD. METHODS This study is a pragmatic, open-label, crossover-cluster, randomized controlled trial with patient preference arms. Two thousand eight hundred eighty patients with GERD from 48 hospitals in China will be enrolled. These hospitals will be divided into a compulsory randomization cluster (24 hospitals) and a patient preference cluster (24 hospitals). Patients in the compulsory randomization cluster will be randomized to three regimens according to the crossover-cluster randomization. Patients in the patient preference cluster may choose to receive any regimen if they have a preference; otherwise, patients will be randomly assigned. The three treatment regimens will last 4 weeks, including (1) vonoprazan 20 mg p.o. after breakfast, (2) vonoprazan 20 mg p.o. after dinner, and (3) vonoprazan 20 mg p.o. after breakfast and after dinner. Patients will attend a baseline visit, a 4-week e-diary, a fourth-week visit, and a sixth-month visit online. The primary outcome is the symptom relief rate of all patients after 4-week therapy. Secondary outcomes include the healing rate of EE patients, the severity of symptoms, compliance with the therapy at the fourth-week follow-up visit, recurrent symptoms, and the frequency of self-conscious doctor visits at the sixth-month follow-up visit. DISCUSSION This trial will explore the effectiveness of different regimens of vonoprazan that will be implemented with GERD patients in China. The randomization with patient preferences considered and the crossover-cluster component may improve the robustness and extrapolation of study conclusions. TRIAL REGISTRATION https://www.chictr.org.cn ChiCTR2300069857. Registered on 28 March 2023. PROTOCOL VERSION February 18, 2023, Version 2.
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Affiliation(s)
- Dongke Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Zhou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghuang Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyue Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Garel N, Drury J, Thibault Lévesque J, Goyette N, Lehmann A, Looper K, Erritzoe D, Dames S, Turecki G, Rej S, Richard-Devantoy S, Greenway KT. The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression. Front Psychiatry 2023; 14:1268832. [PMID: 37795512 PMCID: PMC10546328 DOI: 10.3389/fpsyt.2023.1268832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Subanesthetic ketamine has accumulated meta-analytic evidence for rapid antidepressant effects in treatment-resistant depression (TRD), resulting in both excitement and debate. Many unanswered questions surround ketamine's mechanisms of action and its integration into real-world psychiatric care, resulting in diverse utilizations that variously resemble electroconvulsive therapy, conventional antidepressants, or serotonergic psychedelics. There is thus an unmet need for clinical approaches to ketamine that are tailored to its unique therapeutic properties. Methods This article presents the Montreal model, a comprehensive biopsychosocial approach to ketamine for severe TRD refined over 6 years in public healthcare settings. To contextualize its development, we review the evidence for ketamine as a biomedical and as a psychedelic treatment of depression, emphasizing each perspectives' strengths, weaknesses, and distinct methods of utilization. We then describe the key clinical experiences and research findings that shaped the model's various components, which are presented in detail. Results The Montreal model, as implemented in a recent randomized clinical trial, aims to synergistically pair ketamine infusions with conventional and psychedelic biopsychosocial care. Ketamine is broadly conceptualized as a brief intervention that can produce windows of opportunity for enhanced psychiatric care, as well as powerful occasions for psychological growth. The model combines structured psychiatric care and concomitant psychotherapy with six ketamine infusions, administered with psychedelic-inspired nonpharmacological adjuncts including rolling preparative and integrative psychological support. Discussion Our integrative model aims to bridge the biomedical-psychedelic divide to offer a feasible, flexible, and standardized approach to ketamine for TRD. Our learnings from developing and implementing this psychedelic-inspired model for severe, real-world patients in two academic hospitals may offer valuable insights for the ongoing roll-out of a range of psychedelic therapies. Further research is needed to assess the Montreal model's effectiveness and hypothesized psychological mechanisms.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Jessica Drury
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Nathalie Goyette
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Alexandre Lehmann
- International Laboratory for Brain, Music and Sound Research, Montreal, QC, Canada
- Department of Otolaryngology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Karl Looper
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
| | - Shannon Dames
- Health Sciences and Human Services, Vancouver Island University, Nanaimo, BC, Canada
| | - Gustavo Turecki
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Kyle T. Greenway
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Division of Psychiatry, Department of Brain Sciences, Centres for Neuropsychopharmacology and Psychedelic Research, Imperial College London, London, United Kingdom
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McCall H, Dear BF, Landry C, Beahm JD, Gregory J, Titov N, Carleton RN, Hadjistavropoulos HD. Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy. Internet Interv 2023; 33:100656. [PMID: 37609530 PMCID: PMC10440509 DOI: 10.1016/j.invent.2023.100656] [Citation(s) in RCA: 3] [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: 05/11/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Public safety personnel (PSP) face high rates of mental health problems and many barriers to care. Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated outcomes of PTSD-specific ICBT among PSP or PSP's preferences for transdiagnostic or PTSD-specific ICBT. The current paper presents the initial outcomes (N = 150) of a mixed-methods observational study designed to (a) investigate preferences for transdiagnostic or PTSD-specific ICBT among PSP with elevated symptoms of PTSD and/or a primary concern with PTSD symptoms and (b) explore potential differences in client engagement, satisfaction, and symptom changes between the two forms of ICBT. PSP completed questionnaires before and after their preferred ICBT program. Mixed-methods analyses included generalized estimating equations, descriptive statistics, and inductive conventional qualitative content analysis. More clients (n = 85; 57 %) selected transdiagnostic ICBT than PTSD-specific ICBT (n = 65; 43 %), but the difference in the number of clients who selected each course was not statistically significant. Clients in both ICBT programs reported similar and favorable treatment satisfaction (e.g., 98 % would recommend the course to a friend), treatment engagement (i.e., 69 % accessed at least four of the five lessons), and pre-post improvement in symptoms (e.g., Hedges' g = 0.81 for reduction in PTSD symptom). Transdiagnostic ICBT resulted in greater reductions in symptoms of panic disorder than PTSD-specific ICBT. Qualitative analyses showed similarities across the ICBT programs in client feedback. The current study provides further evidence supporting the use and outcomes of ICBT for PSP in both transdiagnostic and disorder-specific formats. Implications for the literatures on PSP mental health and ICBT, as well as practical recommendations, are discussed.
