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Olde Loohuis KM, de Kok BC, Bruner W, Jonker A, Salia E, Tunçalp Ö, Portela A, Mehrtash H, Grobbee DE, Srofeneyoh E, Adu-Bonsaffoh K, Brown Amoakoh H, Amoakoh-Coleman M, Browne JL. Strategies to improve interpersonal communication along the continuum of maternal and newborn care: A scoping review and narrative synthesis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002449. [PMID: 37819950 PMCID: PMC10566738 DOI: 10.1371/journal.pgph.0002449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
Effective interpersonal communication is essential to provide respectful and quality maternal and newborn care (MNC). This scoping review mapped, categorized, and analysed strategies implemented to improve interpersonal communication within MNC up to 42 days after birth. Twelve bibliographic databases were searched for quantitative and qualitative studies that evaluated interventions to improve interpersonal communication between health workers and women, their partners or newborns' families. Eligible studies were published in English between January 1st 2000 and July 1st 2020. In addition, communication studies in reproduction related domains in sexual and reproductive health and rights were included. Data extracted included study design, study population, and details of the communication intervention. Communication strategies were analysed and categorized based on existing conceptualizations of communication goals and interpersonal communication processes. A total of 138 articles were included. These reported on 128 strategies to improve interpersonal communication and were conducted in Europe and North America (n = 85), Sub-Saharan Africa (n = 12), Australia and New Zealand (n = 10), Central and Southern Asia (n = 9), Latin America and the Caribbean (n = 6), Northern Africa and Western Asia (n = 4) and Eastern and South-Eastern Asia (n = 2). Strategies addressed three communication goals: facilitating exchange of information (n = 97), creating a good interpersonal relationship (n = 57), and/or enabling the inclusion of women and partners in the decision making (n = 41). Two main approaches to strengthen interpersonal communication were identified: training health workers (n = 74) and using tools (n = 63). Narrative analysis of these interventions led to an update of an existing communication framework. The categorization of different forms of interpersonal communication strategy can inform the design, implementation and evaluation of communication improvement strategies. While most interventions focused on information provision, incorporating other communication goals (building a relationship, inclusion of women and partners in decision making) could further improve the experience of care for women, their partners and the families of newborns.
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Affiliation(s)
- Klaartje M. Olde Loohuis
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bregje C. de Kok
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Winter Bruner
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Annemoon Jonker
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmanuella Salia
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research Including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research Including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Diederick E. Grobbee
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmanuel Srofeneyoh
- Department of Obstetrics and Gynecology, Greater Regional Hospital, Accra, Ghana
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Hannah Brown Amoakoh
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Accra, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Accra, Accra, Ghana
| | - Joyce L. Browne
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
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Veenendaal HV, Chernova G, Bouman CM, Etten-Jamaludin FSV, Dieren SV, Ubbink DT. Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107561. [PMID: 36434862 DOI: 10.1016/j.pec.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE 1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. METHODS MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. RESULTS Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23). CONCLUSION Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. PRACTICE IMPLICATIONS The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Genya Chernova
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Carlijn Mb Bouman
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Faridi S van Etten-Jamaludin
- Amsterdam UMC, location University of Amsterdam, Medical Library AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Susan van Dieren
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Dirk T Ubbink
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Leu S, Cahill J, Grundy PL. A prospective study of shared decision-making in brain tumor surgery. Acta Neurochir (Wien) 2023; 165:15-25. [PMID: 36576561 PMCID: PMC9795149 DOI: 10.1007/s00701-022-05451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/25/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Shared decision-making (SDM) is a key tenet of personalized care and is becoming an essential component of informed consent in an increasing number of countries. The aim of this study is to analyze patient and healthcare staff satisfaction with the SDM process before and after SDM was officially introduced as the standard of care. Decision grids are important tools in the SDM process, and we developed them for three different types of intracranial tumors. METHODS This prospective study was conducted in a high-volume neuro-oncological center on all consecutive eligible patients undergoing consideration of treatment for intracranial glioma and metastases. Twenty-two patients participated before and 74 after the introduction of SDM. Six and 5 staff members respectively participated in the analysis before and after team training and the introduction of SDM. The main outcome was patient and healthcare staff satisfaction with the SDM process. RESULTS Patients reported high satisfaction with the SDM process before (mean CollaboRATE score 26 of 27 points) and after (mean CollaboRATE score 26.3 of 27 points, p = 0.23) the introduction of SDM. Interestingly, staff attitude toward SDM improved significantly from 61.68 before to 90.95% after the introduction of SDM (p-value < 0.001). Decision grids that were developed for three different types of intracranial tumors are presented. CONCLUSIONS Team training in SDM and the introduction of techniques into daily practice can increase staff satisfaction with the SDM process. High levels of patient satisfaction were observed before, with a non-significant increase after the introduction of SDM. Decision grids are an important tool to facilitate the conveyance and understanding of complex information and to achieve SDM in daily clinical practice.
