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Brown S, Hind D, Strong E, Bradburn M, Din FVN, Lee E, Lee MJ, Lund J, Moffatt C, Morton J, Senapati A, Shackley P, Vaughan-Shaw P, Wysocki AP, Callaghan T, Jones H, Wickramasekera N. Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation. Health Technol Assess 2024; 28:1-113. [PMID: 39045854 DOI: 10.3310/kfdq2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Background There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. Objectives A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. Design Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Setting Thirty-one National Health Service trusts. Participants Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Interventions Surgery. Main outcome measures Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Results Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Limitations Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Conclusions and future work Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. Trial registration This trial is registered as ISRCTN95551898. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steven Brown
- Department of General Surgery, Northern General Hospital, Sheffield, UK
| | - Daniel Hind
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emily Strong
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Farhat Vanessa Nasim Din
- Academic Coloproctology, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Jonathan Lund
- Derby Royal Infirmary, University Hospitals of Derby and Burton, Derby, UK
| | | | - Jonathan Morton
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Asha Senapati
- St Mark's Hospital, London, UK; Queen Alexandra Hospital, Portsmouth, UK
| | - Philip Shackley
- School of Health and Related Research, Regent Court, Sheffield, UK
| | - Peter Vaughan-Shaw
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | | | - Tia Callaghan
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Goodwill JR, Fike KJ. Black in the pandemic: Comparing experiences of mistrust, anxiety, and the COVID-19 vaccine among Black adults in the U.S. Soc Sci Med 2023; 338:116302. [PMID: 37871396 DOI: 10.1016/j.socscimed.2023.116302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
COVID-19 vaccine decisions are shaped by many factors including historical and contemporary patterns of medical mistreatment of marginalized communities. In attending to these concerns, we measured whether fear of COVID-19, general feelings of mistrust, and race-specific mistrust of the government and healthcare providers are indirectly associated with COVID-19 vaccination status via anxiety among Black Americans. We analyzed responses from 996 Black adults who participated in the AmeriSpeak panel - a nationally representative probability-based sample recruited from the National Opinion Research Center from April-June 2022. We used multiple-group structural equation modeling to compare outcomes among those who lost a loved one to COVID-19 to those who did not. Results indicate that fear of COVID-19 was associated with a greater probability of being fully vaccinated for those who lost a family member/friend. Race-specific mistrust was positively associated with anxiety, but was negatively associated with being fully vaccinated for bereaved Black Americans. Targeted efforts are needed to specifically reach those who lost a loved one to COVID-19. More within-group evaluations are needed to identify barriers to COVID-19 vaccination that are specific to Black Americans living with loss and grief.
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Affiliation(s)
- Janelle R Goodwill
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, United States.
| | - Kayla J Fike
- Vanderbilt University, Peabody College of Education and Human Development, United States
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Whitty JA, Littlejohns P, Ratcliffe J, Rixon K, Wilson A, Kendall E, Burton P, Chalkidou K, Scuffham PA. Impact of information and deliberation on the consistency of preferences for prioritization in health care - evidence from discrete choice experiments undertaken alongside citizens' juries. J Med Econ 2023; 26:1237-1249. [PMID: 37738383 DOI: 10.1080/13696998.2023.2262329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery. METHODS Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs (n = 28); (ii) controls who did not participate in the jury (n = 21); (iii) population sample (n = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations. RESULTS The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury. CONCLUSION Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.
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Affiliation(s)
- Jennifer A Whitty
- Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, The University of East Anglia, Norwich, UK
- NIHR Applied Research Collaboration (ARC), East of England, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Patient Centered Research, Evidera, London, UK
| | | | - Julie Ratcliffe
- Menzies Centre for Health Policy and Economics, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Kylie Rixon
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Paul Burton
- Cities Research Institute, Griffith University, Queensland, Australia
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Monis M, O'Connell R, Andrews T. 'It will dictate how many children I will have"- Women's decision-making in pregnancy following a previous caesarean birth (CB). Midwifery 2023; 116:103533. [PMID: 36347147 DOI: 10.1016/j.midw.2022.103533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/17/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]
Abstract
Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC. AIM To develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women's birth choice and their decision making for birth following a previous CB. DESIGN Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital. FINDINGS The theory of 'Mentalizing Possibilities' is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of 'Mentalizing Possibilities' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process. CONCLUSION Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.
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Coates E, Wickramasekera N, Barr A, Shackley P, Lee M, Hind D, Probert C, Sebastian S, Totton N, Blackwell S, Bedford H, Dames N, Lobo A. Patient preferences and current practice for adults with steroid-resistant ulcerative colitis: POPSTER mixed-methods study. Health Technol Assess 2022; 26:1-118. [DOI: 10.3310/rhxr5192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background
Corticosteroids are a mainstay of the treatment of moderately severe relapses of ulcerative colitis, yet almost 50% of patients do not respond fully to these and risk prolonged steroid use and side effects. There is a lack of clarity about the definitions of steroid resistance, the optimum choice of treatment, and patient and health-care professional treatment preferences.
Objectives
The overall aim of this research was to understand how steroid-resistant ulcerative colitis is managed in adult secondary care and how current practice compares with patient and health-care professional preferences.