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Affiliation(s)
- Hugh McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F. Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Caeleigh Landry
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Julia Gregory
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
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9
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Donovan LM, Hoyos CM, Kimoff RJ, Morrell MJ, Bosch NA, Chooljian DM, McEvoy RD, Sawyer AM, Wagner TH, Al-Lamee RR, Bishop D, Carno MA, Epstein M, Hanson M, Ip MSM, Létourneau M, Pamidi S, Patel SR, Pépin JL, Punjabi NM, Redline S, Thornton JD, Patil SP. Strategies to Assess the Effect of Continuous Positive Airway Pressure on Long-Term Clinically Important Outcomes among Patients with Symptomatic Obstructive Sleep Apnea: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:931-943. [PMID: 37387624 DOI: 10.1513/annalsats.202303-258st] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnea (OSA). Although CPAP improves symptoms (e.g., daytime sleepiness), there is a lack of high-quality evidence that CPAP prevents many long-term outcomes, including cognitive impairment, myocardial infarction, and stroke. Observational studies suggest that patients with symptoms may be particularly likely to experience these preventive benefits with CPAP, but ethical and practical concerns limited the participation of such patients in prior long-term randomized trials. As a result, there is uncertainty about the full benefits of CPAP, and resolving this uncertainty is a key priority for the field. This workshop assembled clinicians, researchers, ethicists, and patients to identify strategies to understand the causal effects of CPAP on long-term clinically important outcomes among patients with symptomatic OSA. Quasi-experimental designs can provide valuable information and are less time and resource intensive than trials. Under specific conditions and assumptions, quasi-experimental studies may be able to provide causal estimates of CPAP's effectiveness from generalizable observational cohorts. However, randomized trials represent the most reliable approach to understanding the causal effects of CPAP among patients with symptoms. Randomized trials of CPAP can ethically include patients with symptomatic OSA, as long as there is outcome-specific equipoise, adequate informed consent, and a plan to maximize safety while minimizing harm (e.g., monitoring for pathologic sleepiness). Furthermore, multiple strategies exist to ensure the generalizability and practicality of future randomized trials of CPAP. These strategies include reducing the burden of trial procedures, improving patient-centeredness, and engaging historically excluded and underserved populations.
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Lanier VM, Lohse KR, Hooker QL, Francois SJ, van Dillen LR. Treatment preference changes after exposure to treatment in adults with chronic low back pain. PM R 2023; 15:817-827. [PMID: 36106673 PMCID: PMC10014477 DOI: 10.1002/pmrj.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients' pretreatment preferences can influence outcomes of nonpharmacologic treatments for musculoskeletal pain. Less is known about how patients' treatment preferences change following exposure to treatment. OBJECTIVE To examine the effect of exposure to treatment and change in disability and pain on treatment preference ratings of two exercise-based treatments for people with chronic low back pain (LBP). DESIGN Secondary analysis of a subsample of participants from a randomized clinical trial. SETTING Academic research setting. PARTICIPANTS Individuals with chronic LBP (n = 83). INTERVENTIONS 6 weekly sessions of motor skill training (MST) or strength and flexibility exercise (SFE). MAIN OUTCOME MEASURES Prior to treatment, participants completed a treatment preference assessment measure (TPA) describing MST and SFE. Participants rated four attributes (effectiveness, acceptability/logicality, suitability/appropriateness, convenience) of each treatment on a 5-point Likert scale (0-4) with higher scores indicating higher ratings. An overall preference rating was calculated as the mean of the attribute ratings. The TPA was administered 12 months post treatment to reassess participants' ratings of the treatment they received. RESULTS Participants who received MST rated their preference for MST higher 12 months post treatment and participants who received SFE rated their preference for SFE lower. Smaller improvements (to worsening) in pain were associated with a reduction in preference ratings in the SFE group, whereas the MST group generally increased their ratings regardless of pain. Changes in disability were not related to changes in preference ratings. CONCLUSIONS Participants changed their preference ratings of two exercise-based treatments for LBP after exposure to the treatment. Participants who received the less familiar MST viewed this treatment more favorably 12 months post treatment, and this change was less contingent on changes in disability/pain than for participants in the SFE group. Assessing preference ratings at various times during treatment is crucial to understand a person's preference for and perceptions of a treatment.
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Affiliation(s)
- Vanessa M Lanier
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Quenten L Hooker
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sara J Francois
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda R van Dillen
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Sidani S. The impact of treatment preferences: A narrative review. J Eval Clin Pract 2023. [PMID: 37139833 DOI: 10.1111/jep.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
Attending to treatment preferences is an element of person-centred care, reported as beneficial in improving treatment adherence, satisfaction, and outcome, in practice. The results of preference trials were inconsistent in supporting these benefits in intervention evaluation research. Informed by the conceptualisation of treatment preferences positing their indirect impact on outcomes, this narrative review aimed to summarise the evidence on the effects of preferences on enrolment; withdrawal or attrition; engagement, enactment, and satisfaction with treatment; and outcomes. The search yielded 72 studies (57 primary trials and 15 reviews). The results of vote counting indicated that (1) offering participants the opportunity to choose treatment enhances enrolment (reported in 87.5% of studies), and (2) providing treatments that match participants' preferences reduces attrition (48%); enhances engagement (67%), enactment (50%) and satisfaction with (43%) treatment; and improves outcomes (35%). The results are attributed to conceptual and methodological issues including less-than-optimal assessment of treatment preferences, which contributes to ill-identified preferences, accounting for withdrawal, low enactment, and limited satisfaction with treatment. These treatment processes, in turn, mediate the impact of treatment preferences on outcomes. It is important to refine and standardise the methods for assessing preferences and to examine their indirect impact (mediated by treatment processes) on outcomes in future preference trials to validly identify their benefits.
