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Dubois H, Manser T, Häbel H, Härgestam M, Creutzfeldt J. Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams - an observational study with a randomized cross-over design. BMC Emerg Med 2024; 24:118. [PMID: 39009973 PMCID: PMC11247836 DOI: 10.1186/s12873-024-01037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team - creating 'distributed teams'. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing. The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians' perceptions regarding shared decision-making differ between co-located and distributed emergency teams. METHODS In an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations. RESULTS A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category 'Sharing power', the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03). CONCLUSIONS Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.
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Affiliation(s)
- Hanna Dubois
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32 Karolinska University Hospital, Stockholm, S-14186, Sweden.
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, S-11883, Sweden.
| | - Tanja Manser
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32 Karolinska University Hospital, Stockholm, S-14186, Sweden
- FHNW School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Riggenbachstrasse 16, CH-4600, Olten, Switzerland
| | - Henrike Häbel
- Department of Learning, Informatics, Management and Ethics, Medical Statistics Unit, Karolinska Institutet, C7, Stockholm, S-171 77, Sweden
| | - Maria Härgestam
- Department of Nursing, Umeå University, S-907 87, Umeå, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, K32 Karolinska University Hospital, Stockholm, S-14186, Sweden
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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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Shaffer JA, Matlock DD, Boylan JM, Vagnini KM, Rush CL, Martin R, Masters KS. Linking Cardiac Psychology and Cardiovascular Medicine via Self-Determination Theory and Shared Decision-Making. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10014-8. [PMID: 38678122 DOI: 10.1007/s10880-024-10014-8] [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] [Accepted: 03/07/2024] [Indexed: 04/29/2024]
Abstract
Despite considerable progress in recent years, research in cardiac psychology is not widely translated into routine practice by clinical cardiologists or clinical health psychologists. Self-determination theory (SDT), which addresses how basic psychological needs of autonomy, competence, and relatedness contribute to the internalization of motivation, may help bridge this research-practice gap through its application to shared decision-making (SDM). This narrative review discusses the following: (a) brief background information on SDT and SDM, (b) the application of SDT to health behavior change and cardiology interventions, and (c) how SDT and SDM may be merged using a dissemination and implementation (D&I) framework. We address barriers to implementing SDM in cardiology, how SDM and SDT address the need for respect of patient autonomy, and how SDT can enhance D&I of SDM interventions through its focus on autonomy, competence, and relatedness and its consideration of other constructs that facilitate the internalization of motivation.
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Affiliation(s)
- Jonathan A Shaffer
- Department of Psychology, University of Colorado Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA.
| | - Daniel D Matlock
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, USA
| | | | - Katilyn M Vagnini
- Department of Psychology, University of Colorado Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - Christina L Rush
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Rebecca Martin
- Department of Psychology, University of Colorado Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - Kevin S Masters
- Department of Psychology, University of Colorado Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, USA
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Humphreys H, Paddock D, Brown S, Berry C, Cowie A, Dawkes S, Nichols S. Living with myocardial ischaemia and no obstructive coronary arteries: a qualitative study. Open Heart 2024; 11:e002569. [PMID: 38331473 PMCID: PMC10860068 DOI: 10.1136/openhrt-2023-002569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To explore the lived experience of people with myocardial ischaemia with no obstructive arteries. DESIGN Qualitative study using semistructured interviews. SETTING Telephone interviews with 17 participants living in the UK. PARTICIPANTS 17 people (2 males, 15 females; aged 31-69 years) with a presumed or confirmed diagnosis of myocardial ischaemia with no obstructive arteries, recruited via social media and online patient-led support forums. RESULTS Five themes were generated. Theme 1 describes the wide range of experiences that participants described, particularly the frequency and intensity of symptoms, and the uncertainty and fear that symptoms commonly provoked. Theme 2 describes the major impact on social relationships, employment and other aspects of everyday life. Theme 3 illustrates challenging and traumatising experiences participants described around pathways to diagnosis and accessing medical support. Theme 4 highlights the lack of consensus and clarity that participants had been confronted with around treatment and management. Theme 5 describes coping and supportive strategies valued by participants. CONCLUSIONS This study provides insight into the challenges of living with myocardial ischaemia with no obstructive arteries. Findings highlight the significant psychological impact on people living with these conditions and the need for improvements in diagnosis, support and long-term management.
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Affiliation(s)
- Helen Humphreys
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Danielle Paddock
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Sarah Brown
- Cardiovascular Care Partnership, London, UK
- International Heart Spasms Alliance, London, UK
| | - Colin Berry
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Simon Nichols
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
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Code J. At the Heart of Resilience: Empowering Women's Agency in Navigating Cardiovascular Disease. CJC Open 2024; 6:473-484. [PMID: 38487058 PMCID: PMC10935683 DOI: 10.1016/j.cjco.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women's agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. The review highlights the shift toward patient-centred care, a framework in which women are recognized as key decision-makers, a crucial change given the historical underemphasis on women's health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women's agency throughout the diagnostic journey. By highlighting women's agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.