Design
A mixed-methods study, including an online survey, qualitative interviews and discrete choice experiments.
Setting
NHS inflammatory bowel disease services in the UK.
Participants
Adults with ulcerative colitis and health-care professionals treating inflammatory bowel disease.
Results
We carried out a survey of health-care professionals (n = 168), qualitative interviews with health-care professionals (n = 20) and patients (n = 33), discrete choice experiments with health-care professionals (n = 116) and patients (n = 115), and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals showed that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that anti-tumour necrosis factor drugs (particularly infliximab) are the most frequently offered drugs across most steroid-resistant (and steroid-dependent) patient scenarios, but they are less frequently offered to thiopurine-naive patients. Patient interviews identified several factors influencing their treatment choices, including effectiveness of treatment, recommendations from health-care professionals, route of administration and side effects. Over time, depending on the severity and duration of symptoms and, crucially, as medical treatment options become exhausted, patients are willing to try alternative treatments and, eventually, to undergo surgery. The discrete choice experiments found that the probability of remission and of side effects strongly influences the treatment choices of both patients and health-care professionals. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. The treatments ranked most positively by patients were infliximab and tofacitinib (each preferred by 38% of patients), and the predicted probability of uptake by health-care professionals was greatest for infliximab (62%).
Limitations
The survey and the discrete choice experiments with patients and health-care professionals are limited by their relatively small sample sizes. The qualitative studies are subject to selection bias. The timing of the different substudies, both before and during the COVID-19 pandemic, is a potential limitation.
Conclusions
We have identified factors influencing treatment decisions for steroid-resistant ulcerative colitis and the characteristics to consider when choosing treatments to evaluate in future randomised controlled trials. The findings may be used to improve discussions between patients and health-care professionals when they review treatment options for steroid-resistant ulcerative colitis.
Future work
This research highlights the need for consensus work to establish an agreed definition of steroid resistance in ulcerative colitis and a greater understanding of the optimal use of tofacitinib and surgery for this patient group. A randomised controlled trial comparing infliximab with tofacitinib is also recommended.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Amy Barr
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Shackley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Matthew Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher Probert
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Foundation Trust, Hull, UK
| | - Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | | | - Alan Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Parental attitudes towards choosing between operative and nonoperative management of pediatric acute appendicitis. J Pediatr Surg 2022; 57:1592-1598. [PMID: 34872734 DOI: 10.1016/j.jpedsurg.2021.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Making healthcare decisions for children can be challenging for parents or guardians. We aimed to characterize the decision-making preferences and stress of parents or guardians who were offered both appendectomy or nonoperative management (NOM) for children with acute appendicitis. METHODS Criteria was developed for offering operative or NOM for patients. At the time of decision, parents or guardians completed a survey assessing their understanding of treatment options, stress and preferences in being given the choice. An outpatient follow-up survey was later administered to evaluate post-decision satisfaction. RESULTS A total of 45 respondents were included in the study. More than 95% endorsed understanding of the risks/benefits of the options and felt supported and satisfied with their decision. Half felt the process was more than minimally stressful, 77% felt the decision was easy to make, 89% liked being asked and 95% preferred to make the decision themselves with varying degrees of input from their physician. Of the 62% of parents or guardians who completed the follow-up survey, >90% were satisfied with their decision and one respondent regretted their choice. DISCUSSION When offered the choice between operative and NOM of acute appendicitis, half of parents or guardians felt greater than minimal stress. The majority endorsed adequate understanding of the options, felt it was an easy decision, and maintained the desire to be the primary decision maker for their child. Our study provides preliminary data on parental or guardian attitudes towards shared decision-making in the surgical setting. Follow-up studies should focus on identifying predictors for those who feel increased stress and difficulty with decision-making. LEVEL OF EVIDENCE III.
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Strong E, Callaghan T, Beal E, Moffatt C, Wickramasekera N, Brown S, Lee MJ, Winton C, Hind D. Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study. Colorectal Dis 2021; 23:1487-1498. [PMID: 33645880 DOI: 10.1111/codi.15606] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
AIM Little is known about optimal management strategies for pilonidal sinus disease (PSD). We conducted a mixed-methods study to understand why patients make, and sometimes regret, treatment decisions. METHOD We conducted longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients from 13 UK hospitals. Framework analysis was performed, and themes were mapped to (1) the coping in deliberation framework and (2) an acceptability framework. Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months. RESULTS Nine of 20 patients were not offered a choice of treatment, but this was not necessarily seen as negative (SDM median 4; range 2-4). Factors that influenced decision-making included previous experience and anticipated recovery time. Median (range) DR was 5 (0-50). Those with the highest DR (scores 40-50) were, paradoxically, also amongst the highest scores on SDM (scores 4). Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret. CONCLUSION To minimize regret about surgical decisions, people with PSD need better information about the burden of wound care and the risks of recurrence associated with different surgical approaches.