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Affiliation(s)
- Souraya Sidani
- Toronto Metropolitan University Daphne Cockwell School of Nursing, Toronto, Ontario, Canada
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12
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Audet CM, Sack DE, Ndlovu GH, Morkel C, Harris J, Wagner RG, Seabi TM. Women want male partner engagement in antenatal care services: A qualitative study of pregnant women from rural South Africa. PLoS One 2023; 18:e0283789. [PMID: 37011063 PMCID: PMC10069782 DOI: 10.1371/journal.pone.0283789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Evidence strongly shows that a supportive, involved male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral (ART) adherence and increases HIV-free infant survival. Partner engagement in antenatal care (ANC) is influential; however, the most effective strategy to engage male partners is currently unknown. Engaging pregnant women to understand whether male partner involvement is welcome in ANC, what this involvement entails and how best to invite their partner is an important first step in determining how best to engage male partners. METHODS We interviewed 36 pregnant women receiving ANC services at a district hospital in rural Mpumalanga, South Africa to assess the strengths and weaknesses of their current relationship, the type of partner support they receive, whether they would like their male partner to be involved in their ANC, and how best to invite their male partner to their appointments. We conducted a thematic analysis of the qualitative interviews using MAXQDA software. RESULTS Financial, emotional, and physical support were noted as important aspects of support currently provided by male partners, with most pregnant women wanting their partners to engage in ANC services during pregnancy. Preferred engagement strategies included participation in couple-based HIV testing and counseling, regular ANC appointment attendance, and delivery room presence. Women who reported a positive relationship with her partner were more likely to prefer inviting their partner without health facility assistance, while those who reported challenges in their relationship preferred assistance through a letter or community health worker. Pregnant women perceived regular business hours (due to their partner being employed and unable to take off work) and having a partner involved in multiple relationships as barriers in getting their partner to attend ANC services. DISCUSSION Rural South African women, even those in unsatisfactory relationships want their male partners to attend their ANC visits and birth. To make this possible, health facilities will have to tailor male partner engagement outreach strategies to the preferences and needs of the pregnant woman.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel E. Sack
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Godfrey H. Ndlovu
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Morkel
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jacob Harris
- Notre Dame University, Notre Dame, Indiana, United States of America
| | - Ryan G. Wagner
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso M. Seabi
- Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Chen S, Wang W. A scoping review on two-stage randomized preference trial in the field of mental health and addiction. BMC Psychiatry 2023; 23:192. [PMID: 36959551 PMCID: PMC10037890 DOI: 10.1186/s12888-023-04676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Randomized Controlled Trial is the most rigorous study design to test the efficacy and effectiveness of an intervention. Patient preference may negatively affect patient performance and decrease the generalizability of a trial to clinical population. Patient preference trial have particular implications in the field of mental health and addiction since mental health interventions are generally complex, blinding of intervention is often difficult or impossible, patients may have strong preference, and outcome measures are often subjective patient self-report which may be greatly influenced if patient's preference did not match with the intervention received. METHODS In this review, we have surveyed the application of two-stage randomized preference trial with focus on studies in the field of mental health and addiction. The study selection followed the guideline provided by Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. RESULTS Six two-stage randomized preference trials (ten publications) have been identified in the field of mental health field and addiction. In these trials, the pooled dropout rates were 18.3% for the preference arm, and 28.7% for the random arm, with a pooled RR of 0.70 (95% CI, 0.56-0.88; P = 0.010) indicating lower risk of dropout in the preference arm. The standardized preference effects varied widely from 0.07 to 0.57, and could be as large as the treatment effect in some of the trials. CONCLUSION This scoping review has shown that two-stage randomized preference trials are not as popular as expected in mental health research. The results indicated that two-stage randomized preference trials in mental health would be beneficial in retaining patients to expand the generalizability of the trial.
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Affiliation(s)
- Sheng Chen
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Biostatistics Core, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada.
- Center for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, USA.
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Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression: A randomized factorial design trial. Behav Res Ther 2023; 162:104265. [PMID: 36791537 DOI: 10.1016/j.brat.2023.104265] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/17/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across conditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of supervision is not yet clear as advice can be transferred across clients.
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15
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Patient Preferences for Treatment of Bacillus Calmette-Guérin-unresponsive Non-muscle-invasive Bladder Cancer: A Cross-country Choice Experiment. EUR UROL SUPPL 2023; 49:92-99. [PMID: 36874596 PMCID: PMC9974996 DOI: 10.1016/j.euros.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background Patients with non-muscle-invasive bladder cancer (NMIBC) that is unresponsive to bacillus Calmette-Guérin (BCG) immunotherapy face a difficult choice. Immediate radical cystectomy (RC) is effective but might represent overtreatment. Continuing bladder preservation with medical therapy is an alternative, but it risks progression to muscle-invasive bladder cancer (MIBC) and a reduction in survival. Objective To understand the trade-offs patients are willing to make in selecting treatments for BCG-unresponsive NMIBC. Design setting and participants Adults with NMIBC from the UK, France, Germany, and Canada who reported current receipt of BCG, disease unresponsive to BCG, or receipt of RC in the previous 12 mo after failure of BCG were recruited to participate in an online choice experiment. Patients were asked to make repeated choices between two hypothetical medical treatments and the option to undergo immediate RC. The medical treatments required trade-offs between the time to RC, the mode and frequency of administration, the risk of experiencing serious side effects, and the risk of disease progression. Outcome measurements and statistical analysis Error component logit models were used to calculate relative attribute importance (RAI) scores as the maximum percentage contribution to a preference and acceptable benefit-risk trade-offs. Results and limitations Most of the 107 participants (average age 63 yr) never selected RC (89%) as their preferred option in the choice experiment. Preferences were most affected by time to RC (RAI 55%), followed by risk of progressing to MIBC (RAI 25%), medication administration (RAI 12%), and the risk of serious side effects (RAI 8%). To increase the time to RC from 1 yr to 6 yr, patients accepted a 43.8% increase in the risk of progression and a 66.1% increase in the risk of serious side effects. Conclusions Patients with BCG-treated NMIBC valued bladder-sparing treatments and were willing to make substantial benefit-risk trade-offs to delay RC. Patient summary Adults with bladder cancer not invading the bladder muscle completed an online experiment in which they chose between hypothetical medications and bladder removal. The results show that patients would be willing to accept different risks associated with medications to delay bladder removal. Patients considered disease progression the most important risk of medicinal treatment.
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Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the universally recommended treatment of choice for insomnia disorder based on its safety and posttreatment durability of benefit. However, CBT-I does not help all patients achieve remission. The second most evidence-based treatment, hypnotic pharmacotherapy (PCT), does not resolve perpetuating factors of insomnia, resulting in potential waning of benefit and dependence. This article presents a rationale that supports consideration of hypnotic augmentation of CBT-I (COMB), along with a review of select randomized controlled trials relevant to clinical decision-making.