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Affiliation(s)
- Jillianne Code
- Woman with Lived Experience, Victoria, British Columbia, Canada
- HeartLife Foundation of Canada, Vancouver, British Columbia, Canada
- Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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Baugh CW, Blankstein R, Ganguli I, Januzzi JL, Morrow DA, Joseph JW, Jordan C, Donohoe G, Fofi J, McKinley K, Heydarpour M, Scirica BM, DiCarli MF, Nagurney JT. Frequency, compliance, and yield of cardiac testing after high-sensitivity troponin accelerated diagnostic protocol implementation. Am J Emerg Med 2023; 72:64-71. [PMID: 37494772 PMCID: PMC10616758 DOI: 10.1016/j.ajem.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Among persons presenting to the emergency department with suspected acute myocardial infarction (MI), cardiac troponin (cTn) testing is commonly used to detect acute myocardial injury. Accelerated diagnostic protocols (ADPs) guide clinicians to integrate cTn results with other clinical information to decide whether to order further diagnostic testing. OBJECTIVE To determine the change in the rate and yield of stress test or coronary CT angiogram following cTn measurement in patients with chest pain presenting to the emergency department pre- and post-transition to a high-sensitivity (hs-cTn) assay in an updated ADP. METHODS Using electronic health records, we examined visits for chest pain at five emergency departments affiliated with an integrated academic health system 1-year pre- and post-hs-cTn assay transition. Outcomes included stress test or coronary imaging frequency, ADP compliance among those with additional testing, and diagnostic yield (ratio of positive tests to total tests). RESULTS There were 7564 patient-visits for chest pain, including 3665 in the pre- and 3899 in the post-period. Following the updated ADP using hs-cTn, 862 (23.5 per 100 patient visits) visits led to subsequent testing versus 1085 (27.8 per 100 patient visits) in the pre-hs-cTn period, (P < 0.001). Among those who were tested, the protocol-compliant rate fell from 80.9% to 46.5% (P < 0.001), but the yield of those tests rose from 24.5% to 29.2% (P = 0.07). Among tests that were noncompliant with ADP guidance, yield was similar pre- and post-updated hs-cTn ADP implementation (pre 13.0%, post 15.4% (P = 0.43). CONCLUSION Implementation of hs-cTn supported by an updated ADP was associated with a lower rate of stress testing and coronary CT angiogram.
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Affiliation(s)
- Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ishani Ganguli
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, MA, USA
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joshua W Joseph
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Gabrielle Donohoe
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jordyn Fofi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Katie McKinley
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Benjamin M Scirica
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcelo F DiCarli
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Zheng H, Zhang D, Xiang W, Wu Y, Peng Z, Gan Y, Chen S. Interventions to Facilitate Shared Decision-Making Using Decision Aids with Coronary Heart Disease Patients: Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2023; 24:246. [PMID: 39076712 PMCID: PMC11266786 DOI: 10.31083/j.rcm2408246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 07/31/2024] Open
Abstract
Background Coronary heart disease (CHD) is the leading cause of death in the world. There are some decision-making conflicts in the management of chest pain, treatment methods, stent selection, and other aspects due to the unstable condition of CHD in the treatment stage. Although using decision aids to facilitate shared decision-making (SDM) contributes to high-quality decision-making, it has not been evaluated in the field of CHD. This review systematically assessed the effects of SDM in patients with CHD. Methods We conducted a systematic review and meta-analysis of randomized controlled trials of SDM interventions in patients with CHD from database inception to 1 June 2022 (PROSPERO [Unique identifier: CRD42022338938]). We searched for relevant studies in the PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wan Fang databases. The primary outcomes were knowledge and decision conflict. The secondary outcomes were satisfaction, patient participation, trust, acceptance, quality of life, and psychological condition. Results A total of 8244 studies were retrieved. After screening, ten studies were included in the analysis. Compared with the control group, SDM intervention with patient decision aids obviously improved patients' knowledge, decision satisfaction, participation, and medical outcomes and reduced decision-making conflict. There was no significant effect of SDM on trust. Conclusions This study showed that SDM intervention in the form of decision aids was beneficial to decision-making quality and treatment outcomes among patients with CHD. The results of SDM interventions need to be evaluated in different environments.
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Affiliation(s)
- Haoyang Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
| | - Duo Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Wei Xiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
| | - Yuxi Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
| | - Zesheng Peng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
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Zhang D, Zheng H, Zheng Z, Pan Y, Zha Z, Liu J, Zhu L, Wu Q, Hu K, Chen Z, Wang X, Barnabo Nampoukime KP, Zhou Y. The Impact of Shared Decision-Making on the Quality of Decision Making in Aortic Dissection: A before-and-after Comparison Study. Rev Cardiovasc Med 2023; 24:244. [PMID: 39076701 PMCID: PMC11266772 DOI: 10.31083/j.rcm2408244] [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: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 07/31/2024] Open
Abstract
Background Complex surgical plans and consideration of risks and benefits often cause decisional conflicts for decision-makers in aortic dissection (AD) surgery, resulting in decision delay. Shared decision-making (SDM) improves decision readiness and reduces decisional conflicts. The purpose of this study was to investigate the impact of SDM on decision quality in AD. Methods One hundred and sixty AD decision-makers were divided into two groups: control (n = 80) and intervention (n = 80). The surgical plan for the intervention group was determined using patient decision aids. The primary outcome was decisional conflict. Secondary outcomes included decision preparation, decision satisfaction, surgical method, postoperative complications, actual participation role, and duration of consultation. The data were analyzed with SPSS 26.0 (IBM Corp., Chicago, IL, USA). p < 0.05 was considered statistically significant. Results The decisional conflict score was significantly lower in the intervention group than in the control group (p < 0.001). The decision preparation and decision satisfaction scores in the intervention group were significantly higher than those in the control group (p < 0.001). There were more SDM decision-makers in the intervention group (16 [20%] vs. 42 [52.50%]). There was no statistical significance in the choice of surgical, postoperative complications, duration of consultation, and hospital and post-operative intensive care unit stay time (p = 0.267, p = 0.130, p = 0.070, p = 0.397, p = 0.421, respectively). Income, education level, and residence were the influencing factors of decision-making conflict. Conclusions SDM can reduce decisional conflict, improve decision preparation and satisfaction, and help decision-makers actively participate in the medical management of patients with AD without affecting the medical outcome.
