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Longcoy LTH, Mathew A, Jang MK, Mayahara M, Doorenbos AZ. Experiences of Using Patient Decision Aids for Decisions About Cancer Treatment: A Meta-Aggregation of Qualitative Studies. Cancer Nurs 2023:00002820-990000000-00156. [PMID: 37430415 PMCID: PMC10782815 DOI: 10.1097/ncc.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Inconsistent results have been found regarding the effects of patient decision aids (PtDAs) in supporting patients' decision-making for cancer treatment. OBJECTIVE This qualitative meta-aggregation presents the experiences of using PtDAs, as perceived by adult patients with cancer, and highlights the components they perceived as important. METHODS We used the 3-phase process for meta-aggregation suggested by Joanna Briggs Institute to identify published studies with qualitative evidence from CINAHL, Ovid-MEDLINE, APA PsycINFO, and EMBASE databases. The selected studies involved adults with various cancer diagnoses. The phenomenon of interest and the context for this review were people's experiences of using PtDAs for decisions about first-line cancer treatment. RESULTS A total of 16 studies were included. The authors achieved consensus on 5 synthesized findings about PtDAs: (1) improved understanding of treatment options and patient values and preferences; (2) served as platforms for expressing concerns, obtaining support, and having meaningful conversations with healthcare providers; (3) facilitated active personal and family engagement in decision-making; (4) enabled recall of information and evaluation of satisfaction with decisions; and (5) presented potential structural barriers. CONCLUSIONS This study used qualitative evidence to demonstrate the usefulness of PtDAs and identify aspects patients with cancer find particularly beneficial. IMPLICATIONS FOR PRACTICE Nurses play a crucial role in supporting patients and family caregivers throughout the decision-making process for cancer treatment. Patient decision aids that balance complex treatment information with simple language and illustrations or graphs can enhance patients' comprehension. The integration of values clarification exercises into care can further improve patients' decisional outcomes.
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Affiliation(s)
- Li-Ting Huang Longcoy
- Author Affiliations: College of Nursing, University of Illinois Chicago (Drs Longcoy and Doorenbos); Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea (Dr Jang); College of Nursing, Christian Medical College Vellore, Tamil Nadu, India (Dr Mathew); College of Nursing, Rush University, Chicago, Illinois (Dr Mayahara)
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Marshall D, Green S, Jones BM, Starrs C, Montgomery GH, Minassian K, Wunder B, Force J, Schnur JB. Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer. J Am Coll Radiol 2022; 19:1236-1243. [PMID: 36126825 PMCID: PMC10354668 DOI: 10.1016/j.jacr.2022.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation. METHODS The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed. RESULTS Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001). CONCLUSIONS The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.
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Affiliation(s)
- Deborah Marshall
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York.
| | - Sheryl Green
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Medical Director, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Brianna M Jones
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Clodagh Starrs
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Guy H Montgomery
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York; Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin Minassian
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Assistant Chief Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - Bruce Wunder
- Department of Radiation Oncology, Mount Sinai Hospital, New York, New York
| | - James Force
- Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie B Schnur
- Lead Radiation Therapist, Department of Radiation Oncology, Mount Sinai Hospital, New York, New York; Co-Director of the Integrative Behavioral Medicine Program, Icahn School of Medicine at Mount Sinai, New York, New York
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Usability Evaluations of a Newly Developed Wearable Inertial Sensing System for Assessing Elderly Fall Risk. ADVANCES IN PHYSICAL ERGONOMICS & HUMAN FACTORS 2019. [DOI: 10.1007/978-3-319-94484-5_44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Sousa VEC, Dunn Lopez K. Towards Usable E-Health. A Systematic Review of Usability Questionnaires. Appl Clin Inform 2017; 8:470-490. [PMID: 28487932 PMCID: PMC6241759 DOI: 10.4338/aci-2016-10-r-0170] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/26/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of e-health can lead to several positive outcomes. However, the potential for e-health to improve healthcare is partially dependent on its ease of use. In order to determine the usability for any technology, rigorously developed and appropriate measures must be chosen. OBJECTIVES To identify psychometrically tested questionnaires that measure usability of e-health tools, and to appraise their generalizability, attributes coverage, and quality. METHODS We conducted a systematic review of studies that measured usability of e-health tools using four databases (Scopus, PubMed, CINAHL, and HAPI). Non-primary research, studies that did not report measures, studies with children or people with cognitive limitations, and studies about assistive devices or medical equipment were systematically excluded. Two authors independently extracted information including: questionnaire name, number of questions, scoring method, item generation, and psychometrics using a data extraction tool with pre-established categories and a quality appraisal scoring table. RESULTS Using a broad search strategy, 5,558 potentially relevant papers were identified. After removing duplicates and applying exclusion criteria, 35 articles remained that used 15 unique questionnaires. From the 15 questionnaires, only 5 were general enough to be used across studies. Usability attributes covered by the questionnaires were: learnability (15), efficiency (12), and satisfaction (11). Memorability (1) was the least covered attribute. Quality appraisal showed that face/content (14) and construct (7) validity were the most frequent types of validity assessed. All questionnaires reported reliability measurement. Some questionnaires scored low in the quality appraisal for the following reasons: limited validity testing (7), small sample size (3), no reporting of user centeredness (9) or feasibility estimates of time, effort, and expense (7). CONCLUSIONS Existing questionnaires provide a foundation for research on e-health usability. However, future research is needed to broaden the coverage of the usability attributes and psychometric properties of the available questionnaires.
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Affiliation(s)
- Vanessa E C Sousa
- Vanessa E. C. Sousa, PhD, MSN, University of Illinois at Chicago, College of Nursing, Department of Health Systems Science, 845 South Damen St., Chicago, IL 60612, , Phone: 773-814-0517
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Miles A, Chronakis I, Fox J, Mayer A. Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation. BMJ Open 2017; 7:e012935. [PMID: 28341685 PMCID: PMC5372112 DOI: 10.1136/bmjopen-2016-012935] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA. DESIGN Mixed methods. SETTING Single outpatient oncology department in central London. PARTICIPANTS Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14-56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy. PRIMARY OUTCOMES Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA. RESULTS PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone. CONCLUSIONS Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.
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Affiliation(s)
- A Miles
- Birkbeck, University of London, London, UK
| | | | - J Fox
- University College London, London, UK
- Oxford University, Oxford, UK
| | - A Mayer
- Royal Free London NHS Trust, London, UK
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Åhman A, Sarkadi A, Lindgren P, Rubertsson C. 'It made you think twice' - an interview study of women's perception of a web-based decision aid concerning screening and diagnostic testing for fetal anomalies. BMC Pregnancy Childbirth 2016; 16:267. [PMID: 27619366 PMCID: PMC5020555 DOI: 10.1186/s12884-016-1057-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Enabling women to make informed decisions is a key objective in the guidelines governing prenatal screening and diagnostics. Despite efforts to provide information, research shows that women’s choice of prenatal screening is often not based on informed decisions. The aim of this study was to investigate pregnant women’s perceptions of the use of an interactive web-based DA, developed to initiate a process of reflection and deliberate decision-making concerning screening and testing for fetal anomalies. Methods A qualitative study was applied and individual interviews were conducted. Seventeen pregnant women attending antenatal healthcare in Uppsala County, Sweden, who had access to the decision aid were interviewed. Eleven opted to use the decision aid and six did not. Data were analysed by systematic text condensation. Results Women appreciated the decision aid, as it was easily accessible; moreover, they emphasised the importance of a reliable source. It helped them to clarify their own standpoints and engaged their partner in the decision-making process. Women described the decision aid as enhancing their awareness that participating in prenatal screening and diagnostics was a conscious choice. Those who chose not to use the web-based decision aid when offered reported that they already had sufficient knowledge. Conclusions The decision aid was able to initiate a process of deliberate decision-making in pregnant women as a result of their interaction with the tool. Access to a web-based decision aid tool can be valuable to expectant parents in making quality decisions regarding screening for fetal anomalies.
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Affiliation(s)
- Annika Åhman
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden.
| | - Anna Sarkadi
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
| | - Peter Lindgren
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
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Syrowatka A, Krömker D, Meguerditchian AN, Tamblyn R. Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses. J Med Internet Res 2016; 18:e20. [PMID: 26813512 PMCID: PMC4748141 DOI: 10.2196/jmir.4982] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/01/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.
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Affiliation(s)
- Ania Syrowatka
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
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Berry DL, Halpenny B, Bosco JLF, Bruyere J, Sanda MG. Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men. BMC Med Inform Decis Mak 2015. [PMID: 26204920 PMCID: PMC4513952 DOI: 10.1186/s12911-015-0180-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer. METHODS P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized. RESULTS Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid. CONCLUSIONS Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.
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Affiliation(s)
- Donna L Berry
- Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA. .,The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Barbara Halpenny
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jaclyn L F Bosco
- The Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Bruyere
- Joan C. Edwards School of Medicine- Marshall University, Huntington, WV, USA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, USA
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Sawka AM, Straus S, Rodin G, Heus L, Brierley JD, Tsang RW, Rotstein L, Ezzat S, Segal P, Gafni A, Thorpe KE, Goldstein DP. Thyroid cancer patient perceptions of radioactive iodine treatment choice: Follow-up from a decision-aid randomized trial. Cancer 2015. [PMID: 26195199 PMCID: PMC4832354 DOI: 10.1002/cncr.29548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patient decision aids (P-DAs) inform medical decision making, but longer term effects are unknown. This article describes extended follow-up from a thyroid cancer treatment P-DA trial. METHODS In this single-center, parallel-design randomized controlled trial conducted at a Canadian tertiary/quaternary care center, early-stage thyroid cancer patients from a P-DA trial were contacted 15 to 23 months after randomization/radioactive iodine (RAI) decision making to evaluate longer term outcomes. It was previously reported that the use of the computerized P-DA in thyroid cancer patients considering postsurgical RAI treatment significantly improved medical knowledge in comparison with usual care alone. The P-DA and control groups were compared for the following outcomes: feeling informed about the RAI treatment choice, decision satisfaction, decision regret, cancer-related worry, and physician trust. In a subgroup of 20 participants, in-depth interviews were conducted for a qualitative analysis. RESULTS Ninety-five percent (70 of 74) of the original population enrolled in follow-up at a mean of 17.1 months after randomization. P-DA users perceived themselves to be significantly more 1) informed about the treatment choice (P = .008), 2) aware of options (P = .009), 3) knowledgeable about treatment benefits (P = .020), and 4) knowledgeable about treatment risks/side effects (P = .001) in comparison with controls. There were no significant group differences in decision satisfaction (P = .142), decision regret (P = .199), cancer-related worry (P = .645), mood (P = .211), or physician trust (P = .764). In the qualitative analysis, the P-DA was perceived to have increased patient knowledge and confidence in decision making. CONCLUSIONS The P-DA improved cancer survivors' actual and long-term perceived medical knowledge with no adverse effects. More research on the long-term outcomes of P-DA use is needed.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Sharon Straus
- Department of Medicine, St. Michael's Hospital/University of Toronto, Toronto, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Lineke Heus
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - James D Brierley
- Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, University Health Network/University of Toronto, Toronto, Canada
| | - Lorne Rotstein
- Department of Surgery, University Health Network/University of Toronto, Toronto, Canada
| | - Shereen Ezzat
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Phillip Segal
- Division of Endocrinology, Department of Medicine, University Health Network/University of Toronto, Toronto, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto/Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network/University of Toronto, Toronto, Canada
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Sawka AM, Straus S, Rodin G, Tsang RW, Brierley JD, Rotstein L, Segal P, Gafni A, Ezzat S, Goldstein DP. Exploring the relationship between patients' information preference style and knowledge acquisition process in a computerized patient decision aid randomized controlled trial. BMC Med Inform Decis Mak 2015; 15:48. [PMID: 26088605 PMCID: PMC4474358 DOI: 10.1186/s12911-015-0168-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 05/26/2015] [Indexed: 11/22/2022] Open
Abstract
Background We have shown in a randomized controlled trial that a computerized patient decision aid (P-DA) improves medical knowledge and reduces decisional conflict, in early stage papillary thyroid cancer patients considering adjuvant radioactive iodine treatment. Our objectives were to examine the relationship between participants’ baseline information preference style and the following: 1) quantity of detailed information obtained within the P-DA, and 2) medical knowledge. Methods We randomized participants to exposure to a one-time viewing of a computerized P-DA (with usual care) or usual care alone. In pre-planned secondary analyses, we examined the relationship between information preference style (Miller Behavioural Style Scale, including respective monitoring [information seeking preference] and blunting [information avoidance preference] subscale scores) and the following: 1) the quantity of detailed information obtained from the P-DA (number of supplemental information clicks), and 2) medical knowledge. Spearman correlation values were calculated to quantify relationships, in the entire study population and respective study arms. Results In the 37 P-DA users, high monitoring information preference was moderately positively correlated with higher frequency of detailed information acquisition in the P-DA (r = 0.414, p = 0.011). The monitoring subscale score weakly correlated with increased medical knowledge in the entire study population (r = 0.268, p = 0.021, N = 74), but not in the respective study arms. There were no significant associations with the blunting subscale score. Conclusions Individual variability in information preferences may affect the process of information acquisition from computerized P-DA’s. More research is needed to understand how individual information preferences may impact medical knowledge acquisition and decision-making. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0168-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, Toronto General Hospital, 200 Elizabeth Street, 12 EN-212, Toronto, ON, M5G 2C4, Canada.
| | - Sharon Straus
- Department of Medicine, St. Michael's Hospital, 30 Bond Street, Shuter 2-026, Toronto, ON, M5B 1W8, Canada.,Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, M5B 1W8, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology, Princess Margaret Hospital, University Health Network, 16th Floor Room 724, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Department of Psychiatry and Palliative Care, Princess Margaret Hospital, University of Toronto, 16th Floor Room 724, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Richard W Tsang
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, 5th Floor Room 963, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - James D Brierley
- Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, 5th Floor Room 963, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Lorne Rotstein
- Department of Surgery, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 10 EN-220, Toronto, ON, M5G 2C4, Canada.,Toronto General Hospital, University of Toronto, 200 Elizabeth Street, 10 EN-220, Toronto, ON, M5G 2C4, Canada
| | - Phillip Segal
- Division of Endocrinology, Department of Medicine, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 12 EN-216, Toronto, ON, M5G 2C4, Canada.,Toronto General Hospital, University of Toronto, 200 Elizabeth Street, 12 EN-216, Toronto, ON, M5G 2C4, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, CRL-208, Hamilton, ON, L8S 4K1, Canada
| | - Shereen Ezzat
- Endocrine Oncology Site Group, University Health Network, Toronto General Hospital, Endocrine Oncology 585 University Avenue, 9NU-986, Toronto, ON, M5G 2N2, Canada
| | - David P Goldstein
- Department of Otolaryngology Head and Neck Surgery, Wharton Head and Neck Centre, University Health Network, 3-952, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.,Wharton Head and Neck Centre, University of Toronto, 3-952, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Owens OL, Friedman DB, Brandt HM, Bernhardt JM, Hébert JR. An Iterative Process for Developing and Evaluating a Computer-Based Prostate Cancer Decision Aid for African American Men. Health Promot Pract 2015; 16:642-55. [PMID: 25983084 DOI: 10.1177/1524839915585737] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The disproportionate burden of prostate cancer (PrCA) among African American (AA) men amplifies the need for informed decisions about PrCA screening. To create a computer-based decision aid (CBDA) for increasing prostate knowledge, decision self-efficacy, and intention to make an informed decision, the study implemented an iterative approach to develop a culturally appropriate CBDA. METHOD A short CBDA prototype containing PrCA information and interactive activities was developed. A sample of 21 AA men aged 37 to 66 years in South Carolina participated in one of seven 90-minute focus groups and completed a 36-item survey. Updates were made to the CBDA based on participant feedback. The CBDA and heuristic evaluation surveys were then distributed to six expert reviewers. Ten men were also randomly selected from our sample population to participate in interviews regarding usability of the CBDA. RESULTS Participants and expert reviewers expressed consensus on many features of the CBDA, but some suggested changes to the format and graphics in order to enhance the CBDA's effectiveness. Development and evaluation processes and implications are discussed. CONCLUSIONS Using CBDAs for informed decision making may be appropriate for AA men. It is important to engage the community and experts in an iterative development process to ensure that a CBDA is relevant for priority populations.