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Tepper M, Farb E. The Behavioral Health Workforce Crisis and the Need for Complex, Adaptive Change. Psychiatr Serv 2023:appips20220416. [PMID: 36748245 DOI: 10.1176/appi.ps.20220416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Miriam Tepper
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Tepper); Community Health Center, Inc., Hartford, Connecticut, and Yale School of Nursing, Orange, Connecticut (Farb)
| | - Emily Farb
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York City (Tepper); Community Health Center, Inc., Hartford, Connecticut, and Yale School of Nursing, Orange, Connecticut (Farb)
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18
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Development of a Patient Decision Aid for Rectal Cancer Patients with Clinical Complete Response after Neo-Adjuvant Treatment. Cancers (Basel) 2023; 15:cancers15030806. [PMID: 36765766 PMCID: PMC9913303 DOI: 10.3390/cancers15030806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Surgery is the primary component of curative treatment for patients with rectal cancer. However, patients with a clinical complete response (cCR) after neo-adjuvant treatment may avoid the morbidity and mortality of radical surgery. An organ-sparing strategy could be an oncological equivalent alternative. Therefore, shared decision making between the patient and the healthcare professional (HCP) should take place. This can be facilitated by a patient decision aid (PtDA). In this study, we developed a PtDA based on a literature review and the key elements of the Ottawa Decision Support Framework. Additionally, a qualitative study was performed to review and evaluate the PtDA by both HCPs and former rectal cancer patients by a Delphi procedure and semi-structured interviews, respectively. A strong consensus was reached after the first round (I-CVI 0.85-1). Eleven patients were interviewed and most of them indicated that using a PtDA in clinical practice would be of added value in the decision making. Patients indicated that their decisional needs are centered on the impact of side effects on their quality of life and the outcome of the different options. The PtDA was modified taking into account the remarks of patients and HCPs and a second Delphi round was held. The second round again showed a strong consensus (I-CVI 0.87-1).
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19
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Casteleijn FM, de Vries AM, Tu LM, Heesakkers JPFA, Latul Y, Kowalik CR, van Eijndhoven HWF, van Eekelen R, Roovers JPWR. Cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® compared with mid-urethral sling surgery for stress urinary incontinence: A two-arm cohort study. BJOG 2023; 130:674-683. [PMID: 36660885 DOI: 10.1111/1471-0528.17396] [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: 03/10/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® (PDMS-U) compared with mid-urethral sling (MUS) surgery for stress urinary incontinence (SUI) at 1-year follow-up. DESIGN Prospective, two-arm cohort study with 2-year follow-up. SETTING International multicentre. POPULATION Women with moderate to severe SUI. MAIN OUTCOME MEASURES Primary outcome was subjective cure (Patient Global Impression of Improvement). SECONDARY OUTCOMES objective cure (negative cough stress test), Urogenital Distress Inventory (UDI-6), complications and re-interventions. Cost-effectiveness outcomes: total costs, quality-adjusted life year (QALY) using IIQ7-scores (Incontinence Impact Questionnaire) and EQ-5D-5L, incremental cost-effectiveness ratio (ICER) and monetary benefit (adjusted for baseline confounders). RESULTS In all, 131 PDMS-U and 153 MUS surgery patients were treated. Subjective cure rates for MUS surgery and PDMS-U were, respectively: 101/112 (90%) versus 40/87 (46%), adjusted odds ratio (aOR; for age, body mass index [BMI], severity, type of urinary incontinence and previous SUI procedure) was 4.9. Objective cure rates for MUS surgery and PDMS-U were respectively: 98/109 (90%) versus 58/92 (63%), aOR 5.4. Average total costs for PDMS-U and MUS surgery were €3567 and €6688. ICER for MUS surgery cost €15 598 per IIQ QALY and €37 408 per EQ-5D-5L QALY. With a willingness to pay (WTP) of €25 000, MUS has a 84% chance of being cost-effective using IIQ, whereas PDMS-U has a 99% chance of being cost-effective using EQ-5D-5L. CONCLUSION MUS surgery is more cost-effective in realising improved disease-specific quality of life (QoL), while PDMS-U is more cost-effective in realising improved generic QoL.
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Affiliation(s)
- Fenne M Casteleijn
- Department of Obstetrics and Gynecology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Allert M de Vries
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Le Mai Tu
- Department of Urology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Yani Latul
- Department of Obstetrics and Gynecology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Claudia R Kowalik
- Department of Obstetrics and Gynecology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | | | - Rik van Eekelen
- Department of Obstetrics and Gynecology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
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20
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Henriksen M, Christensen R, Kristensen LE, Bliddal H, Bartholdy C, Boesen M, Ellegaard K, Guldberg-Møller J, Hunter DJ, Altman R, Bandak E. Exercise and education vs intra-articular saline for knee osteoarthritis: a 1-year follow-up of a randomized trial. Osteoarthritis Cartilage 2023; 31:627-635. [PMID: 36657659 DOI: 10.1016/j.joca.2022.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the longer-term effect of the Good Life with osteoarthritis in Denmark (GLAD) exercise and education program relative to open-label placebo (OLP) on changes from baseline in core outcomes in individuals with knee osteoarthritis (OA). METHODS In this 1-year follow-up of an open-label, randomized trial, patients with symptomatic and radiographically confirmed knee OA were monitored after being randomized to either the 8-week GLAD program or OLP given as 4 intra-articular saline injections over 8 weeks. The primary outcome was the change from baseline in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale after 1 year in the intention-to-treat population. Key secondary outcomes were the KOOS function and quality of life subscales, and Patients' Global Assessment of disease impact. RESULTS 206 adults were randomly assigned: 102 to GLAD and 104 to OLP, of which only 137 (63/74 GLAD/OLP) provided data at 1 year. At one year the mean changes in KOOS pain were 8.4 for GLAD and 7.0 for OLP (Difference: 1.5 points; 95% CI -2.6 to 5.5). There were no between-group differences in any of the secondary outcomes. CONCLUSIONS In this 1-year follow-up of individuals with knee OA, the 8-week GLAD program and OLP both provided minor longer-term benefits with no group difference. These results require confirmation given the significant loss to follow-up. TRIAL REGISTRATION NUMBER NCT03843931.
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Affiliation(s)
- M Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark.