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Affiliation(s)
- Duo Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Haoyang Zheng
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022 Wuhan, Hubei, China
| | - Zhi Zheng
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Youmin Pan
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Zhengbiao Zha
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Juan Liu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Lisi Zhu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Qiansheng Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Kaili Hu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Zelin Chen
- Department of Virology, Research Institute for Microbial Diseases, Osaka University, 565-0871 Suita, Osaka, Japan
| | - Xiaoxiao Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Kan-Paatib Barnabo Nampoukime
- Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
| | - Yanrong Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China
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van der Horst DEM, Garvelink MM, Bos WJW, Stiggelbout AM, Pieterse AH. For which decisions is Shared Decision Making considered appropriate? - A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 106:3-16. [PMID: 36220675 DOI: 10.1016/j.pec.2022.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used. METHODS We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2). RESULTS From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate. CONCLUSION The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM. PRACTICE IMPLICATIONS The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.
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Affiliation(s)
- Dorinde E M van der Horst
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Santeon, Utrecht, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands.
| | - Mirjam M Garvelink
- St. Antonius Hospital, Department of Value Based Healthcare, Nieuwegein, the Netherlands
| | - Willem Jan W Bos
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands
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Li S, Xie J, Chen Z, Yan J, Zhao Y, Cong Y, Zhao B, Zhang H, Ge H, Ma Q, Shen N. Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China. World J Emerg Med 2023; 14:380-385. [PMID: 37908803 PMCID: PMC10613793 DOI: 10.5847/wjem.j.1920-8642.2023.076] [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: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. METHODS This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from "very unimportant" (a score of 1) to "extremely important" (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall's W coefficient was calculated to evaluate the consensus of experts. RESULTS A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall's W coefficient was achieved. CONCLUSION A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives.
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Affiliation(s)
- Shu Li
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jing Xie
- Department of Infectious Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ziyi Chen
- Department of Neurology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yuliang Zhao
- Department of Nephrology, West China Hospital, West China School of Medicine, Chengdu 610041, China
| | - Yali Cong
- Institute of Medical Humanities, School of Foundational Education, Peking University Health Science Center, Beijing 100191, China
| | - Bin Zhao
- Department of Emergency Medicine, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing 100035, China
| | - Hua Zhang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - Hongxia Ge
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qingbian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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Mirzadeh SI, Arefeen A, Ardo J, Fallahzadeh R, Minor B, Lee JA, Hildebrand JA, Cook D, Ghasemzadeh H, Evangelista LS. Use of machine learning to predict medication adherence in individuals at risk for atherosclerotic cardiovascular disease. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 26:100328. [PMID: 37169026 PMCID: PMC10168531 DOI: 10.1016/j.smhl.2022.100328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background Medication nonadherence is a critical problem with severe implications in individuals at risk for atherosclerotic cardiovascular disease. Many studies have attempted to predict medication adherence in this population, but few, if any, have been effective in prediction, sug-gesting that essential risk factors remain unidentified. Objective This study's objective was to (1) establish an accurate prediction model of medi-cation adherence in individuals at risk for atherosclerotic cardiovascular disease and (2) identify significant contributing factors to the predictive accuracy of medication adherence. In particular, we aimed to use only the baseline questionnaire data to assess medication adherence prediction feasibility. Methods A sample of 40 individuals at risk for atherosclerotic cardiovascular disease was recruited for an eight-week feasibility study. After collecting baseline data, we recorded data from a pillbox that sent events to a cloud-based server. Health measures and medication use events were analyzed using machine learning algorithms to identify variables that best predict medication adherence. Results Our adherence prediction model, based on only the ten most relevant variables, achieved an average error rate of 12.9%. Medication adherence was closely correlated with being encouraged to play an active role in their treatment, having confidence about what to do in an emergency, knowledge about their medications, and having a special person in their life. Conclusions Our results showed the significance of clinical and psychosocial factors for predicting medication adherence in people at risk for atherosclerotic cardiovascular diseases. Clini-cians and researchers can use these factors to stratify individuals to make evidence-based decisions to reduce the risks.
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Affiliation(s)
- Seyed Iman Mirzadeh
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Asiful Arefeen
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
- Corresponding author: (A. Arefeen)
| | - Jessica Ardo
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Ramin Fallahzadeh
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Bryan Minor
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing University of California Irvine, Irvine, CA, 92697, USA
| | - Janett A. Hildebrand
- Department of Nursing at the School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - Diane Cook
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA, 99163, USA
| | - Hassan Ghasemzadeh
- College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
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12
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Ashburn NP, Snavely AC, Paradee BE, O'Neill JC, Stopyra JP, Mahler SA. Age differences in the safety and effectiveness of the HEART Pathway accelerated diagnostic protocol for acute chest pain. J Am Geriatr Soc 2022; 70:2246-2257. [PMID: 35383887 PMCID: PMC9378522 DOI: 10.1111/jgs.17777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The HEART Pathway is a validated protocol for risk stratifying emergency department (ED) patients with possible acute coronary syndrome (ACS). Its performance in different age groups is unknown. The objective of this study is to evaluate its safety and effectiveness among older adults. METHODS A pre-planned subgroup analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time series accrued adult ED patients with possible ACS who were without ST-elevation across three US sites from 11/2013-01/2016. After implementation, providers prospectively used the HEART Pathway to stratify patients as low-risk or non-low-risk. Patients were classified as older adults (≥65 years), middle-aged (46-64 years), and young (21-45 years). Primary safety and effectiveness outcomes were 30-day death or MI and hospitalization at 30 days, determined from health records, insurance claims, and death index data. Fisher's exact test compared low-risk proportions between groups. Sensitivity for 30-day death or MI and adjusted odds ratios (aORs) for hospitalization and objective cardiac testing were calculated. RESULTS The HEART Pathway implementation study accrued 8474 patients, of which 26.9% (2281/8474) were older adults, 45.5% (3862/8474) middle-aged, and 27.5% (2331/8474) were young. The HEART Pathway identified 7.4% (97/1303) of older adults, 32.0% (683/2131) of middle-aged, and 51.4% (681/1326) of young patients as low-risk (p < 0.001). The HEART Pathway was 98.8% (95% CI 97.1-100) sensitive for 30-day death or MI among older adults. Following implementation, the rate of 30-day hospitalization was similar among older adults (aOR 1.25, 95% CI 1.00-1.55) and cardiac testing increased (aOR 1.25, 95% CI 1.04-1.51). CONCLUSION The HEART Pathway identified fewer older adults as low-risk and did not decrease hospitalizations in this age group.