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Patel SS, Goldfarb M. Well-differentiated thyroid carcinoma: The role of post-operative radioactive iodine administration. J Surg Oncol 2012. [DOI: 10.1002/jso.23295] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Sawka AM, Straus S, Rotstein L, Brierley JD, Tsang RW, Asa S, Segal P, Kelly C, Zahedi A, Freeman J, Solomon P, Anderson J, Thorpe KE, Gafni A, Rodin G, Goldstein DP. Randomized Controlled Trial of a Computerized Decision Aid on Adjuvant Radioactive Iodine Treatment for Patients With Early-Stage Papillary Thyroid Cancer. J Clin Oncol 2012; 30:2906-11. [DOI: 10.1200/jco.2011.41.2734] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Decision-making on adjuvant radioactive iodine (RAI) treatment for early-stage papillary thyroid cancer (PTC) is complex because of uncertainties in medical evidence. Using a parallel, two-arm, randomized, controlled trial design, we examined the impact of a patient-directed computerized decision aid (DA) on the medical knowledge and decisional conflict in patients with early-stage PTC considering the choice of being treated with adjuvant RAI or not. The DA describes the rationale, possible risks and benefits, and the medical evidence uncertainty relating to the choice. Patients and Methods We recruited 74 patients with early-stage PTC after thyroidectomy. Participants were assigned by using 1:1 central computerized randomization to either the DA group with usual care (intervention) or usual care alone (control). Medical knowledge about PTC and RAI treatment (the primary outcome), as well as decisional conflict (a secondary outcome), were measured by using validated questionnaires, and the respective scores were compared between groups. Results Consistent with PTC epidemiology, 83.8% (62 of 74) of the participants were women, and the mean age was 45.8 years (range, 19 to 79 years). Medical knowledge about PTC and RAI treatment was significantly greater and decisional conflict was significantly reduced in the DA group compared with the control group (respective P values < .001). The use of adjuvant RAI treatment was not significantly different between groups (DA group, 11 of 37 [29.7%]; controls, seven of 37 [18.9%]; P = .278). Conclusion A computerized DA improves informed decision making in patients with early-stage PTC who are considering adjuvant RAI treatment. DAs are useful for patients facing decisions subject to medical evidence uncertainty.
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Affiliation(s)
- Anna M. Sawka
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Sharon Straus
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Lorne Rotstein
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - James D. Brierley
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Richard W. Tsang
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Sylvia Asa
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Phillip Segal
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Catherine Kelly
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Afshan Zahedi
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Jeremy Freeman
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Philip Solomon
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Jennifer Anderson
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Kevin E. Thorpe
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Amiram Gafni
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - Gary Rodin
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
| | - David P. Goldstein
- Anna M. Sawka, Lorne Rotstein, James D. Brierley, Richard W. Tsang, Sylvia Asa, Phillip Segal, Gary Rodin, and David P. Goldstein, University Health Network and University of Toronto; Sharon Straus and Jennifer Anderson, St Michael's Hospital and University of Toronto; Catherine Kelly and Afshan Zahedi, Women's College Hospital and University of Toronto; Jeremy Freeman, Mount Sinai Hospital and University of Toronto; Philip Solomon, University of Toronto; Kevin E. Thorpe, Keenan Research Centre, Li Ka
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Sawka AM, Straus S, Gafni A, Brierley JD, Tsang RW, Rotstein L, Ezzat S, Thabane L, Rodin G, Meiyappan S, David D, Goldstein DP. How can we meet the information needs of patients with early stage papillary thyroid cancer considering radioactive iodine remnant ablation? Clin Endocrinol (Oxf) 2011; 74:419-23. [PMID: 21198742 PMCID: PMC3084509 DOI: 10.1111/j.1365-2265.2010.03966.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In patients with early stage papillary thyroid carcinoma (PTC) who have had a thyroidectomy, the decision must be made to accept or reject radioactive iodine remnant ablation (RRA). Counselling patients about this decision can be challenging, given the medical evidence uncertainties and the complexity of related information. Although physicians are the primary source of medical information for patients considering RRA, some patients have a desire for supplemental information from sources such as the internet. Yet, thyroid cancer resources on the internet are of variable quality, and some may not be applicable to the individual case. We have developed a computerized educational tool [called a decision aid (DA)], directed to patients with early stage papillary thyroid cancer, and intended as an adjunct to physician counselling, to relay evidence-based medical information on disease prognosis and the choice to accept or reject RRA. DAs are tools used to inform patients about available treatment options and have been utilized in oncologic decision-making. We tested our web-based DA in fifty patients with early stage PTC and found that it improved medical knowledge. Furthermore, participants found the technical usability of the tool acceptable. We are currently conducting a randomized controlled trial comparing the use of the DA plus usual care to usual care alone to confirm the educational benefit of the website and examine its impact on the decision-making process. In the future, DAs may play an expanded role as an adjunct to physician counselling in the care of patients with thyroid cancer.
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Affiliation(s)
- A M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada.
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