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Affiliation(s)
- Severina Leu
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK.
- Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Julian Cahill
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
- The National Centre for Stereotactic Radiosurgery, Sheffield, South Yorkshire, UK
| | - Paul L Grundy
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK
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Dawson A, Assifi A, Turkmani S. Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines. Reprod Health 2022; 19:50. [PMID: 35193606 PMCID: PMC8862274 DOI: 10.1186/s12978-022-01356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. METHOD We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. FINDINGS One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. CONCLUSION This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.
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Affiliation(s)
- Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia.
| | - Anisa Assifi
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sabera Turkmani
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia
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Rake EA, Dreesens D, Venhorst K, Meinders MJ, Geltink T, Wolswinkel JT, Dannenberg M, Kremer JAM, Elwyn G, Aarts JWM. Potential impact of encounter patient decision aids on the patient-clinician dialogue: a qualitative study on Dutch and American medical specialists' experiences. BMJ Open 2022; 12:e048146. [PMID: 35105563 PMCID: PMC8808398 DOI: 10.1136/bmjopen-2020-048146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To examine the experiences among Dutch and American clinicians on the impact of using encounter patient decision aids (ePDAs) on their clinical practice, and subsequently to formulate recommendations for sustained ePDA use in clinical practice. DESIGN Qualitative study using semi-structured interviews with clinicians who used 11 different ePDAs (applicable to their specialty) for 3 months after a short training. The verbatim transcribed interviews were coded with thematic analysis by six researchers via ATLAS.ti. SETTING Nine hospitals in the Netherlands and two hospitals in the USA. PARTICIPANTS Twenty-five clinicians were interviewed: 16 Dutch medical specialists from four different disciplines (gynaecologists, ear-nose-throat specialists, neurologists and orthopaedic surgeon), 5 American gynaecologists and 4 American gynaecology medical trainees. RESULTS The interviews showed that the ePDA potentially impacted the patient-clinician dialogue in several ways. We identified six themes that illustrate this: that is, (1) communication style, for example, structuring the conversation; (2) the patient's role, for example, encouraging patients to ask more questions; (3) the clinician's role, for example, prompting clinicians to discuss more information; (4) workflow, for example, familiarity with the ePDA's content helped to integrate it into practice; (5) shared decision-making (SDM), for example, mixed experiences whether the ePDA contributed to SDM; and (6) content of the ePDA. Recommendations to possibly improve ePDA use based on the clinician's experiences: (1) add pictorial health information to the ePDA instead of text only and (2) instruct clinicians how to use the ePDA in a flexible (depending on their discipline and setting) and personalised way adapting the ePDA to the patients' needs (e.g., mark off irrelevant options). CONCLUSIONS ePDAs contributed to the patient-clinician dialogue in several ways according to medical specialists. A flexible and personalised approach appeared appropriate to integrate the use of ePDAs into the clinician's workflow, and customise their use to individual patients' needs.
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Affiliation(s)
- Ester A Rake
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboudumc, Nijmegen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Dunja Dreesens
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Kristie Venhorst
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Marjan J Meinders
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Tessa Geltink
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Jenny T Wolswinkel
- Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, The Netherlands
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Jan A M Kremer
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Glyn Elwyn
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboudumc, Nijmegen, The Netherlands
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, USA
| | - Johanna W M Aarts
- Department of Obstetrics and Gynecology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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Aarts JWM, Thompson R, Alam SS, Dannenberg M, Elwyn G, Foster TC. Encounter decision aids to facilitate shared decision-making with women experiencing heavy menstrual bleeding or symptomatic uterine fibroids: A before-after study. PATIENT EDUCATION AND COUNSELING 2021; 104:2259-2265. [PMID: 33632633 DOI: 10.1016/j.pec.2021.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 11/19/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. METHODS This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION5. Consultation transcripts in the 'after' group were checked for adherence to the steps required for intended use of decision aids. RESULTS 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53-19.47). CONCLUSION The level of SDM was higher after the introduction of the package than before. PRACTICE IMPLICATIONS This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.