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Affiliation(s)
- Nicklaus P. Ashburn
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA,Section on Cardiovascular Medicine, Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Anna C. Snavely
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA,Department of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Brennan E. Paradee
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James C. O'Neill
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jason P. Stopyra
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Simon A. Mahler
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA,Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA,Department of Implementation ScienceWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Prick JCM, Zonjee VJ, van Schaik SM, Dahmen R, Garvelink MM, Brouwers PJAM, Saxena R, Keus SHJ, Deijle IA, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM. Experiences with information provision and preferences for decision making of patients with acute stroke. PATIENT EDUCATION AND COUNSELING 2022; 105:1123-1129. [PMID: 34462248 DOI: 10.1016/j.pec.2021.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to gain insight into experiences of patients with acute stroke regarding information provision and their preferred involvement in decision-making processes during the initial period of hospitalisation. METHODS A sequential explanatory design was used in two independent cohorts of patients with stroke, starting with a survey after discharge from hospital (cohort 1) followed by observations and structured interviews during hospitalisation (cohort 2). Quantitative data were analysed descriptively. RESULTS In total, 72 patients participated in this study (52 in cohort 1 and 20 in cohort 2). During hospitalisation, the majority of the patients were educated about acute stroke and their treatment. Approximately half of the patients preferred to have an active role in the decision-making process, whereas only 21% reported to be actively involved. In cohort 2, 60% of the patients considered themselves capable to carefully consider treatment options. CONCLUSIONS Active involvement in the acute decision-making process is preferred by approximately half of the patients with acute stroke and most of them consider themselves capable of doing so. However, they experience a limited degree of actual involvement. PRACTICE IMPLICATIONS Physicians can facilitate patient engagement by explicitly emphasising when a decision has to be made in which the patient's opinion is important.
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Affiliation(s)
- J C M Prick
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Santeon, Utrecht, The Netherlands.
| | - V J Zonjee
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M M Garvelink
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Saxena
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - S H J Keus
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | - I A Deijle
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | | | - P J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Niederdöckl JD, Simon A, Buchtele N, Schütz N, Cacioppo F, Oppenauer J, Gupta S, Lutnik M, Schnaubelt S, Spiel A, Roth D, Wimbauer F, Fegers-Wustrow I, Esefeld K, Halle M, Scharhag J, Laschitz T, Herkner H, Domanovits H, Schwameis M. Prediction of Successful Pharmacological Cardioversion in Acute Symptomatic Atrial Fibrillation: The Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) Score. J Pers Med 2022; 12:544. [PMID: 35455660 PMCID: PMC9025522 DOI: 10.3390/jpm12040544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Modern personalised medicine requires patient-tailored decisions. This is particularly important when considering pharmacological cardioversion for the acute treatment of haemodynamically stable atrial fibrillation and atrial flutter in a shared decision-making process. We aimed to develop and validate a predictive model to estimate the individual probability of successful pharmacological cardioversion using different intravenous antiarrhythmic agents. Methods: We analysed data from a prospective atrial fibrillation registry comprising 3053 cases of first-detected or recurrent haemodynamically stable, non-permanent, symptomatic atrial fibrillation presenting to an Austrian academic emergency department between January 2012 and December 2017. Using multivariable analysis, a prediction score was developed and externally validated. The clinical utility of the score was assessed using decision curve analysis. Results: A total of 1528 cases were included in the development cohort (median age 69 years, IQR 58−76; 43.9% female), and 1525 cases were included in the validation cohort (median age 68 years, IQR (58−75); 39.5% female). Finally, 421 cases were available for score development and 330 cases for score validation The weighted score included atrial flutter (8 points), duration of symptoms associated with AF (<24 h; 8 points), absence of previous electrical cardioversion (10 points), and the specific intravenous antiarrhythmic drug (amiodarone 10 points, vernakalant 11 points, ibutilide 13 points). The final score, the “Successful Intravenous Cardioversion for Atrial Fibrillation (SIC-AF) score,” showed good calibration (R2 = 0.955 and R2 = 0.954) and discrimination in both sets (c-indices: 0.68 and 0.66) and net clinical benefit. Conclusions: A predictive model was developed to estimate the success of intravenous pharmacological cardioversion using different antiarrhythmic agents in a cohort of patients with haemodynamically stable, non-permanent, symptomatic atrial fibrillation. External temporal validation confirmed good calibration, discrimination, and clinical usefulness. The SIC-AF score may help patients and physicians jointly decide on the appropriate treatment strategy for acute symptomatic atrial fibrillation. Registration: NCT03272620.
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Affiliation(s)
- Jan Daniel Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Alexander Simon
- Zentrale Notaufnahme, Klinik Ottakring, 1160 Vienna, Austria;
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Julia Oppenauer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Sophie Gupta
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Martin Lutnik
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Alexander Spiel
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
- Zentrale Notaufnahme, Klinik Ottakring, 1160 Vienna, Austria;
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Fritz Wimbauer
- Clinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, Germany; (F.W.); (I.F.-W.); (K.E.); (M.H.)
| | - Isabel Fegers-Wustrow
- Clinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, Germany; (F.W.); (I.F.-W.); (K.E.); (M.H.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
| | - Katrin Esefeld
- Clinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, Germany; (F.W.); (I.F.-W.); (K.E.); (M.H.)
| | - Martin Halle
- Clinic for Prevention, Rehabilitation, and Sports Medicine, Technical University of Munich-Klinikum Rechts der Isar, 80992 Munich, Germany; (F.W.); (I.F.-W.); (K.E.); (M.H.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80992 Munich, Germany
| | - Jürgen Scharhag
- Department of Sports Medicine, Exercise Physiology and Prevention, Institute of Sport Science, Centre for Sport Science and University Sports, University of Vienna, 1150 Vienna, Austria;
| | - Thomas Laschitz
- Department of Obstetrics and Gynecology, Landesklinikum Korneuburg, 2102 Korneuburg, Austria;
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (N.S.); (F.C.); (J.O.); (S.G.); (M.L.); (S.S.); (A.S.); (D.R.); (H.H.); (H.D.); (M.S.)
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15
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Billah T, Gordon L, Schoenfeld EM, Chang BP, Hess EP, Probst MA. Clinicians' perspectives on the implementation of patient decision aids in the emergency department: A qualitative interview study. J Am Coll Emerg Physicians Open 2022; 3:e12629. [PMID: 35079731 PMCID: PMC8769071 DOI: 10.1002/emp2.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Decision aids (DAs) are tools to facilitate and standardize shared decision making (SDM). Although most emergency clinicians (ECs) perceive SDM appropriate for emergency care, there is limited uptake of DAs in clinical practice. The objective of this study was to explore barriers and facilitators identified by ECs regarding the implementation of DAs in the emergency department (ED). METHODS We conducted a qualitative interview study guided by implementation science frameworks. ECs participated in interviews focused on the implementation of DAs for the disposition of patients with low-risk chest pain and unexplained syncope in the ED. Interviews were recorded and transcribed verbatim. We then iteratively developed a codebook with directed qualitative content analysis. RESULTS We approached 25 ECs working in urban New York, of whom 20 agreed to be interviewed (mean age, 41 years; 25% women). The following 6 main barriers were identified: (1) poor DA accessibility, (2) concern for increased medicolegal risk, (3) lack of perceived need for a DA, (4) patient factors including lack of capacity and limited health literacy, (5) skepticism about validity of DAs, and (6) lack of time to use DAs. The 6 main facilitators identified were (1) positive attitudes toward SDM, (2) patient access to follow-up care, (3) potential for improved patient satisfaction, (4) potential for improved risk communication, (5) strategic integration of DAs into the clinical workflow, and (6) institutional support of DAs. CONCLUSIONS ECs identified multiple barriers and facilitators to the implementation of DAs into clinical practice. These findings could guide implementation efforts targeting the uptake of DA use in the ED.
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Affiliation(s)
- Tausif Billah
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
| | - Lauren Gordon
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency MedicineUniversity of Massachusetts Medical School–BaystateSpringfieldMassachusettsUSA
| | - Bernard P. Chang
- Department of Emergency MedicineColumbia University Medical CenterNew YorkNew YorkUSA
| | - Erik P. Hess
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Marc A. Probst
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
- Department of Emergency MedicineColumbia University Medical CenterNew YorkNew YorkUSA
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16
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McRae AD, O'Rielly CM, Lang ES. High-Sensitivity Cardiac Troponins and Clinical Decision Making in Caring for Patients With Chest Pain. Ann Intern Med 2022; 175:137-138. [PMID: 34807715 DOI: 10.7326/m21-4342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Andrew D McRae
- Departments of Emergency Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Connor M O'Rielly
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy S Lang
- Departments of Emergency Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Melo CDF, Magalhães MRDAL, Meneses LMSD, Alves RSF, Magalhães JJC. Comunicação de más notícias no trabalho médico: um olhar do paciente com prognóstico reservado. TRABALHO, EDUCAÇÃO E SAÚDE 2022. [DOI: 10.1590/1981-7746-ojs226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Resumo O processo de comunicação é central na relação médico-paciente. É fato que para evitar distanásia deve se dispor dos cuidados paliativos como alternativa. Assim, objetivou-se avaliar a qualidade da comunicação de más notícias realizadas por médicos, na perspectiva de pacientes em processo de finitude, comparando seus índices entre aqueles em cuidados paliativos e em distanásia. Realizou-se uma pesquisa quantitativa, com amostra não probabilística, formada por 234 pacientes com câncer em processo de finitude, oriundos de cinco unidades hospitalares do Ceará, que responderam a dois questionários - um biodemográfico e outro de avaliação da comunicação, analisados por meio de estatística descritiva e bivariada. Os resultados demonstraram a importância da relação médico-paciente. Enquanto os pacientes em distanásia expressaram terem sido melhor preparados para o estabelecimento de uma adequada comunicação, os que estavam em cuidados paliativos relataram uma experiência menos negativa em relação à ‘comunicação de más notícias’ - fruto de um adequado preparo do médico paliativista, bem como da participação efetiva da família na decisão terapêutica. Conclui-se que as etapas de preparação para a comunicação, transmissão da informação, acolhimento e fechamento devem estar baseadas na identificação do conteúdo prévio dos pacientes sobre a doença e suas expectativas de informação.
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18
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Ismailov RM, Lerut J, Aceña Á, Khasanova ZD. Enhancing knowledge and awareness of transthyretin cardiac amyloidosis and shared decision-making among cardiology team members in Colorado, USA via an online educational initiative. Hosp Pract (1995) 2021; 50:37-41. [PMID: 34879213 DOI: 10.1080/21548331.2021.2016334] [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: 10/19/2022]
Abstract
OBJECTIVES Our project aimed to increase knowledge of noninvasive diagnostic modalities (including bone radiotracer scintigraphy), raise suspicion of transthyretin cardiac amyloidosis (ATTR-CA), and improve cardiology team member's awareness and knowledge of shared decision-making (SDM), as well as the quality of SDM communication between cardiology team members and patients. METHODS An online educational module and survey was developed and cardiology team members in Colorado, USA, were invited to participate. This online educational module included various important topics related to ATTR-CA (e.g., the cause of ATTR-CA, endomyocardial biopsy, and noninvasive methods to diagnose ATTR-CA) and SDM (e.g., benefits of SDM, the role of SDM in the diagnosis of ATTR-CA, implementation of SDM in cardiology practice, and the 3-talk model). RESULTS There were 34 survey respondents, over one-third of whom were cardiologists. Most respondents agreed on the importance of diagnosing ATTR-CA at an early stage, and about three-quarters of the survey takers agreed that bone scintigraphy can reliably diagnose ATTR-CA without the need for endomyocardial biopsy. Concern over increased time commitment was the leading barrier to the implementation of SDM in respondents' clinical practice. The majority of respondents identified the correct answer regarding ATTR-CA and SDM after reading the online educational module. This improvement in scores after exposure to the online educational module was statistically significant. CONCLUSION Baseline knowledge and awareness of various issues related to ATTR-CA was relatively low among cardiology team members. Participants' knowledge was enhanced through our effective online educational program. Prospective educational projects focused on various methods of detecting ATTR-CA as well as other amyloid conditions in diverse clinical settings will remain important.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, USA
| | - Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Université Catholique Louvain (UCL, Brussels, Belgium
| | - Álvaro Aceña
- Cardiology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, USA
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De Freitas Melo C, Lima Magalhães MRDA, Studart de Meneses LM, Fernandes Alves RS, Eberhardt Lins AC, Kern de Castro E. Relationship between doctors and patients in the end of life process in palliative care and dysthanasia. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.74539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: In the course of an illness, when the patient receives a poor prognosis, he can be assisted with dysthanasia or palliative care. The therapeutic choice and the adherence to it are related, among other factors, to the quality of the doctor-patient relationship. The objective of this study was to evaluate the patients’ point of view of the doctor-patient relationship in the end of life process, and compare scores between patients in palliative care and those experiencing dysthanasia. Method: The design was a descriptive survey with a non-probabilistic sample composed of 234 patients with cancer in the end of life process: 117 in palliative care and 117 expriencing dysthanasia. Two instruments were used: a biodemographic questionnaire and the Questionnaire for Assessing the Doctor-Patient Relationship in the End of Life Process, and data were analyzed using descriptive and bivariate statistics in the Statistical Package for the Social Sciences software. Results: The results showed good evaluations of the doctor-patient relationship. Palliative care patients attributed better scores in terms of time dedicated, attention, confidence, understanding and communication; and patients experiencing dysthanasia made better assessments in terms of frequency of visits and continuity of care. Conclusion: It is concluded that this study represents an advance in studies on the subject and indicates that patients in palliative care perceive the doctor-patient relationship more positively than patients undergoing dysthanasia. It stressed that it is necessary to invest in training medical students and professionals to carry out interventions that prioritize the use of their oldest, simplest and most powerful technology: the relationship between professionals and patients.
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Abstract
The International Research Project for the Humanization of Intensive Care Units (Proyecto HU-CI) was initiated in 2014. The aim of this project is to change the current paradigm toward a human-centered care model. Patients, families, and professionals (everyday stakeholders) were asked to describe their ideal intensive care unit (ICU). Using their opinions, 8 fields of research to improve the management of ICUs and change the reality of care throughout the world were designed. This replicable tested model to humanize the ICU care delivery model is presented.
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Affiliation(s)
- José Manuel Velasco Bueno
- Hospital Virgen de la Victoria, Málaga, Spain; International Research Project for the Humanization of Intensive Care Units (Proyecto HU-CI)
| | - Gabriel Heras La Calle
- International Research Project for the Humanization of Intensive Care Units (Proyecto HU-CI); Intensive Care Unit, Hospital Universitario de Torrejón, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain.
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21
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El-Hussein MT, Cuncannon A. Syncope in the Emergency Department: A Guide for Clinicians. J Emerg Nurs 2020; 47:342-351. [PMID: 33317859 DOI: 10.1016/j.jen.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/11/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
Syncope is a common presenting symptom to emergency departments, but its evaluation and initial management can be challenging for ED practitioners and particularly urgent in the presence of high-risk features that increase the likelihood of cardiac etiology. Even after thorough clinical evaluation, syncope may remain unexplained. In such instances, practitioners' clinical judgment and risk assessments are critical to guide further management. In this article, evidence-informed strategies are outlined to approach the diagnosis of syncope and provide an overview of syncope clinical decision rules and shared decision-making. By incorporating risk stratification and shared decision-making into syncope care, practitioners can more confidently engage patients and families in disposition decisions to organize appropriate outpatient and follow-up care, observation, or admission.
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22
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Finlay J, Wilson T, Javaheri PA, Pearson W, Connolly C, Elliott MJ, Graham MM, Norris CM, Wilton SB, James MT. Patient and physician perspectives on shared decision-making for coronary procedures in people with chronic kidney disease: a patient-oriented qualitative study. CMAJ Open 2020; 8:E860-E868. [PMID: 33303572 PMCID: PMC7867031 DOI: 10.9778/cmajo.20200039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and heart disease face challenging treatment decisions. We sought to explore the perceptions of patients and physicians about shared decision-making for coronary procedures for people with CKD, as well as opinions about strategies and tools to improve these decisions. METHODS We partnered with 4 patients with CKD and 1 caregiver to design and conduct a qualitative descriptive study using semi-structured interviews and content analysis. Patient participants with CKD and either acute coronary syndrome or cardiac catheterization in the preceding year were recruited from a provincial cardiac registry, cardiology wards and clinics in Calgary between March and September 2018. Cardiologists from the region also participated in the study. Data analysis emphasized identifying, organizing and describing themes found within the data. RESULTS Twenty patients with CKD and 10 cardiologists identified several complexities related to bidirectional information exchange needed for shared decision-making. Themes identified by both patients and physicians included challenges synthesizing best evidence, variable patient knowledge seeking, timeliness in the acute care setting and influence of roles on decision-making. Themes identified by physicians related to processes and tools to help support shared decision-making in this setting included personalization to reflect the variability of risks and heterogeneity of patient preferences as well as allowing for physicians to share their clinical judgment. INTERPRETATION There are complexities related to bidirectional information exchange between patients with CKD and their physicians for shared decision-making about coronary procedures. Processes and tools to facilitate shared decision-making in this setting require personalization and need to be time sensitive.
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Affiliation(s)
- Juli Finlay
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Todd Wilson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Pantea Amin Javaheri
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Winnie Pearson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Carol Connolly
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Meghan J Elliott
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Michelle M Graham
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Colleen M Norris
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Stephen B Wilton
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Matthew T James
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta.
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Probst MA, Lin MP, Sze JJ, Hess EP, Breslin M, Frosch DL, Sun BC, Langan M, Thiruganasambandamoorthy V, Richardson LD. Shared Decision Making for Syncope in the Emergency Department: A Randomized Controlled Feasibility Trial. Acad Emerg Med 2020; 27:853-865. [PMID: 32147870 DOI: 10.1111/acem.13955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Significant practice variation is seen in the management of syncope in the emergency department (ED). We sought to evaluate the feasibility of performing a randomized controlled trial of a shared decision making (SDM) tool for low-to-intermediate-risk syncope patients presenting to the ED. METHODS We performed a randomized controlled trial of adults (≥30 years) with unexplained syncope who presented to an academic ED in the United States. Patients with a serious diagnosis identified in the ED were excluded. Patients were randomized, 1:1, to receive either usual care or a personalized syncope decision aid (SynDA) meant to facilitate SDM. Our primary outcome was feasibility, i.e., ability to enroll 50 patients in 24 months. Secondary outcomes included patient knowledge, involvement (measured with OPTION-5), rating of care, and clinical outcomes at 30 days post-ED visit. RESULTS After screening 351 patients, we enrolled 50 participants with unexplained syncope from January 2017 to January 2019. The most common reason for exclusion was lack of clinical equipoise to justify SDM (n = 124). Patients in the SynDA arm tended to have greater patient involvement, as shown by higher OPTION-5 scores: 52/100 versus 27/100 (between-group difference = -25.4, 95% confidence interval = -13.5 to -37.3). Both groups had similar levels of clinical knowledge, ratings of care, and serious clinical outcomes at 30 days. CONCLUSIONS Among ED patients with unexplained syncope, a randomized controlled trial of a shared decision-making tool is feasible. Although this study was not powered to detect differences in clinical outcomes, it demonstrates feasibility, while providing key lessons and effect sizes that could inform the design of future SDM trials.
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Affiliation(s)
- Marc A. Probst
- From the Department of Emergency MedicineIcahn School of Medicine at Mount Sinai New York NY
| | - Michelle P. Lin
- From the Department of Emergency MedicineIcahn School of Medicine at Mount Sinai New York NY
| | - Jeremy J. Sze
- From the Department of Emergency MedicineIcahn School of Medicine at Mount Sinai New York NY
| | - Erik P. Hess
- the Department of Emergency Medicine University of Alabama at Birmingham Birmingham AL
| | | | | | - Benjamin C. Sun
- the Department of Emergency Medicine University of Pennsylvania Philadelphia PA
| | - Marie‐Noelle Langan
- and the Division of Cardiology Department of Medicine Icahn School of Medicine at Mount Sinai New York NY
| | | | - Lynne D. Richardson
- From the Department of Emergency MedicineIcahn School of Medicine at Mount Sinai New York NY
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Shinkunas LA, Klipowicz CJ, Carlisle EM. Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak 2020; 20:190. [PMID: 32787950 PMCID: PMC7424662 DOI: 10.1186/s12911-020-01211-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.
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Affiliation(s)
- Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Erica M Carlisle
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA. .,Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
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25
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Lindman BR, Arnold SV, Bagur R, Clarke L, Coylewright M, Evans F, Hung J, Lauck SB, Peschin S, Sachdev V, Tate LM, Wasfy JH, Otto CM. Priorities for Patient-Centered Research in Valvular Heart Disease: A Report From the National Heart, Lung, and Blood Institute Working Group. J Am Heart Assoc 2020; 9:e015975. [PMID: 32326818 PMCID: PMC7428554 DOI: 10.1161/jaha.119.015975] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past decade, the field of valvular heart disease (VHD) has rapidly transformed, largely as a result of the development and improvement of less invasive transcatheter approaches to valve repair or replacement. This transformation has been supported by numerous well-designed randomized trials, but they have centered almost entirely on devices and procedures. Outside this scope of focus, however, myriad aspects of therapy and management for patients with VHD have either no guidelines or recommendations based only on expert opinion and observational studies. Further, research in VHD has often failed to engage patients to inform study design and identify research questions of greatest importance and relevance from a patient perspective. Accordingly, the National Heart, Lung, and Blood Institute convened a Working Group on Patient-Centered Research in Valvular Heart Disease, composed of clinician and research experts and patient advocacy experts to identify gaps and barriers to research in VHD and identify research priorities. While recognizing that important research remains to be done to test the safety and efficacy of devices and procedures to treat VHD, we intentionally focused less attention on these areas of research as they are more commonly pursued and supported by industry. Herein, we present the patient-centered research gaps, barriers, and priorities in VHD and organized our report according to the "patient journey," including access to care, screening and diagnosis, preprocedure therapy and management, decision making when a procedure is contemplated (clinician and patient perspectives), and postprocedure therapy and management. It is hoped that this report will foster collaboration among diverse stakeholders and highlight for funding bodies the pressing patient-centered research gaps, opportunities, and priorities in VHD in order to produce impactful patient-centered research that will inform and improve patient-centered policy and care.
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Affiliation(s)
- Brian R Lindman
- Cardiovascular Medicine Division Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN
| | | | - Rodrigo Bagur
- Division of Cardiology University Hospital London Health Sciences Centre London Ontario Canada
| | | | - Megan Coylewright
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH
| | - Frank Evans
- National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda MD
| | - Judy Hung
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
| | - Sandra B Lauck
- Centre for Heart Valve Innovation St. Paul's Hospital University of British Columbia Vancouver British Columbia Canada
| | | | - Vandana Sachdev
- National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda MD
| | | | - Jason H Wasfy
- Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
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Lown M, Wilcox CR, Hughes S, Santer M, Lewith G, Moore M, Little P. Patients' views about screening for atrial fibrillation (AF): a qualitative study in primary care. BMJ Open 2020; 10:e033061. [PMID: 32193260 PMCID: PMC7150591 DOI: 10.1136/bmjopen-2019-033061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients' views and understanding of AF and AF screening to determine acceptability and inform future recommendations. SETTING A single primary care practice in Hampshire, UK. PARTICIPANTS 15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS Participants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening. CONCLUSIONS Our study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening. TRIAL REGISTRATION NUMBER ISRCTN 17495003.
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Affiliation(s)
- Mark Lown
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Christopher R Wilcox
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - George Lewith
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
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Abstract
OBJECTIVES To (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting. DESIGN Systematic review. ELIGIBILITY CRITERIA Peer-reviewed articles in English presenting a new or adapted model of SDM. INFORMATION SOURCES Academic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019. RESULTS Forty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment options was the most prominent component across models. Components present in >50% of models were: Make the decision (75%), Patient preferences (65%), Tailor information (65%), Deliberate (58%), Create choice awareness (55%), and Learn about the patient (53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time, Describe treatment options and Make the decision are the two components which are present in most models in any time period. Create choice awareness stood out for being present in a markedly larger proportion of models over time. CONCLUSIONS This review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key. TRIAL REGISTRATION PROSPERO registration CRD42015019740.
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Affiliation(s)
| | - Fania R Gärtner
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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28
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Egerton-Warburton D, Cullen L, Keijzers G, Fatovich DM. ‘What the hell is water?’ How to use deliberate clinical inertia in common emergency department situations. Emerg Med Australas 2018; 30:426-430. [DOI: 10.1111/1742-6723.12950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Diana Egerton-Warburton
- School of Clinical Science at Monash Health; Monash University Faculty of Medicine, Nursing and Health Sciences; Melbourne Victoria Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Queensland University of Technology; The University of Queensland; Brisbane Queensland Australia
| | - Gerben Keijzers
- Department of Emergency Medicine; Gold Coast University Hospital; Gold Coast Queensland Australia
- School of Medicine; Bond University; Gold Coast Queensland Australia
- School of Medicine, Griffith University; Gold Coast Queensland Australia
| | - Daniel M Fatovich
- Emergency Medicine; Royal Perth Hospital, The University of Western Australia; Perth Western Australia Australia
- Centre for Clinical Research in Emergency Medicine; Harry Perkins Institute of Medical Research; Perth Western Australia Australia
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29
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Derech RD, Neves FDS. Shared decision-making when choosing the feeding method of patients with severe dementia: a systematic review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.170169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objectives: To evaluate whether the use of a support tool for shared decision-making in the choice of feeding method for patients with severe dementia can benefit the patient/caregiver dyad, and to evaluate the quality of the decision-making process. Method: A search was performed in the Medline, LILACS, IBECS, SciELO, WHOLIS databases for randomized controlled trials, whether double-blind or otherwise, and quasi-experimental, cohort, case-control, or cross-sectional observational studies in Portuguese, Spanish, English and French. Results: Eight articles were found that showed that the use of a decision support tool, as an aid for the shared decision-making method, is beneficial as it reduces decisional conflict and increases the knowledge of caregivers about the subject. The quality of the decision-making process is unsatisfactory due to the low frequency of discussions between caregivers and the health team and the poor evaluation of caregivers about the participation of the team in the decision-making process. Conclusion: Decision support tools provide benefits for caregivers/patients undergoing the difficult task of deciding about feeding methods. Findings suggest that the current quality of decision-making is inadequate.
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