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - L E Kristensen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - C Bartholdy
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - K Ellegaard
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - J Guldberg-Møller
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
| | - D J Hunter
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, The University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - R Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital - Bispebjerg Frederiksberg, Denmark
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Henriksen M, Nielsen SM, Christensen R, Kristensen LE, Bliddal H, Bartholdy C, Boesen M, Ellegaard K, Hunter DJ, Altman R, Bandak E. Who are likely to benefit from the Good Life with osteoArthritis in Denmark (GLAD) exercise and education program? An effect modifier analysis of a randomised controlled trial. Osteoarthritis Cartilage 2023; 31:106-114. [PMID: 36089229 DOI: 10.1016/j.joca.2022.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify contextual factors that modify the treatment effect of the 'Good Life with osteoArthritis in Denmark' (GLAD) exercise and education programme compared to open-label placebo (OLP) on knee pain in individuals with knee osteoarthritis (OA). METHODS Secondary effect modifier analysis of a randomised controlled trial. 206 participants with symptomatic and radiographic knee OA were randomised to either the 8-week GLAD programme (n = 102) or OLP given as 4 intra-articular saline injections over 8 weeks (n = 104). The primary outcome was change from baseline to week 9 in the Knee injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale (range 0 (worst) to 100 (best)). Subgroups were created based on baseline information: BMI, swollen study knee, bilateral radiographic knee OA, sports participation as a young adult, sex, median age, a priori treatment preference, regular use of analgesics (NSAIDs or paracetamol), radiographic disease severity, and presence of constant or intermittent pain. RESULTS Participants who reported use of analgesics at baseline seem to benefit from the GLAD programme over OLP (subgroup contrast: 10.3 KOOS pain points (95% CI 3.0 to 17.6)). Participants with constant pain at baseline also seem to benefit from GLAD over OLP (subgroup contrast: 10.0 points (95% CI 2.8 to 17.2)). CONCLUSIONS These results imply that patients who take analgesics or report constant knee pain, GLAD seems to yield clinically relevant benefits on knee pain when compared to OLP. The results support a stratified recommendation of GLAD as management of knee OA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843931. EudraCT number 2019-000809-71.
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Affiliation(s)
- M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - S M Nielsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - L E Kristensen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - K Ellegaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - R Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark
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22
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Leung LB, Ziobrowski HN, Puac-Polanco V, Bossarte RM, Bryant C, Keusch J, Liu H, Pigeon WR, Oslin DW, Post EP, Zaslavsky AM, Zubizarreta JR, Kessler RC. Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration. J Gen Intern Med 2022; 37:3235-3241. [PMID: 34613577 PMCID: PMC8493943 DOI: 10.1007/s11606-021-07136-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes. OBJECTIVE To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment. DESIGN Patient self-report surveys at treatment initiation linked to medical records. SETTING Veterans Health Administration (VA) clinics nationally, 2018-2020. PARTICIPANTS A total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) MAIN MEASURES: Patient self-reported preferences for medication and psychotherapy on 0-10 self-anchoring visual analog scales (0="completely unwilling"; 10="completely willing"). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables. KEY RESULTS More patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p<0.001). A total of 32.1% of patients who preferred (7-10/10) medication and 21.8% who preferred psychotherapy did not receive these treatments. Patients who strongly preferred medication were substantially more likely to receive medication than those who had strong negative preferences (odds ratios [OR]=17.5; 95% confidence interval [CI]=12.5-24.5). Compared with patients who had strong negative psychotherapy preferences, those with strong psychotherapy preferences were about twice as likely to receive psychotherapy (OR=1.9; 95% CI=1.0-3.5). Patients who strongly preferred psychotherapy were more likely to adhere to psychotherapy than those with strong negative preferences (OR=3.3; 95% CI=1.4-7.4). Treatment preferences were not associated with medication or combined treatment adherence. Patients in primary care settings had lower odds of receiving (but not adhering to) psychotherapy than patients in specialty mental health settings. Depression severity was not associated with treatment receipt or adherence. CONCLUSIONS Mismatches between treatment preferences and treatment type received were common and associated with worse treatment adherence for psychotherapy. Future research could examine ways to decrease mismatch between patient preferences and treatments received and potential effects on patient outcomes.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of General Internal Medicine, and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | | | - Victor Puac-Polanco
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Robert M Bossarte
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA.,Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
| | - Corey Bryant
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Janelle Keusch
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.,Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VAMC, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David W Oslin
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research Education and Clinical Center, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward P Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jose R Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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23
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Davidson GH, Monsell SE, Evans H, Voldal EC, Fannon E, Lawrence SO, Krishnadasan A, Talan DA, Bizzell B, Heagerty PJ, Comstock BA, Lavallee DC, Villegas C, Winchell R, Thompson CM, Self WH, Kao LS, Dodwad SJ, Sabbatini AK, Droullard D, Machado-Aranda D, Gibbons MM, Kaji AH, DeUgarte DA, Ferrigno L, Salzberg M, Mandell KA, Siparsky N, Price TP, Raman A, Corsa J, Wisler J, Ayoung-Chee P, Victory J, Jones A, Kutcher M, McGrane K, Holihan J, Liang MK, Cuschieri J, Johnson J, Fischkoff K, Drake FT, Sanchez SE, Odom SR, Kessler LG, Flum DR. Self-selection vs Randomized Assignment of Treatment for Appendicitis. JAMA Surg 2022; 157:598-608. [PMID: 35612859 DOI: 10.1001/jamasurg.2022.1554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance For adults with appendicitis, several randomized clinical trials have demonstrated that antibiotics are an effective alternative to appendectomy. However, it remains unknown how the characteristics of patients in such trials compare with those of patients who select their treatment and whether outcomes differ. Objective To compare participants in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) randomized clinical trial (RCT) with a parallel cohort study of participants who declined randomization and self-selected treatment. Design, Setting, and Participants The CODA trial was conducted in 25 US medical centers. Participants were enrolled between May 3, 2016, and February 5, 2020; all participants were eligible for at least 1 year of follow-up, with all follow-up ending in 2021. The randomized cohort included 1094 adults with appendicitis; the self-selection cohort included patients who declined participation in the randomized group, of whom 253 selected appendectomy and 257 selected antibiotics. In this secondary analysis, characteristics and outcomes in both self-selection and randomized cohorts are described with an exploratory analysis of cohort status and receipt of appendectomy. Interventions Appendectomy vs antibiotics. Main Outcomes and Measures Characteristics among participants randomized to either appendectomy or antibiotics were compared with those of participants who selected their own treatment. Results Clinical characteristics were similar across the self-selection cohort (510 patients; mean age, 35.8 years [95% CI, 34.5-37.1]; 218 female [43%; 95% CI, 39%-47%]) and the randomized group (1094 patients; mean age, 38.2 years [95% CI, 37.4-39.0]; 386 female [35%; 95% CI, 33%-38%]). Compared with the randomized group, those in the self-selection cohort were less often Spanish speaking (n = 99 [19%; 95% CI, 16%-23%] vs n = 336 [31%; 95% CI, 28%-34%]), reported more formal education (some college or more, n = 355 [72%; 95% CI, 68%-76%] vs n = 674 [63%; 95% CI, 60%-65%]), and more often had commercial insurance (n = 259 [53%; 95% CI, 48%-57%] vs n = 486 [45%; 95% CI, 42%-48%]). Most outcomes were similar between the self-selection and randomized cohorts. The number of patients undergoing appendectomy by 30 days was 38 (15.3%; 95% CI, 10.7%-19.7%) among those selecting antibiotics and 155 (19.2%; 95% CI, 15.9%-22.5%) in those who were randomized to antibiotics (difference, 3.9%; 95% CI, -1.7% to 9.5%). Differences in the rate of appendectomy were primarily observed in the non-appendicolith subgroup. Conclusions and Relevance This secondary analysis of the CODA RCT found substantially similar outcomes across the randomized and self-selection cohorts, suggesting that the randomized trial results are generalizable to the community at large. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
| | | | | | - Heather Evans
- Harborview Medical Center, Seattle, Washington.,Medical University of South Carolina, Charleston, South Carolina
| | | | - Erin Fannon
- University of Washington, Seattle, Washington
| | | | | | - David A Talan
- Olive View UCLA Medical Center, Los Angeles, California.,Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | | | | | - Danielle C Lavallee
- University of Washington, Seattle, Washington.,BC Academic Health Science Network, Vancouver, British Columbia, Canada
| | | | | | - Callie M Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee.,University of Utah, Salt Lake City, Utah
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lillian S Kao
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Shah-Jahan Dodwad
- McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | | | | | | | | | - Amy H Kaji
- Harbor UCLA Medical Center, Los Angeles, California.,Statistical Editor, JAMA Surgery
| | | | - Lisa Ferrigno
- UCHealth University of Colorado Hospital, Denver, Colorado
| | | | | | | | - Thea P Price
- Rush University Medical Center, Chicago, Illinois
| | | | - Joshua Corsa
- Providence Regional Medical Center, Everett, Washington
| | - Jon Wisler
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Patricia Ayoung-Chee
- Tisch Hospital NYU Langone Medical Center, New York, New York.,Grady Health, Morehouse School of Medicine, Atlanta, Georgia
| | - Jesse Victory
- Bellevue Hospital Center NYU School of Medicine, New York, New York
| | - Alan Jones
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Matthew Kutcher
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Karen McGrane
- Madigan Army Medical Center, Tacoma, Washington.,Mason General Hospital, Shelton, Washington
| | - Julie Holihan
- University of Texas Lyndon B. Johnson General Hospital, Houston, Texas
| | - Mike K Liang
- University of Texas Lyndon B. Johnson General Hospital, Houston, Texas.,University of Houston, HCA Healthcare, Kingwood, Texas
| | - Joseph Cuschieri
- Harborview Medical Center, Seattle, Washington.,University of California, San Francisco, San Francisco, California
| | | | | | | | | | - Stephen R Odom
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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Dahlin M, Johansson A, Romare H, Carlbring P, Andersson G. Worry-specific versus self-tailored internet-based treatments for generalized anxiety disorder, with scheduled support or support on demand: A pilot factorial design trial. Internet Interv 2022; 28:100531. [PMID: 35371926 PMCID: PMC8971948 DOI: 10.1016/j.invent.2022.100531] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Studies suggest that internet-delivered cognitive behaviour therapy (ICBT) can be effective when treating generalized anxiety disorder (GAD). This pilot factorial design study examined the effects of two types of ICBT (worry-specific and self-tailored treatment), and two support types (scheduled weekly support and support on demand), on measures of worry, anxiety, and depressive symptoms. Participants (N = 85) were randomized into four treatment groups. Post-treatment measures were completed by 76.5% after eight weeks (n = 65). Intention to treat analysis showed significant improvements, with moderate to large within-group effects on the primary outcome measure, Penn State Worry Questionnaire (Cohen's d = 0.77-1.43). Minor to large effects on the secondary measures were found in all groups (Cohen's d = 0.13-1.66). No significant differences in outcome measures were found between the groups. Receiving scheduled support and self-tailored treatment was rated as more positive than receiving support on demand and the worry-specific program. A limitation is the low number of participants. The pilot results suggest that GAD can be treated with both worry-specific and self-tailored treatments, and that ICBT can be supported both with scheduled and support on demand.
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Affiliation(s)
- Mats Dahlin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Psykologpartners, Private practice, Linköping, Sweden
| | - Andreas Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Harry Romare
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden,Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
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25
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Owens M, Bunce HLI. The Potential for Outdoor Nature-Based Interventions in the Treatment and Prevention of Depression. Front Psychol 2022; 13:740210. [PMID: 35401311 PMCID: PMC8984301 DOI: 10.3389/fpsyg.2022.740210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 01/05/2023] Open
Abstract
There is growing interest in nature-based interventions (NBI) to improve human health and wellbeing. An important nascent area is exploring the potential of outdoor therapies to treat and prevent common mental health problems like depression. In this conceptual analysis on the nature-depression nexus, we distil some of the main issues for consideration when NBIs for depression are being developed. We argue that understanding the mechanisms, or 'active ingredients' in NBIs is crucial to understand what works and for whom. Successfully identifying modifiable mediating intervention targets will pave the way for interventions with increased efficacy. We highlight a non-exhaustive list of five clinically relevant putative, candidate mechanisms which may underly the beneficial effects of NBIs on depression: stress, rumination, mindfulness, sleep and exercise. We also make the case that when developing NBIs it is important to not neglect young people, explore personalised approaches and focus on both treatment and prevention approaches. To achieve these aims methodologically rigorous programmes of clinical research are needed that include well-powered and controlled experimental designs including randomised controlled trials, qualitative research, longitudinal studies and large prospective cohorts.
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Affiliation(s)
- Matthew Owens
- Department of Psychology, The Mood Disorders Centre, University of Exeter, Exeter, United Kingdom
| | - Hannah L. I. Bunce
- CEDAR, University of Exeter and Somerset Foundation Trust NHS, Taunton, United Kingdom
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26
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Systematic Review and Meta-Analysis of Cognitive-Behavioural Therapy for Insomnia on Subjective and Actigraphy-Measured Sleep and Comorbid Symptoms in Cancer Survivors. Sleep Med Rev 2022; 63:101615. [DOI: 10.1016/j.smrv.2022.101615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
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27
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Cabezón-Gutiérrez L, Álamo-González C, Monge-Martín D, Caballero-Martínez F. Analyzing Differences in Perception between Oncologists and Patients to Adapt Pharmacological Treatment for Breakthrough Cancer Pain: Observational ADAPTATE Study. J Palliat Med 2022; 25:925-931. [DOI: 10.1089/jpm.2021.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology Department, University Hospital of Torrejón, Torrejón de Ardoz, Madrid, Spain
| | | | - Diana Monge-Martín
- Research Unit, Faculty of Medicine, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
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28
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Supported Housing for non-homeless individuals with severe mental illness: Comparison of two effectiveness studies using a randomised controlled and an observational study design. Front Psychiatry 2022; 13:1033328. [PMID: 36440393 PMCID: PMC9685807 DOI: 10.3389/fpsyt.2022.1033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field. METHODS A two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms. RESULTS The study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [-0.08 to 13.35]) and the OS (2.24 [-2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [-0.52 to 0.75]; OS: 0.16 [-0.26 to 0.58]) and symptoms (RCT: -0.18 [-0.75 to 0.40]; OS: 0.21 [-0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants' willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable. CONCLUSION Participants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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29
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Bialosky JE, Cleland JA, Mintken P, Beneciuk JM, Bishop MD. The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain. J Man Manip Ther 2021; 30:68-77. [PMID: 34657575 DOI: 10.1080/10669817.2021.1989754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.
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Affiliation(s)
- Joel E Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA.,Brooks-PHHP Research Collaboration, Gainesville, Florida, USA
| | - Josh A Cleland
- Department of Physical Therapy, Tufts University, Boston, Massachusetts, USA
| | - Paul Mintken
- Department of Physical Therapy, University of Colorado Physical Medicine and Rehabilitation- Physical Therapy, Aurora, Colorado, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA.,Center for Pain Research and Behavioral Health, Gainesville, Florida, USA
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30
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Ericson J, Anagrius C, Rygaard A, Guntram L, Wendel SB, Hesselman S. Women's experiences of receiving information about and consenting or declining to participate in a randomized controlled trial involving episiotomy in vacuum-assisted delivery: a qualitative study. Trials 2021; 22:658. [PMID: 34565424 PMCID: PMC8474868 DOI: 10.1186/s13063-021-05624-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Information about and invitation to participate in a clinical trial involving an intervention during childbirth may cause fear or worry in pregnant women. The aim of this study was to describe nulliparous women’s experiences of receiving an invitation to participate in a randomized controlled trial (RCT) of lateral episiotomy versus no episiotomy in vacuum-assisted delivery (EVA trial). Methods This qualitative study was nested in the ongoing EVA trial. Data were collected through semistructured telephone interviews with 23 women regarding their experiences of the information and invitation to participate in the EVA trial. Interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was used to analyse the interview contents. Results Three main experience categories were identified among the participants. “Timing of trial information and understanding” revealed that women preferred to obtain information about the trial early on during pregnancy. “Reasons to consent to or decline participation in the trial” encompassed a variety of reasons for women to consent, such as goodwill for science or personal benefits, or to decline, such as not wanting to be randomized or fear of increased risk of having a vacuum-assisted delivery. “Thoughts evoked regarding childbirth” were diverse, ranging from not being affected at all to having increased anxiety. Conclusions The women’s experience of receiving an invitation to participate in an RCT of episiotomy in vacuum-assisted delivery varied widely, from immediately giving consent without further worries to increased anxiety or declining participation. Early and personal information with time for reflection was considered most satisfactory. Trial registration ClinicalTrials.govNCT02643108. Registered on December 28, 2015. The Lateral Episiotomy or Not in Vacuum Assisted Delivery in Non-parous Women (EVA) trial was registered at www.clinicaltrials.gov.
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Affiliation(s)
- Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. .,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden. .,Department of Pediatrics, Falu Hospital, Falun, Sweden.
| | - Cecilia Anagrius
- Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden
| | - Agnes Rygaard
- Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden
| | - Lisa Guntram
- Department of Thematic Studies - Technology and Social Change, Linköping University, Linköping, Sweden
| | - Sophia Brismar Wendel
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Susanne Hesselman
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Department of Gynecology and Obstetrics, Falu Hospital, Falun, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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31
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Schwartzkopff L, Gutermann J, Steil R, Müller-Engelmann M. Which Trauma Treatment Suits me? Identification of Patients' Treatment Preferences for Posttraumatic Stress Disorder (PTSD). Front Psychol 2021; 12:694038. [PMID: 34456808 PMCID: PMC8387597 DOI: 10.3389/fpsyg.2021.694038] [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: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Several psychotherapy treatments exist for posttraumatic stress disorder. This study examines the treatment preferences of treatment-seeking traumatized adults in Germany and investigates the reasons for their treatment choices. Preferences for prolonged exposure, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), psychodynamic psychotherapy and stabilization were assessed via an online survey. Reasons for preferences were analyzed by means of thematic coding by two independent rates. 104 traumatized adults completed the survey. Prolonged exposure and CBT were each preferred by nearly 30%, and EMDR and psychodynamic psychotherapy were preferred by nearly 20%. Stabilization was significantly less preferred than all other options, by only 4%. Significantly higher proportions of patients were disinclined to choose EMDR and stabilization. Patients who preferred psychodynamic psychotherapy were significantly older than those who preferred CBT. Reasons underlying preferences included the perceived treatment mechanisms and treatment efficacy. Traumatized patients vary in their treatment preferences. Preference assessments may help clinicians comprehensively address patients' individual needs and thus improve therapy outcomes.