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Affiliation(s)
- Emily Strong
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tia Callaghan
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Erin Beal
- University of Liverpool, Liverpool, UK
| | - Christine Moffatt
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | | | - Steven Brown
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.,Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Matthew J Lee
- Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Catherine Winton
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
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Decision-making for Risk-reducing Salpingo-oophorectomy (RRSO) in Southeast Asian BRCA Mutation Carriers With Breast Cancer: A Qualitative Study. Int J Behav Med 2021; 29:1-13. [PMID: 33791992 DOI: 10.1007/s12529-021-09984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The uptake of risk-reducing salpingo-oophorectomy (RRSO) in Asian countries is variable despite being the most effective option for ovarian cancer risk reduction in BRCA mutation carriers. Exploration of factors which may impact the RRSO decision-making of BRCA mutation carriers from Malaysia, a developing country in Southeast Asia, was undertaken. METHODS In-depth interviews with 28 Malaysian BRCA mutation carriers with a history of breast cancer were conducted in addition to observing their RRSO decision-making consultations in the clinic. RESULTS The decision-making considerations among the carriers were centered around the overarching theme of "Negotiating cancer risk and womanhood priorities," with the following themes: (1) risk perception, (2) self-preservation, (3) motherhood obligation, and (4) the preciousness of marriage. Cognitive knowledge of BRCA risk was often conceptualized based on personal and family history of cancer, personal beliefs, and faith. Many women reported fears that RRSO would affect them physically and emotionally, worrying about the post-surgical impact on their motherhood responsibilities. Nevertheless, some reported feeling obliged to choose RRSO for the sake of their children. For some, their husband's support and approval were critical, with emotional well-being and sexuality reportedly perceived as important to sustaining married life. Despite reporting hesitancy toward RRSO, women's decisions about choosing this option evolved as their priorities changed at different stages of life. CONCLUSIONS Recognizing during clinic encounters with Malaysian women that RRSO decision-making involves negotiating the likelihood of developing cancer with the societal priorities of being a woman, mother, and wife may serve to support their decision-making.
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Sa'at H, Lee YK, Yoon SY, Wong SW, Woo YL, Barlow-Stewart K, Mohd Taib NA. The needs of Southeast Asian BRCA mutation carriers considering risk-reducing salpingo-oophorectomy: a qualitative study. Fam Cancer 2021; 21:21-33. [PMID: 33604745 DOI: 10.1007/s10689-021-00232-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022]
Abstract
The decision to have risk-reducing salpingo-oophorectomy (RRSO) by BRCA mutation carriers to reduce the risk of ovarian cancer is difficult. The choice involves trade-offs in terms of its risks and benefits. To date, understanding the decision-making needs of RRSO among Southeast Asian BRCA mutation carriers is limited. This study aimed to explore the decision-making needs of Malaysian BRCA mutation carriers as an exemplar for the Southeast Asian community. In-depth interviews and clinic observations were conducted with 31 BRCA mutation carriers and analysed thematically. The core theme identified was 'Coping with complex information and alleviating uncertainties' with the following subthemes: (1) the need for an adjustment period, (2) information support, (3) social support and, (4) religious support. We found that women required time to accept their BRCA mutation status before they were ready to make a risk-reducing choice; that understanding complex genetic information and multiple risk management options can be an overwhelming experience; and obtaining further information and a second opinion were challenging. Many described the need for experiential information from other peer-carriers who had undergone RRSO. Support from their spouse and family members was thought to be essential for them to feel reassured with their decision. Many relied on religion to positively cope with cancer risk and cancer worry; Muslim BRCA carriers sought religious guidance through prayers and Islamic fatwas to feel more certain about their RRSO decision. These findings underscore the importance of the provision of resources and support that includes input from peers, husband, family members and religion to underpin the decision-making needs of Malaysian BRCA mutation carriers considering RRSO.
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Affiliation(s)
- Hamizah Sa'at
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yew-Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sook-Yee Yoon
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Siu Wan Wong
- Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- University of Malaya Cancer Institute, University of Malaya, Kuala Lumpur, Malaysia.
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Sarabia-Tapia C, Corona T, Lopez-Alamillo S, Resendiz-Henriquez E, Cervantes-Arriaga A, Rodríguez-Violante M. Independence of Coping Styles With the Patient-Doctor Relationship and Shared Decision-Making in People With Parkinson's Disease. J Patient Exp 2021; 7:1271-1277. [PMID: 33457575 PMCID: PMC7786658 DOI: 10.1177/2374373520918725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Coping styles have a mediating effect on several clinical outcomes. The patient–doctor relationship and the patient’s role in decision-making process might be influenced by the way the patient reacts to certain stressors or problems due to the evolution of their disease. Objective: To assess the role of coping strategies on the patient–doctor relationship and the patient’s role in decision-making in a group of people with Parkinson’s disease (PD). Methods: A cross-sectional study was carried out. The Coping Style Questionnaire (CSQ-40), the 9-item Patient–Doctor Relationship Questionnaire (PDRQ-9), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) were applied. Results: A total of 36 women and 64 men with PD were included. The predominant coping style in women was rational. In men, the detachment style was more frequent. The SDM-Q-9 mean score was 33.2 ± 11.2 (transformed median score of 80). The PDRQ-9 average score was 2.9 ± 1 (sum score of 26.1 ± 8.7). No association was found between the CSQ-40 with the PDRQ-9 or SDM-Q-9. On the other hand, the PDRQ-9 mean score and the transformed SDM-Q-9 score highly correlated (r = 0.62, P < .001). Conclusion: Patient–doctor relationship and shared decision-making are independent of the coping style in people with PD.