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Affiliation(s)
- Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, the Netherlands.
| | - Rachel Thompson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Shama S Alam
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA
| | - Tina C Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon NH, USA; Department Obstetrics & Gynaecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Schubbe D, Yen RW, Saunders CH, Elwyn G, Forcino RC, O'Malley AJ, Politi MC, Margenthaler J, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bradley A, Goodwin C, van den Muijsenbergh M, Aarts JWM, Scalia P, Durand MA. Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices. Implement Sci 2021; 16:51. [PMID: 33971913 PMCID: PMC8108365 DOI: 10.1186/s13012-021-01115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. METHODS We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. RESULTS We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. CONCLUSIONS Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136367 , registered on May 2, 2017.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert J Volk
- Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sanja Percac-Lima
- Massachusetts General Hospital's Chelsea Healthcare Center, Chelsea, MA, USA
| | - Ann Bradley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- UMR 1295, CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
- Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
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Brand DA, Mock A, Cohn E, Krilov LR. Implementing the 2016 American Academy of Pediatrics Guideline on Brief Resolved Unexplained Events: The Parent's Perspective. Pediatr Emerg Care 2021; 37:e243-e248. [PMID: 30399064 DOI: 10.1097/pec.0000000000001659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A "brief resolved unexplained event" refers to sudden alterations in an infant's breathing, color, tone, or responsiveness that prompt the parent or caregiver to seek emergency medical care. A recently published clinical practice guideline encourages discharging many of these infants home from the emergency department if they have a benign presentation. The goal is to avoid aggressive inpatient investigations of uncertain benefit. The present research explored parents' reactions to the prospect of returning home with their infant following such an event. METHODS The study used qualitative research methods to analyze semistructured, audio-recorded interviews of parents who had witnessed a brief resolved unexplained event between 2011 and 2015 and taken their infant to the emergency department of an academic teaching hospital. RESULTS A total of 22 parent interviews were conducted. The infants included 8 boys and 14 girls aged 3.6 ± 3.5 months (mean ± SD). Qualitative analysis of interview transcripts revealed a near-universal apprehension about the child's well-being, ambivalence about the best course of action after the evaluation in the emergency department, and need for reassurance about the unlikelihood of a recurrence. Parents did not, however, answer the main research question with a single voice: attitudes toward the return-home scenario ranged from unthinkable to extreme relief. Two-thirds of parents expressed at least some reservations about the idea of returning home. CONCLUSIONS Successful implementation of the 2016 guideline will require close attention to the parent's point of view. Otherwise, parental resistance is likely to compromise clinicians' best efforts.
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Affiliation(s)
| | - Ann Mock
- Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola
| | - Elizabeth Cohn
- Center for Health Innovation, Adelphi University, Garden City, NY
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Durand MA, Yen RW, O'Malley AJ, Schubbe D, Politi MC, Saunders CH, Dhage S, Rosenkranz K, Margenthaler J, Tosteson ANA, Crayton E, Jackson S, Bradley A, Walling L, Marx CM, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bergin E, Goodwin C, Miller C, Harris C, Barth RJ, Aft R, Feldman S, Cyr AE, Angeles CV, Jiang S, Elwyn G. What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata. Cancer 2020; 127:422-436. [PMID: 33170506 PMCID: PMC7983934 DOI: 10.1002/cncr.33248] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
Abstract
Background Women of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women across socioeconomic strata in making breast cancer surgery choices. Methods We conducted a 3‐arm (Option Grid, Picture Option Grid, and usual care), multisite, randomized controlled superiority trial with surgeon‐level randomization. The Option Grid (text only) and Picture Option Grid (pictures plus text) conversation aids were evidence‐based summaries of available breast cancer surgery options on paper. Decision quality (primary outcome), treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care were measured from T0 (pre‐consultation) to T5 (1‐year after surgery. Results Sixteen surgeons saw 571 of 622 consented patients. Patients in the Picture Option Grid arm (n = 248) had higher knowledge (immediately after the visit [T2] and 1 week after surgery or within 2 weeks of the first postoperative visit [T3]), an improved decision process (T2 and T3), lower decision regret (T3), and more SDM (observed and self‐reported) compared to usual care (n = 257). Patients in the Option Grid arm (n = 66) had higher decision process scores (T2 and T3), better coordination of care (12 weeks after surgery or within 2 weeks of the second postoperative visit [T4]), and more observed SDM (during the surgical visit [T1]) compared to usual care arm. Subgroup analyses suggested that the Picture Option Grid had more impact among women of lower SES and health literacy. Neither intervention affected concordance, treatment choice, or anxiety. Conclusions Paper‐based conversation aids improved key outcomes over usual care. The Picture Option Grid had more impact among disadvantaged patients. Lay Summary The objective of this study was to understand how to help women with lower incomes or less formal education to make breast cancer surgery choices. Compared with usual care, a conversation aid with pictures and text led to higher knowledge. It improved the decision process and shared decision making (SDM) and lowered decision regret. A text‐only conversation aid led to an improved decision process, more coordinated care, and higher SDM compared to usual care. The conversation aid with pictures was more helpful for women with lower income or less formal education. Conversation aids with pictures and text helped women make better breast cancer surgery choices.
A paper‐based pictorial conversation aid (pictures plus text) is beneficial to all patients with early‐stage breast cancer and particularly to disadvantaged patients. Between‐surgeon variation suggests that the maximal impact of such interventions requires standardized physician training combined with these interventions.
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Affiliation(s)
- Marie-Anne Durand
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,UMR 1027 Team EQUITY, Paul Sabatier University, Toulouse, France
| | - Renata W Yen
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - A James O'Malley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Danielle Schubbe
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine H Saunders
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Shubhada Dhage
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | | | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Eloise Crayton
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sherrill Jackson
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ann Bradley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Linda Walling
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Christine M Marx
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elissa Ozanne
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sanja Percac-Lima
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts
| | | | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Camille Harris
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | | | - Rebecca Aft
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Amy E Cyr
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Shuai Jiang
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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10
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Yen RW, Durand MA, Harris C, Cohen S, Ward A, O'Malley AJ, Schubbe D, Saunders CH, Elwyn G. Text-only and picture conversation aids both supported shared decision making for breast cancer surgery: Analysis from a cluster randomized trial. PATIENT EDUCATION AND COUNSELING 2020; 103:2235-2243. [PMID: 32782181 DOI: 10.1016/j.pec.2020.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine if two encounter conversation aids for early-stage breast cancer surgery increased observed and patient-reported shared decision making (SDM) compared with usual care and if observed and patient-reported SDM were associated. METHODS Surgeons in a cluster randomized trial at four cancer centers were randomized to use an Option Grid, Picture Option Grid, or usual care. We used bivariate statistics, linear regression, and multilevel models to evaluate the influence of trial arm, patient socioeconomic status and health literacy on observed SDM (via OPTION-5) and patient-reported SDM (via collaboRATE). RESULTS From 311 recordings, OPTION-5 scores were 73/100 for Option Grid (n = 40), 56.3/100 for Picture Option Grid (n = 144), and 41.0/100 for usual care (n = 127; p < 0.0001). Top collaboRATE scores were 81.6 % for Option Grid, 80.0 % for Picture Option Grid, and 56.4 % for usual care (p < 0.001). Top collaboRATE scores correlated with an 8.60 point (95 %CI 0.66, 13.7) higher OPTION-5 score (p = 0.008) with no correlation in the multilevel analysis. Patients of lower socioeconomic status had lower OPTION-5 scores before accounting for clustering. CONCLUSIONS Both conversation aids led to meaningfully higher observed and patient-reported SDM. Observed and patient-reported SDM were not strongly correlated. PRACTICE IMPLICATIONS Healthcare providers could implement these conversation aids in real-world settings.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Camille Harris
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | | | | | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
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11
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Munro S, Manski R, Donnelly KZ, Agusti D, Stevens G, Banach M, Boardman MB, Brady P, Bradt CC, Foster T, Johnson DJ, Norsigian J, Nothnagle M, Shepherd HL, Stern L, Trevena L, Elwyn G, Thompson R. Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implement Sci 2019; 14:95. [PMID: 31706329 PMCID: PMC6842477 DOI: 10.1186/s13012-019-0941-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training). Methods Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions. Results Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions. Conclusions Variation in capabilities and motivation among clinical and administrative staff, coupled with inconsistent use of the interventions in routine workflow contributed to suboptimal implementation of the interventions. Future trials may benefit by using implementation strategies that embed SDM in the organizational culture of clinical settings.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, E204 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. .,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Ruth Manski
- Society of Family Planning, 225 South 17th Street, Suite 2709, Philadelphia, PA, 19103, USA
| | - Kyla Z Donnelly
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Daniela Agusti
- Dartmouth College Health Service, 7 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Gabrielle Stevens
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | | | - Maureen B Boardman
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | | | | | - Tina Foster
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.,Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Deborah J Johnson
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Judy Norsigian
- Our Bodies Ourselves, P.O. Box 590403, Newton Center, MA, 02459, USA
| | - Melissa Nothnagle
- Department of Family and Community Medicine, University of California San Francisco, Natividad Medical Center, 1441 Constitution Blvd, Salinas, CA, 93906, USA
| | - Heather L Shepherd
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
| | - Lisa Stern
- Planned Parenthood Northern California, 2185 Pacheco St, Concord, CA, 94520, USA
| | - Lyndal Trevena
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
| | - Glyn Elwyn
- Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Rachel Thompson
- Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia
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12
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Scalia P, Durand MA, Forcino RC, Schubbe D, Barr PJ, O’Brien N, O’Malley AJ, Foster T, Politi MC, Laughlin-Tommaso S, Banks E, Madden T, Anchan RM, Aarts JWM, Velentgas P, Balls-Berry J, Bacon C, Adams-Foster M, Mulligan CC, Venable S, Cochran NE, Elwyn G. Implementation of the uterine fibroids Option Grid patient decision aids across five organizational settings: a randomized stepped-wedge study protocol. Implement Sci 2019; 14:88. [PMID: 31477140 PMCID: PMC6721118 DOI: 10.1186/s13012-019-0933-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Uterine fibroids are non-cancerous overgrowths of the smooth muscle in the uterus. As they grow, some cause problems such as heavy menstrual bleeding, pelvic pain, discomfort during sexual intercourse, and rarely pregnancy complications or difficulty becoming pregnant. Multiple treatment options are available. The lack of comparative evidence demonstrating superiority of any one treatment means that choosing the best option is sensitive to individual preferences. Women with fibroids wish to consider treatment trade-offs. Tools known as patient decision aids (PDAs) are effective in increasing patient engagement in the decision-making process. However, the implementation of PDAs in routine care remains challenging. Our aim is to use a multi-component implementation strategy to implement the uterine fibroids Option Grid™ PDAs at five organizational settings in the USA. METHODS We will conduct a randomized stepped-wedge implementation study where five sites will be randomized to implement the uterine fibroid Option Grid PDA in practice at different time points. Implementation will be guided by the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT). There will be a 6-month pre-implementation phase, a 2-month initiation phase where participating clinicians will receive training and be introduced to the Option Grid PDAs (available in text, picture, or online formats), and a 6-month active implementation phase where clinicians will be expected to use the PDAs with patients who are assigned female sex at birth, are at least 18 years of age, speak fluent English or Spanish, and have new or recurrent symptoms of uterine fibroids. We will exclude postmenopausal patients. Our primary outcome measure is the number of eligible patients who receive the Option Grid PDAs. We will use logistic and linear regression analyses to compare binary and continuous quantitative outcome measures (including survey scores and Option Grid use) between the pre- and active implementation phases while adjusting for patient and clinician characteristics. DISCUSSION This study may help identify the factors that impact the implementation and sustained use of a PDA in clinic workflow from various stakeholder perspectives while helping patients with uterine fibroids make treatment decisions that align with their preferences. TRIAL REGISTRATION Clinicaltrials.gov , NCT03985449. Registered 13 July 2019, https://clinicaltrials.gov/ct2/show/NCT03985449.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Rachel C. Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Paul J. Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Nancy O’Brien
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Tina Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Mary C. Politi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO USA
| | | | - Erika Banks
- Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Tessa Madden
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO USA
| | - Raymond M. Anchan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology & Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Johanna W. M. Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Carla Bacon
- National Uterine Fibroids Foundation, Colorado Springs, CO USA
| | - Monica Adams-Foster
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Carrie Cahill Mulligan
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | | | - Nancy E. Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, One Medical Center Drive, 5th floor, Lebanon, NH 03756 USA
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13
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Scalia P, Durand MA, Faber M, Kremer JA, Song J, Elwyn G. User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability. BMJ Open 2019; 9:e026748. [PMID: 31133587 PMCID: PMC6538002 DOI: 10.1136/bmjopen-2018-026748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To user-test a web-based, interactive Option Grid decision aid 'prostate-specific antigen (PSA) test: yes or no?' to determine its usability, acceptability and feasibility with men of high and low health literacy. DESIGN A semi-structured interview study. SETTING Interviews were conducted at a senior centre, academic hospital or college library in New Hampshire and Vermont. PARTICIPANTS Individuals over 45 years of age with no history of prostate cancer who voluntarily contacted study authors after viewing local invitations were eligible for inclusion. Twenty interviews were conducted: 10 participants had not completed a college degree, of which eight had low health literacy, and 10 participants had high health literacy. INTERVENTION An interactive, web-based Option Grid patient decision aid for considering whether or not to have a PSA test. RESULTS Users with lower health literacy levels were able to understand the content in the tool but were not able to navigate the Option Grid independent of assistance. The tool was used independently by men with high health literacy. In terms of acceptability, the flow of questions and answers embedded in the tool did not seem intuitive to some users who preferred seeing more risk information related to age and family history. Users envisioned that the tool could be feasibly implemented in clinical workflows. CONCLUSION Men in our sample with limited health literacy had difficulty navigating the Option Grid, thus suggesting that the tool was not appropriately designed to be usable by all audiences. The information provided in the tool is acceptable, but users preferred to view personalised risk information. Some participants could envision using this tool prior to an encounter in order to facilitate a better dialogue with their clinician. ETHICS APPROVAL The study received ethical approval from the Dartmouth College Committee for the Protection of Human Subjects (STUDY00030116).
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Marjan Faber
- Radboud University Medical Centre, Radboud University, Nijmegen, The Netherlands
| | - J A Kremer
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Julia Song
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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14
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Muscat DM, Shepherd HL, Hay L, Shivarev A, Patel B, McKinn S, Bonner C, McCaffery K, Jansen J. Discussions about evidence and preferences in real-life general practice consultations with older patients. PATIENT EDUCATION AND COUNSELING 2019; 102:879-887. [PMID: 30578105 DOI: 10.1016/j.pec.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. METHODS Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION5 scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. RESULTS Overall, Observer OPTION5 and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. CONCLUSION We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. PRACTICE IMPLICATIONS Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.
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Affiliation(s)
- Danielle Marie Muscat
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Louise Hay
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Alex Shivarev
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Bindu Patel
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Australia; The George Institute for Global Health, University of New South Wales, Australia
| | - Shannon McKinn
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Carissa Bonner
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Kirsten McCaffery
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Jesse Jansen
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia.
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15
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Scalia P, Durand MA, Berkowitz JL, Ramesh NP, Faber MJ, Kremer JAM, Elwyn G. The impact and utility of encounter patient decision aids: Systematic review, meta-analysis and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2019; 102:817-841. [PMID: 30612829 DOI: 10.1016/j.pec.2018.12.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows. METHODS Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies. RESULTS We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD = 0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD = 0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR = 1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level. CONCLUSION Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers. PRACTICAL IMPLICATIONS The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Julia L Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Nithya P Ramesh
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marjan J Faber
- Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands.
| | - Jan A M Kremer
- Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
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16
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Kunneman M, Gionfriddo MR, Toloza FJK, Gärtner FR, Spencer-Bonilla G, Hargraves IG, Erwin PJ, Montori VM. Humanistic communication in the evaluation of shared decision making: A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:452-466. [PMID: 30458971 DOI: 10.1016/j.pec.2018.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy). METHODS We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication. RESULTS Of the 154 eligible studies, 14 (9%) included ≥1 statements regarding humanistic communication, either in framing the study (N = 2), measuring impact (e.g., empathy, respect, interpersonal skills; N = 9), as patients'/clinicians' accounts of SDM (N = 2), in interpreting study results (N = 3), and in discussing implications of study findings (N = 3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication. CONCLUSION Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication. PRACTICE IMPLICATIONS Considering SDM as merely a technique may reduce SDM's patient-centeredness and undermine its' contribution to patient care.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, PA, USA.
| | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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17
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Grande SW, O'Neill ES, Sherman AE, Coylewright M. Are Older Adults Willing to Consider New Strategies to Reduce Stroke Risk? QUALITATIVE HEALTH RESEARCH 2019; 29:568-576. [PMID: 28985686 DOI: 10.1177/1049732317720682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation (AF) is a common arrhythmia that increases patients' risk of stroke, and determining an optimal prevention therapy is a preference-sensitive decision appropriate for shared decision making (SDM). Utilizing community-based focus groups, we explored beliefs and values around options for stroke prevention. Interview transcripts from five independent focus groups were qualitatively assessed and organized into themes. Most participants were taking a blood thinner (93%) and more than half of participants (64%) reported having AF. Few participants were familiar with newer therapies. Qualitative analysis revealed three themes: (a) fearing loss of self-control through debilitating stroke, (b) recognizing uncertainty in how to weigh risks and benefits of new treatments, and (c) needing mutual respect between clinicians and patients to consider new/alternative treatment regimens. These findings help direct future research efforts examining optimal timing for SDM and decision aids to promote mutual respect.
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Affiliation(s)
- Stuart W Grande
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | | | - Ariel E Sherman
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Megan Coylewright
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Boland L, Graham ID, Légaré F, Lewis K, Jull J, Shephard A, Lawson ML, Davis A, Yameogo A, Stacey D. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement Sci 2019; 14:7. [PMID: 30658670 PMCID: PMC6339273 DOI: 10.1186/s13012-018-0851-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved). METHODS We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality. RESULTS Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings. CONCLUSIONS Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice. TRIAL REGISTRATION PROSPERO CRD42015020527.
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Affiliation(s)
- Laura Boland
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON, K1G 5Z3, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec City, Quebec, G1L 3L5, Canada
| | - Krystina Lewis
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street Kingston, Ottawa, ON, K7L 3N6, Canada
| | - Allyson Shephard
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Alexandra Davis
- Learning Services, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Audrey Yameogo
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Hahlweg P, Witzel I, Müller V, Elwyn G, Durand MA, Scholl I. Adaptation and qualitative evaluation of encounter decision aids in breast cancer care. Arch Gynecol Obstet 2019; 299:1141-1149. [PMID: 30649604 PMCID: PMC6435605 DOI: 10.1007/s00404-018-5035-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/18/2018] [Indexed: 11/27/2022]
Abstract
Purpose Shared decision-making is currently not widely implemented in breast cancer care. Encounter decision aids support shared decision-making by helping patients and physicians compare treatment options. So far, little was known about adaptation needs for translated encounter decision aids, and encounter decision aids for breast cancer treatments were not available in Germany. This study aimed to adapt and evaluate the implementation of two encounter decision aids on breast cancer treatments in routine care. Methods We conducted a multi-phase qualitative study: (1) translation of two breast cancer Option Grid™ decision aids; comparison to national clinical standards; cognitive interviews to test patients’ understanding; (2) focus groups to assess acceptability; (3) testing in routine care using participant observation. Data were analysed using qualitative content analysis. Results Physicians and patients reacted positively to the idea of encounter decision aids, and reported being interested in using them; patients were most receptive. Several adaptation cycles were necessary. Uncertainty about feasibility of using encounter decision aids in clinical settings was the main physician-reported barrier. During real-world testing (N = 77 encounters), physicians used encounter decision aids in one-third of potentially relevant encounters. However, they did not use the encounter decision aids to stimulate dialogue, which is contrary to their original scope and purpose. Conclusions The idea of using encounter decision aids was welcomed, but more by patients than by physicians. Adaptation was a complex process and required resources. Clinicians did not follow suggested strategies for using encounter decision aids. Our study indicates that production of encounter decision aids alone will not lead to successful implementation, and has to be accompanied by training of health care providers. Electronic supplementary material The online version of this article (10.1007/s00404-018-5035-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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20
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Scalia P, Elwyn G, Barr P, Song J, Zisman-Ilani Y, Lesniak M, Mullin S, Kurek K, Bushell M, Durand MA. Exploring the use of Option Grid™ patient decision aids in a sample of clinics in Poland. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 134:1-8. [DOI: 10.1016/j.zefq.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/11/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
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What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata. BMC Public Health 2018; 18:241. [PMID: 29439691 PMCID: PMC5812033 DOI: 10.1186/s12889-018-5109-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/22/2018] [Indexed: 01/25/2023] Open
Abstract
Background Breast cancer is the most commonly diagnosed malignancy in women. Mastectomy and breast-conserving surgery (BCS) have equivalent survival for early stage breast cancer. However, each surgery has different benefits and harms that women may value differently. Women of lower socioeconomic status (SES) diagnosed with early stage breast cancer are more likely to experience poorer doctor-patient communication, lower satisfaction with surgery and decision-making, and higher decision regret compared to women of higher SES. They often play a more passive role in decision-making and are less likely to undergo BCS. Our aim is to understand how best to support women of lower SES in making decisions about early stage breast cancer treatments and to reduce disparities in decision quality across socioeconomic strata. Methods We will conduct a three-arm, multi-site randomized controlled superiority trial with stratification by SES and clinician-level randomization. At four large cancer centers in the United States, 1100 patients (half higher SES and half lower SES) will be randomized to: (1) Option Grid, (2) Picture Option Grid, or (3) usual care. Interviews, field-notes, and observations will be used to explore strategies that promote the interventions’ sustained use and dissemination. Community-Based Participatory Research will be used throughout. We will include women aged at least 18 years of age with a confirmed diagnosis of early stage breast cancer (I to IIIA) from both higher and lower SES, provided they speak English, Spanish, or Mandarin Chinese. Our primary outcome measure is the 16-item validated Decision Quality Instrument. We will use a regression framework, mediation analyses, and multiple informants analysis. Heterogeneity of treatment effects analyses for SES, age, ethnicity, race, literacy, language, and study site will be performed. Discussion Currently, women of lower SES are more likely to make treatment decisions based on incomplete or uninformed preferences, potentially leading to poorer decision quality, quality of life, and decision regret. This study hopes to identify solutions that effectively improve patient-centered care across socioeconomic strata and reduce disparities in decision and care quality. Trial registration NCT03136367 at ClinicalTrials.gov Protocol version: Manuscript based on study protocol version 2.2, 7 November 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5109-2) contains supplementary material, which is available to authorized users.
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Barnett ER, Boucher EA, Daviss WB, Elwyn G. Supporting Shared Decision-making for Children's Complex Behavioral Problems: Development and User Testing of an Option Grid™ Decision Aid. Community Ment Health J 2018; 54:7-16. [PMID: 28401416 DOI: 10.1007/s10597-017-0136-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/25/2017] [Indexed: 11/25/2022]
Abstract
There is a lack of research to guide collaborative treatment decision-making for children who have complex behavioral problems, despite the extensive use of mental health services in this population. We developed and pilot-tested a one-page Option Grid™ patient decision aid to facilitate shared decision-making for these situations. An editorial team of parents, child psychiatrists, researchers, and other stakeholders developed the scope and structure of the decision aid. Researchers included information about a carefully chosen number of psychosocial and pharmacological treatment options, using descriptions based on the best available evidence. Using semi-structured qualitative interviews (n = 18), we conducted user testing with four parents and four clinical prescribers and field testing with four parents, four clinical prescribers, and two clinic administrators. The researchers coded and synthesized the interview responses using mixed inductive and deductive methods. Parents, clinicians, and administrators felt the Option Grid had significant value, although they reported that additional training and other support would be required in order to successfully implement the Option Grid and achieve shared decision-making in clinical practice.
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Affiliation(s)
- Erin R Barnett
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth Trauma Interventions Research Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Elizabeth A Boucher
- Center for Program Design and Evaluation at Dartmouth, 21 Lafayette #373, Lebanon, NH, 03756, USA
| | - William B Daviss
- Department of Psychiatry, Dartmouth-Hitchcock Psychiatric Associates, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, One Medical Center Drive, Lebanon, NH, 03756, USA
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Scalia P, Durand MA, Kremer J, Faber M, Elwyn G. Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences. Med Decis Making 2017; 38:56-68. [DOI: 10.1177/0272989x17734538] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Randomized trials have shown that patient decision aids can modify users’ preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. Objectives. The aim of this study was to investigate people’s preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre–post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Methods. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar–Bowker paired test was used to compare stated pre–post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Results. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. Conclusion. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, USA (PS, MD, GE)
- Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands (JK, MF)
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, USA (PS, MD, GE)
- Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands (JK, MF)
| | - Jan Kremer
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, USA (PS, MD, GE)
- Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands (JK, MF)
| | - Marjan Faber
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, USA (PS, MD, GE)
- Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands (JK, MF)
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, USA (PS, MD, GE)
- Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands (JK, MF)
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Tom DM, Aquino C, Arredondo AR, Foster BA. Parent Preferences for Shared Decision-making in Acute Versus Chronic Illness. Hosp Pediatr 2017; 7:602-609. [PMID: 28951430 PMCID: PMC5613816 DOI: 10.1542/hpeds.2017-0049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The goal of this study was to examine preferences for shared decision-making (SDM) in parents of acutely ill versus chronically ill children in the inpatient setting. Additionally, we explored the effect of parental perception of illness severity and uncertainty in illness on decision-making preference. METHODS In this cross-sectional study, we surveyed parents of children admitted to pediatric inpatient units at an academic, tertiary-care hospital. Surveys were administered in person and used validated tools to assess SDM preferences and uncertainty in illness. Descriptive statistics evaluated associations stratified by acute versus chronic illness, and multivariable analyses were performed. RESULTS Of the 200 parents who participated, the majority were women (78%), Hispanic (81.5%), English speaking (73%), between 30 and 39 years old (37.5%), and had an education achievement of less than a college degree (77%). The mean age of hospitalized children was 8.1 years, and half reported a chronic illness. Most parents preferred an active (43%) or collaborative (40%) role in SDM. There was no association with SDM preference by demographics, number of previous hospitalizations, perception of illness severity, or uncertainty. However, parents of chronically ill children significantly preferred a passive role in SDM when they perceived a high level of uncertainty in illness. CONCLUSIONS Most parents of hospitalized children prefer to take an active or collaborative role in SDM. However, parents of chronically ill children who perceive high levels of uncertainty surrounding their children's illness prefer a passive role, thus illustrating the complexity in decision-making among this parent population.
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Affiliation(s)
- Dina M Tom
- Division of Inpatient Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and
- University Hospital, San Antonio, Texas
| | - Christian Aquino
- Division of Inpatient Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and
- University Hospital, San Antonio, Texas
| | - Anthony R Arredondo
- Division of Inpatient Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and
- University Hospital, San Antonio, Texas
| | - Byron A Foster
- Division of Inpatient Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; and
- University Hospital, San Antonio, Texas
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Scalia P, Elwyn G, