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Rake EA, Meinders MJ, Brand G, Dreesens D, Kremer JAM, Elwyn G, Aarts JWM. Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations. BMJ Open 2024; 14:e079540. [PMID: 38760032 PMCID: PMC11103202 DOI: 10.1136/bmjopen-2023-079540] [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: 09/04/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5. PARTICIPANTS Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.
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Affiliation(s)
- Ester A Rake
- IQ Health, Radboudumc, Nijmegen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Guus Brand
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
| | - Dunja Dreesens
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Glyn Elwyn
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, The Netherlands
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Bechthold AC, Azuero A, Puga F, Ejem DB, Kent EE, Ornstein KA, Ladores SL, Wilson CM, Knoepke CE, Miller-Sonet E, Odom JN. What Is Most Important to Family Caregivers When Helping Patients Make Treatment-Related Decisions: Findings from a National Survey. Cancers (Basel) 2023; 15:4792. [PMID: 37835486 PMCID: PMC10572058 DOI: 10.3390/cancers15194792] [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] [Received: 07/25/2023] [Revised: 09/01/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Prioritizing patient values-who/what matters most-is central to palliative care and critical to treatment decision making. Yet which factors are most important to family caregivers in these decisions remains understudied. Using data from a U.S. national survey of cancer caregivers (N = 1661), we examined differences in factors considered very important by caregivers when partnering with patients in cancer treatment decision making by cancer stage and caregiver sociodemographics. Fifteen factors were rated on a 4-point Likert-scale from 'very unimportant' to 'very important.' Descriptive statistics were used to characterize caregiver factors and tabulate proportions of importance for each. Generalized linear mixed effect modeling was used to examine the importance of factors by cancer stage, and chi-square analyses were performed to determine associations between caregiver sociodemographics and the five most commonly endorsed factors: quality of life (69%), physical well-being (68%), length of life (66%), emotional well-being (63%), and opinions/feelings of oncology team (59%). Significant associations (all p's < 0.05) of small magnitude were found between the most endorsed factors and caregiver age, race, gender, and ethnicity, most especially 'opinions/feelings of the oncology team'. Future work is needed to determine the best timing and approach for eliciting and effectively incorporating caregiver values and preferences into shared treatment decision making.
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Affiliation(s)
- Avery C. Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
| | - Erin E. Kent
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Katherine A. Ornstein
- Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Sigrid L. Ladores
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
| | - Christina M. Wilson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
- Division of Gynecologic Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Christopher E. Knoepke
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - J. Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (A.C.B.)
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Bechthold AC, Montgomery AP, Fazeli PL, Dionne-Odom JN. Values elicitation among adults making health-related decisions: A concept analysis. Nurs Forum 2022; 57:885-892. [PMID: 35430733 DOI: 10.1111/nuf.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
AIM To conduct a concept analysis of values elicitation in the context of health care and treatment decision-making and formulate a conceptual definition. BACKGROUND Values elicitation is a commonly cited term for an activity to help patients identify values and evaluate their application in health care decision-making, yet it remains ambiguous and difficult to differentiate from similar concepts. DESIGN Concept analysis. DATA SOURCE Three databases, including PubMed, CINAHL Plus, and Scopus, were searched from inception to February 2021. REVIEW METHODS Walker and Avant's eight-stage method was used to identify attributes, cases, antecedents, consequences, and empirical referents and formulate a conceptual definition. RESULTS The concept analysis identified 3 attributes, 10 consequences, 7 antecedents, and 3 empirical referents. Our analysis defines values elicitation as an intentional process whereby individuals explore their core beliefs, alone or with others, to (1) determine their preference, or a lack thereof, between health or treatment options, and (2) frame decisions. CONCLUSIONS The findings have the potential to influence the identification, discussion, and measurement of values elicitation by nurses and researchers across disciplines. Further exploration of this concept is warranted as the literature continues to emerge.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aoyjai P Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Suskind AM, Vaittinen T, Gibson W, Hajebrahimi S, Ostaszkiewicz J, Davis N, Dickinson T, Spencer M, Wagg A. International Continence Society white paper on ethical considerations in older adults with urinary incontinence. Neurourol Urodyn 2021; 41:14-30. [PMID: 34558106 DOI: 10.1002/nau.24795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, California, USA
| | - Tiina Vaittinen
- Department of Social Sciences, Tampere University, Tampere, Finland
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sakineh Hajebrahimi
- Departments of Urology and Family Medicine, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nina Davis
- Department of Urology, University of Oregon Health Sciences, Portland, Oregon, USA
| | - Tamara Dickinson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Martha Spencer
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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On Evolutions and Revolutions in Emergency Care: Commemorating the Emergency Nurses Association’s 50th Anniversary. J Emerg Nurs 2020; 46:2-7. [DOI: 10.1016/j.jen.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
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