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Affiliation(s)
- Cynthia Sarabia-Tapia
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Teresa Corona
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Susana Lopez-Alamillo
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Etienne Resendiz-Henriquez
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Patient-reported factors that influence the vestibular schwannoma treatment decision: a qualitative study. Eur Arch Otorhinolaryngol 2020; 278:3237-3244. [PMID: 33026499 PMCID: PMC8328891 DOI: 10.1007/s00405-020-06401-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022]
Abstract
Purpose In cases of small- to medium-sized vestibular schwannomas, three management strategies can be opted for: active surveillance, surgery or radiotherapy. In these cases, the patient’s preference is pivotal in decision-making. The aim of this study was to identify factors that influence a patient’s decision for a particular management strategy. Methods A qualitative inductive thematic analysis was performed based on semi-structured interviews. Eighteen patients with small- to medium-sized vestibular schwannomas were interviewed. All patients were diagnosed or treated at one of the two participating university medical centers in the Netherlands.
Results Ten themes were identified that influenced the decision, classified as either medical or patient-related. The medical themes that emerged were: tumor characteristics, the physician’s recommendation, treatment outcomes and the perceived center’s experience. The patient-related themes were: personal characteristics, anxiety, experiences, cognitions, logistics and trust in the physician.
Conclusion Knowledge of the factors that influence decision-making helps physicians to tailor their consultations to arrive at a true shared decision on vestibular schwannoma management.
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Gupta L, Goel A. COVID-19 at the intersections of science, morality and practice - reflections of the physician's soul. J R Coll Physicians Edinb 2020; 50:274-276. [PMID: 32936101 DOI: 10.4997/jrcpe.2020.311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Goel
- Department of Medicine, University College of Medical Sciences, New Delhi, India,
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Tucker Edmonds B, Hoffman SM, Laitano T, Bhamidipalli SS, Jeffries E, Fadel W, Kavanaugh K. Values clarification: Eliciting the values that inform and influence parents' treatment decisions for periviable birth. Paediatr Perinat Epidemiol 2020; 34:556-564. [PMID: 31637742 DOI: 10.1111/ppe.12590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Values clarification can assist families facing the threat of periviable delivery in navigating the complexity of competing values related to death, disability, and quality of life (QOL). OBJECTIVE We piloted values clarification exercises to inform resuscitation decision making and qualitatively assess perceptions of QOL. METHODS We conducted a mixed-method study of women with threatened periviable delivery (22 0/7-24 6/7 weeks) and their important others (IOs). Participants engaged in three values clarification activities as part of a semi-structured interview-(a) Card sorting nine conditions as an acceptable/unacceptable QOL for a child; (b) Rating/ranking seven common concerns in periviable decision making (scale 0-10, not at all to extremely important); and (c) "Agreed/disagreed" with six statements regarding end-of-life treatment, disability, and QOL. Participants were also asked to define "QOL" and describe their perceptions of a good and poor QOL for their child. Analysis was conducted using SAS version 9.4 and NVivo 12. RESULTS All mild disabilities were an acceptable QOL, while two-thirds of participants considered long-term mechanical ventilation unacceptable. Although pregnant women rated "Impact on Your Physical/Mental Health" (average 5.6) and IOs rated "Financial Concerns" the highest (average 6.6), both groups ranked "Financial Concerns" as the most important concern (median 5.0 and 6.0, respectively). Most participants agreed that "Any amount of life is better than no life at all" (pregnant women 62.1%; IOs 75.0%) and disagreed that resuscitation would cause "Too much suffering" for their child (pregnant women 71.4%; IOs 80.0%). Half were familiar with the phrase "QOL". Although the majority described a good QOL in terms of emotional well-being (eg "loved", "happy", "supported"), a poor QOL was described in terms of functionality (eg "dependent" and "confined"). Additionally, financial stability emerged as a distinctive theme when IOs discussed poor QOL. CONCLUSION The study offers important insights on parental perspectives in periviable decision making and potential values clarification tools for decision support.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shelley M Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tatiana Laitano
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Surya Sruthi Bhamidipalli
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Erin Jeffries
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William Fadel
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Karen Kavanaugh
- Children's Hospital of Wisconsin, Milwaukee, WI, USA.,College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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van Leersum CM, van Steenkiste B, Moser A, Wolf JRLM, van der Weijden T. Proposal for a Framework to Enable Elicitation of Preferences for Clients in Need of Long-Term Care. Patient Prefer Adherence 2020; 14:1553-1566. [PMID: 32904562 PMCID: PMC7457579 DOI: 10.2147/ppa.s257501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Collaborative deliberation comprises personal engagement, recognition of alternative actions, comparative learning, preference elicitation, and preference integration. Collaborative deliberation may be improved by assisting preference elicitation during shared decision-making. This study proposes a framework for preference elicitation to facilitate collaborative deliberation in long-term care consultations. METHODS First, a literature overview was conducted comprising current models for the elicitation of preferences in health and social care settings. The models were reviewed and compared. Second, qualitative research was applied to explore those issues that matter most to clients in long-term care. Data were collected from clients in long-term care, comprising 16 interviews, 3 focus groups, 79 client records, and 200 online client reports. The qualitative analysis followed a deductive approach. The results of the literature overview and qualitative research were combined. RESULTS Based on the literature overview, five overarching domains of preferences were described: "Health", "Daily life", "Family and friends", "Living conditions", and "Finances". The credibility of these domains was confirmed by qualitative data analysis. During interviews, clients addressed issues that matter in their lives, including a "click" with their care professional, safety, contact with loved ones, and assistance with daily structure and activities. These data were used to determine the content of the domains. CONCLUSION A framework for preference elicitation in long-term care is proposed. This framework could be useful for clients and professionals in preference elicitation during collaborative deliberation.
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Affiliation(s)
- Catharina M van Leersum
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
- Correspondence: Catharina M van Leersum Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Peter Debyeplein 1 (Room 3.022), Maastricht6229 HA, the NetherlandsTel +31 43 388 2295 Email
| | - Ben van Steenkiste
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albine Moser
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
- Research Center for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Judith R L M Wolf
- Impuls-Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
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Lifford KJ, Edwards A, Burton M, Harder H, Armitage F, Morgan JL, Caldon L, Balachandran K, Ring A, Collins K, Reed M, Wyld L, Brain K. Efficient development and usability testing of decision support interventions for older women with breast cancer. Patient Prefer Adherence 2019; 13:131-143. [PMID: 30679905 PMCID: PMC6338238 DOI: 10.2147/ppa.s178347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Around one-third of breast cancers diagnosed every year in the UK are in women aged ≥70 years. However, there are currently no decision support interventions (DESIs) for older women who have a choice between primary endocrine therapy and surgery followed by adjuvant endocrine therapy (surgery+endocrine therapy), or who can choose whether or not to have chemotherapy following surgery. There is also little evidence-based guidance specifically on the management of these older patients. A large UK cohort study is currently underway to address this lack of evidence and to develop two DESIs to facilitate shared decision-making with older women about breast cancer treatments. Here, we present the development and initial testing of these two DESIs. METHODS An initial prototype DESI was developed for the choice of primary endocrine therapy or surgery+endocrine therapy. Semi-structured interviews with healthy volunteers and patients explored DESI acceptability, usability, and utility. A framework approach was used for analysis. A second DESI for the choice of having chemotherapy or not was subsequently developed based on more focused development and testing. RESULTS Participants (n=22, aged 75-94 years, 64% healthy volunteers, 36% patients) found the primary endocrine therapy /surgery+endocrine therapy DESI acceptable, and contributed to improved wording and illustrations to address misunderstandings. The chemotherapy DESI (tested with 14 participants, aged 70-87 years, 57% healthy volunteers, 43% patients) was mostly understandable, however, suggestions for rewording sections were made. Most participants considered the DESIs helpful, but highlighted the importance of complementary discussions with clinicians. CONCLUSION It was possible to use a template DESI to efficiently create a second prototype for a different treatment option (chemotherapy). Both DESIs were acceptable and considered helpful to support/augment consultations. Development of acceptable additional DESIs for similar target populations using simplified methods may be an efficient way to develop future DESIs. Further research is needed to test the effectiveness of the DESIs.
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Affiliation(s)
- Kate J Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK,
| | - Maria Burton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Helena Harder
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Fiona Armitage
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jenna L Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lisa Caldon
- Department of General Surgery, The Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Alistair Ring
- Breast Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, UK
| | - Karen Collins
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK,
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Gul S, Turkman YE, Bakitas MA, Dionne-Odom JN. Surrogates' Perceptions of Service Quality While Making Decisions for ICU Patients. West J Nurs Res 2018; 41:1370-1384. [PMID: 30574823 DOI: 10.1177/0193945918820098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A qualitative secondary analysis was undertaken to identify aspects of health care service quality in an intensive care unit from the perspective of surrogate decision makers (N = 19) who were making decisions for relatives at end of life. Directed content analysis was guided by the Donabedian model of health care quality. Nineteen participants averaged 59 years old and were over half female (53%) and patients' spouses (53%) and adult children (32%). Salient aspects of quality service included surrogate perceptions that clinicians conveyed honesty about the patient's condition and in an easily understandable way; staff were sensitive and responsive to emotions and practical needs; clinicians demonstrated a clear, confident understanding of the patient's condition; and support by clinicians was given for surrogates' choices. Surrogates also commented on the hospital and intensive care unit environment, including cleanliness, comfort, privacy, and noise level. Further research is needed to explore how decision-support strategies might include service quality concepts.
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Affiliation(s)
- Senay Gul
- Hacettepe University, Ankara, Turkey
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18
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Superdock AK, Barfield RC, Brandon DH, Docherty SL. Exploring the vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliat Care 2018; 17:107. [PMID: 30208902 PMCID: PMC6134505 DOI: 10.1186/s12904-018-0360-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medical advances have led to new challenges in decision-making for parents of seriously ill children. Many parents say religion and spirituality (R&S) influence their decisions, but the mechanism and outcomes of this influence are unknown. Health care providers (HCPs) often feel unprepared to discuss R&S with parents or address conflicts between R&S beliefs and clinical recommendations. Our study sought to illuminate the influence of R&S on parental decision-making and explore how HCPs interact with parents for whom R&S are important. METHODS A longitudinal, qualitative, descriptive design was used to (1) identify R&S factors affecting parental decision-making, (2) observe changes in R&S themes over time, and (3) learn about HCP perspectives on parental R&S. The study sample included 16 cases featuring children with complex life-threatening conditions. The length of study for each case varied, ranging in duration from 8 to 531 days (median = 380, mean = 324, SD = 174). Data from each case included medical records and sets of interviews conducted at least monthly with mothers (n = 16), fathers (n = 12), and HCPs (n = 108). Thematic analysis was performed on 363 narrative interviews to identify R&S themes and content related to decision-making. RESULTS Parents from 13 cases reported R&S directly influenced decision-making. Most HCPs were unaware of this influence. Fifteen R&S themes appeared in parent and HCP transcripts. Themes most often associated with decision-making were Hope & Faith, God is in Control, Miracles, and Prayer. Despite instability in the child's condition, these themes remained consistently relevant across the trajectory of illness. R&S influenced decisions about treatment initiation, procedures, and life-sustaining therapy, but the variance in effect of R&S on parents' choices ultimately depended upon other medical & non-medical factors. CONCLUSIONS Parents consider R&S fundamental to decision-making, but apply R&S concepts in vague ways, suggesting R&S impact how decisions are made more than what decisions are made. Lack of clarity in parental expressions of R&S does not necessarily indicate insincerity or underestimation of the seriousness of the child's prognosis; R&S can be applied to decision-making in both functional and dysfunctional ways. We present three models of how religious and spiritual vagueness functions in parental decision-making and suggest clinical applications.
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Affiliation(s)
- Alexandra K. Superdock
- School of Medicine, Duke University, Durham, NC USA
- Pediatrics Residency Program, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, 15224 PA USA
| | - Raymond C. Barfield
- Division of Pediatric Hematology and Oncology, Duke University School of Medicine, 2 Chapel Drive, 0034 Westbrook, Durham, NC 27708 USA
| | - Debra H. Brandon
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
| | - Sharron L. Docherty
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
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Heringa M, Floor-Schreudering A, De Smet PAGM, Bouvy ML. Aspects influencing patients' preferences for the management of drug-drug interactions: A focus group study. PATIENT EDUCATION AND COUNSELING 2018; 101:723-729. [PMID: 29173959 DOI: 10.1016/j.pec.2017.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The management of drug-drug interactions (DDIs) involves a complex risk-benefit assessment, in which patients' preferences should be taken into account. The aim of this study was to examine the aspects influencing patients' preferences with regard to DDI management options. METHODS A qualitative study consisting of five focus groups with patients chronically using cardiovascular drugs was conducted. Key questions concerned preferences regarding DDI management options for a provided fictitious DDI. Thematic analysis of the verbatim transcripts was performed. RESULTS Despite their limited knowledge with respect to DDIs, patients easily chose a management option for the presented DDI. When additional information was provided, preferences showed to be fluid. Ten interdependent aspects influencing preferences were derived from patients' argumentations: risk perception, fear, acceptance of uncertainty, openness to change, willingness to take risk, trust in health care professional, financial & practical burdens, health condition, experience, and knowledge & assumptions. CONCLUSION Patients' preferences regarding DDI management options were often determined by provided information. Preferences were dependent on an interplay of diverse aspects. PRACTICE IMPLICATIONS Tailored provision of information and individualized counseling is needed for active patient involvement in DDI decision making.
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Affiliation(s)
- Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Health Base Foundation, Houten, The Netherlands.
| | - Annemieke Floor-Schreudering
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Peter A G M De Smet
- Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, The Netherlands.
| | - Marcel L Bouvy
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
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Colley A, Halpern J, Paul S, Micco G, Lahiff M, Wright F, Levine JD, Mastick J, Hammer MJ, Miaskowski C, Dunn LB. Factors associated with oncology patients' involvement in shared decision making during chemotherapy. Psychooncology 2016; 26:1972-1979. [PMID: 27649058 DOI: 10.1002/pon.4284] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Oncology patients are increasingly encouraged to play an active role in treatment decision making. While previous studies have evaluated relationships between demographic characteristics and decision-making roles, less is known about the association of symptoms and psychological adjustment characteristics (eg, coping styles and personality traits) and decision-making roles. METHODS As part of a larger study of symptom clusters, patients (n = 765) receiving chemotherapy for breast, gastrointestinal, gynecological, or lung cancer provided information on demographic, clinical, symptom, and psychological adjustment characteristics. Patient-reported treatment decision-making roles (ie, preferred role and role actually played) were assessed using the Control Preferences Scale. Differences among patients, who were classified as passive, collaborative, or active, were evaluated using χ2 analyses and analyses of variance. RESULTS Over half (56.3%) of the patients reported that they both preferred and actually played a collaborative role. Among those patients with concordant roles, those who were older, those with less education and lower income, and those who were less resilient were more likely to prefer a passive role. Several psychological adjustment characteristics were associated with decision-making role, including coping style, personality, and fatalism. CONCLUSIONS Oncology patients' preferences for involvement in treatment decision making are associated with demographic characteristics as well as with symptoms and psychological adjustment characteristics, such as coping style and personality. These results reaffirm the complexities of predicting patients' preferences for involvement in decision making. Further study is needed to determine if role or coping style may be influenced by interventions designed to teach adaptive coping skills.