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Affiliation(s)
- Laura Schwartzkopff
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
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Oprel DAC, Hoeboer CM, Schoorl M, de Kleine RA, Cloitre M, Wigard IG, van Minnen A, van der Does W. Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2021; 12:1851511. [PMID: 34630934 PMCID: PMC8500700 DOI: 10.1080/20008198.2020.1851511] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity. Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen's d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t135 = -2.85, p = .005, d = .49) but not clinician-assessed symptoms (t135 = -1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t135 = -4.11, p < .001, d = .71) and clinician-assessed symptoms (t135 = -2.77, p = .006, Cohen's d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions. Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes. The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113.
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Affiliation(s)
- Danielle A C Oprel
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,PsyQ, Parnassiagroep, The Hague, The Netherlands
| | - Chris M Hoeboer
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,PsyQ, Parnassiagroep, The Hague, The Netherlands
| | - Maartje Schoorl
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,PsyQ, Parnassiagroep, The Hague, The Netherlands
| | - Rianne A de Kleine
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Marylene Cloitre
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.,National Center for PTSD Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Agnes van Minnen
- PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Willem van der Does
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,PsyQ, Parnassiagroep, The Hague, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Sommer J, Dyczmons J, Grobosch S, Gontscharuk V, Vomhof M, Roden M, Icks A. Preferences of people with type 2 diabetes for telemedical lifestyle programmes in Germany: protocol of a discrete choice experiment. BMJ Open 2020; 10:e036995. [PMID: 32907900 PMCID: PMC7482475 DOI: 10.1136/bmjopen-2020-036995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Telemedical lifestyle programmes for people with type 2 diabetes mellitus (T2DM) provide an opportunity to develop a healthier lifestyle and consequently to improve health outcomes. When implementing new programmes into standard care, considering patients' preferences may increase the success of the participants. This study aims to examine the preferences of people with T2DM with respect to telemedical lifestyle programmes, to analyse whether these preferences predict programme success and to explore the changes that may occur during a telemedical lifestyle intervention. METHODS AND ANALYSIS We outline the protocol of the development and assessment of a discrete choice experiment (DCE) to examine patient preferences in a telemedical lifestyle programme with regard to the functions of the online portal, communication, responsibilities, group activities and time requirements. To develop the design of the DCE, we conducted pilot work involving healthcare experts and in particular people with T2DM using cognitive pretesting. The final DCE is being implemented within a randomised controlled trial for investigating whether participation in a telemedical lifestyle intervention programme sustainably improves the HbA1c values in 850 members of a large German statutory health insurance with T2DM. Preferences are being assessed before and after participants complete the programme. The DCE data will be analysed using regression and latent class analyses. ETHICS AND DISSEMINATION The DCE study has been approved by the ethics committee of the medical faculty of the Heinrich Heine University Duesseldorf, registration number 2018-242-ProspDEuA, registered on 6 December 2018. The TeLIPro trial is registered at the US National Library of Medicine, registration number NCT03675919, registered on 15 September 2018. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Jana Sommer
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jan Dyczmons
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sandra Grobosch
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Division of Endocrinology and Diabetology, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Beneciuk JM, Verstandig D, Taylor C, Scott D, Levin J, Osborne R, Bialosky JE, Lentz TA, Buck T, Davis AL, Harder C, Beneciuk MB, Wittmer V, Sylvester J, Rowe R, McInnes D, Fisher TP, McGarrie L. Musculoskeletal pain stakeholder engagement and partnership development: determining patient-centered research priorities. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:28. [PMID: 32514375 PMCID: PMC7268422 DOI: 10.1186/s40900-020-00192-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) pain is a global public health problem with increased societal burden. Increased attention has focused toward patient and other stakeholder perspectives when determining future MSK pain research priorities, however infrastructure and capacity building within the community are needed for individuals and organizations to participate in patient-centered outcomes research. The purpose of this manuscript is to describe our collaborative experiences with several MSK pain stakeholders and processes to identify a top priority research topic. METHODS Lunch meetings and formalized workshops were used to develop infrastructure for engaging patients and other stakeholders with early capacity building for partners to identify MSK pain research ideas based on their personal experiences. Additional capacity building and engagement through literature searching further prepared partners to contribute informed decisions about MSK pain research topics and subsequent selection of an important research question. RESULTS Several key deliverables (e.g., Governance Document, Communication Plan) were developed and completed over the course of this project to provide partnership structure. Other key deliverables included a list of preliminary comparative effectiveness research ideas (n = 8) and selection of shared decision making for MSK pain as the top priority research topic with patient partners identifying pain self-efficacy as an important outcome domain. CONCLUSIONS Our patient partners provided the catalyst for identifying shared decision making as a high priority research topic based on a wide spectrum of stakeholder perspectives and unique experiences. Patient partners were primarily identified using a single rehabilitation health system and clinician partners were heavily weighted by physical therapists which may have introduced selection bias.
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Affiliation(s)
- Jason M. Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, Florida USA
- Brooks Rehabilitation and University of Florida College of Public Health & Health Professions Research Collaboration, Jacksonville, Florida USA
| | | | | | - Doug Scott
- Patient partner, Jacksonville, Florida USA
| | - Joan Levin
- Patient partner, Jacksonville, Florida USA
| | | | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville, Florida USA
- Brooks Rehabilitation and University of Florida College of Public Health & Health Professions Research Collaboration, Jacksonville, Florida USA
| | - Trevor A. Lentz
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina USA
| | - Tava Buck
- Mayo Clinic, Jacksonville, Florida USA
| | - Anita L. Davis
- Brooks Rehabilitation Behavioral Medicine, Jacksonville, Florida USA
| | | | | | - Virgil Wittmer
- Brooks Rehabilitation Behavioral Medicine, Jacksonville, Florida USA
| | | | - Robert Rowe
- Brooks Rehabilitation, Institute of Higher Learning, Jacksonville, Florida USA
| | - David McInnes
- St. Vincent’s Family Medicine Residency Program, Ascension St. Vincent’s, Jacksonville, Florida USA
| | - Tad P. Fisher
- Florida Physical Therapy Association, Tallahassee, Florida USA
| | - Lisa McGarrie
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
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