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Affiliation(s)
- Alexis Colley
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Jodi Halpern
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Guy Micco
- UC Berkeley-UC San Francisco Joint Medical Program, University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Maureen Lahiff
- School of Public Health, Division of Biostatistics, University of California, Berkeley, CA, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, CT, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | | | | | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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González-Ramírez LP, De la Roca-Chiapas JM, Daneri-Navarro A, Colunga-Rodríguez C, Contreras AM, Martínez-Arriaga R, del Toro-Valero A, Oceguera-Villanueva A. Consejo genético oncológico: las aplicaciones de la Psicooncología. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dowie J, Kjer Kaltoft M, Salkeld G, Cunich M. Towards generic online multicriteria decision support in patient-centred health care. Health Expect 2015; 18:689-702. [PMID: 23910715 PMCID: PMC5060847 DOI: 10.1111/hex.12111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). BACKGROUND All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. METHODS The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. CONCLUSION The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided.
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Affiliation(s)
- Jack Dowie
- London School of Hygiene and Tropical MedicineLondonUK
| | | | - Glenn Salkeld
- Sydney School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - Michelle Cunich
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSWAustralia
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Carvalho MS, Coeli CM, Chor D, Pinheiro RS, da Fonseca MDJM, de Sá Carvalho LC. The Challenge of Cardiovascular Diseases and Diabetes to Public Health: A Study Based on Qualitative Systemic Approach. PLoS One 2015; 10:e0132216. [PMID: 26171854 PMCID: PMC4501838 DOI: 10.1371/journal.pone.0132216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/08/2015] [Indexed: 01/02/2023] Open
Abstract
The most common modeling approaches to understanding incidence, prevalence and control of chronic diseases in populations, such as statistical regression models, are limited when it comes to dealing with the complexity of those problems. Those complex adaptive systems have characteristics such as emerging properties, self-organization and feedbacks, which structure the system stability and resistance to changes. Recently, system science approaches have been proposed to deal with the range, complexity, and multifactor nature of those public health problems. In this paper we applied a multilevel systemic approach to create an integrated, coherent, and increasingly precise conceptual framework, capable of aggregating different partial or specialized studies, based on the challenges of the Longitudinal Study of Adult Health - ELSA-Brasil. The failure to control blood pressure found in several of the study's subjects was discussed, based on the proposed model, analyzing different loops, time lags, and feedback that influence this outcome in a population with high educational level, with reasonably good health services access. We were able to identify the internal circularities and cycles that generate the system's resistance to change. We believe that this study can contribute to propose some new possibilities of the research agenda and to the discussion of integrated actions in the field of public health.
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Affiliation(s)
- Marilia Sá Carvalho
- Scientific Computing Program, Oswaldo Cruz Foundation, Antiga Residência Oficial, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Claudia Medina Coeli
- Institute for Studies in Collective Health. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Dóra Chor
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Institute for Studies in Collective Health. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lifford KJ, Witt J, Burton M, Collins K, Caldon L, Edwards A, Reed M, Wyld L, Brain K. Understanding older women's decision making and coping in the context of breast cancer treatment. BMC Med Inform Decis Mak 2015; 15:45. [PMID: 26058557 PMCID: PMC4461993 DOI: 10.1186/s12911-015-0167-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/25/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI). METHODS Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process. RESULTS Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation. CONCLUSIONS Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting.
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Affiliation(s)
- Kate J Lifford
- />Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Jana Witt
- />Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE5 9PJ UK
| | - Maria Burton
- />Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP UK
| | - Karen Collins
- />Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP UK
| | - Lisa Caldon
- />Academic Unit of Surgical Oncology, University of Sheffield Medical School, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2RX UK
| | - Adrian Edwards
- />Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Malcolm Reed
- />Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX UK
| | - Lynda Wyld
- />Academic Unit of Surgical Oncology, University of Sheffield Medical School, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2RX UK
| | - Kate Brain
- />Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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Witt J, Elwyn G, Wood F, Rogers MT, Menon U, Brain K. Adapting the coping in deliberation (CODE) framework: a multi-method approach in the context of familial ovarian cancer risk management. PATIENT EDUCATION AND COUNSELING 2014; 97:200-210. [PMID: 25064250 DOI: 10.1016/j.pec.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 06/28/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To test whether the coping in deliberation (CODE) framework can be adapted to a specific preference-sensitive medical decision: risk-reducing bilateral salpingo-oophorectomy (RRSO) in women at increased risk of ovarian cancer. METHODS We performed a systematic literature search to identify issues important to women during deliberations about RRSO. Three focus groups with patients (most were pre-menopausal and untested for genetic mutations) and 11 interviews with health professionals were conducted to determine which issues mattered in the UK context. Data were used to adapt the generic CODE framework. RESULTS The literature search yielded 49 relevant studies, which highlighted various issues and coping options important during deliberations, including mutation status, risks of surgery, family obligations, physician recommendation, peer support and reliable information sources. Consultations with UK stakeholders confirmed most of these factors as pertinent influences on deliberations. Questions in the generic framework were adapted to reflect the issues and coping options identified. CONCLUSIONS The generic CODE framework was readily adapted to a specific preference-sensitive medical decision, showing that deliberations and coping are linked during deliberations about RRSO. PRACTICE IMPLICATIONS Adapted versions of the CODE framework may be used to develop tailored decision support methods and materials in order to improve patient-centred care.
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Affiliation(s)
- Jana Witt
- Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
| | - Glyn Elwyn
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, USA; Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Fiona Wood
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | | | - Usha Menon
- Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Kate Brain
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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Cummings CR, Bentley KJ. Contemporary health-related decision aids: tools for social work practice. SOCIAL WORK IN HEALTH CARE 2014; 53:762-775. [PMID: 25255339 DOI: 10.1080/00981389.2014.944252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The escalating complexity in health-related decisions that people face have important implications for social work interventions. This article explores the nature of these implications within the context of decisional conflict, shared decision making, and the use of decision aids. In addition, the authors present the findings of a content analysis of 29 contemporary health-related decision aids. Emergent categories from this analysis are presented as a resource for social workers as they encounter, adapt, and create decision aids in their work to help address the health-related needs of their clients.
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Affiliation(s)
- Cory R Cummings
- a Virginia Commonwealth University , Richmond , Virginia , USA
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Stacey D, Kryworuchko J, Belkora J, Davison BJ, Durand MA, Eden KB, Hoffman AS, Koerner M, Légaré F, Loiselle MC, Street RL. Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S11. [PMID: 24624995 PMCID: PMC4045677 DOI: 10.1186/1472-6947-13-s2-s11] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts "coaching" and "guidance"; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. METHODS We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. RESULTS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. CONCLUSIONS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 451 Smyth Road (RGN Room 1118), Ottawa, Ontario, K1H 8M5, Canada
| | - Jennifer Kryworuchko
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Jeff Belkora
- Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, California 94118, USA
| | - B Joyce Davison
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Marie-Anne Durand
- Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL 109AB, UK
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098, USA
| | - Aubri S Hoffman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway (HB7250), Lebanon, New Hampshire 03766, USA
| | - Mirjam Koerner
- Department of Medical Psychology and Medical Sociology, University of Freiburg, Hebelstr. 29, 79104 Freiburg, Germany
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Local 4617, Quebec, Province of Quebec G1V 0A6, Canada
| | - Marie-Chantal Loiselle
- School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150, place Charles-Le Moyne (Bureau 200), Longueuil, Province of Quebec J4K 0A8, Canada
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, Texas 77843-4234, USA
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Lifford KJ, Clements A, Fraser L, Lancastle D, Brain K. A qualitative study of women's experiences of familial ovarian cancer screening. Psychooncology 2013; 22:2576-84. [PMID: 23801640 DOI: 10.1002/pon.3324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/29/2013] [Accepted: 05/10/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE One risk management strategy that women at increased familial risk of ovarian cancer may use is screening. Until recently, this has been available as part of the UK Familial Ovarian Cancer Screening Study (UKFOCSS), using ultrasound scans of the ovaries and tumour marker blood tests. The present study aimed to gain an in-depth understanding of women's experiences of participating in ovarian cancer screening. METHODS Semi-structured interviews were conducted with 48 UKFOCSS participants. Interviews were recorded, transcribed and relevant sections analysed using a framework approach. RESULTS Screening provided women with reassurance which they found beneficial. A sense of privilege, as well as feeling proactive in potentially detecting ovarian cancer at an early stage was described. The wider benefit to research and the potential impact this could have on others was also important to women. Negative experiences of screening included worry about the screening tests and results, false reassurance by test results and disappointment with ineffective screening. Aspects of the screening study, such as the logistics, organisation and communication, were described as both good and problematic. When weighed up by the women, most described an overall positive experience of screening. CONCLUSIONS Women reported both positive and negative experiences of screening. Overall, screening seemed to be an acceptable risk management strategy to most women who participated in this interview study. Improvements could be made particularly in helping women to understand the limitations of familial ovarian cancer screening in order to avoid false reassurance.
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Affiliation(s)
- Kate J Lifford
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
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Stacey D, Kryworuchko J, Belkora J, Davison BJ, Durand MA, Eden KB, Hoffman AS, Koerner M, Légaré F, Loiselle MC, Street RL. Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Med Inform Decis Mak 2013. [PMID: 24624995 DOI: 10.1186/1472-6947-13-s2-s11.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts "coaching" and "guidance"; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. METHODS We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. RESULTS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. CONCLUSIONS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.
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Richter T, Buhse S, Kupfer R, Gerlach A, Mühlhauser I, Lenz M. Entwicklung einer Entscheidungshilfe „Organspende nach dem Tod“ - im Spannungsfeld zwischen Evidenz, Ungewissheit, Ängsten und ethisch-moralischen Wertvorstellungen. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2013; 107:622-31. [DOI: 10.1016/j.zefq.2013.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
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Brain KE, Lifford KJ, Fraser L, Rosenthal AN, Rogers MT, Lancastle D, Phelps C, Watson EK, Clements A, Menon U. Psychological outcomes of familial ovarian cancer screening: No evidence of long-term harm. Gynecol Oncol 2012; 127:556-63. [DOI: 10.1016/j.ygyno.2012.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/16/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022]
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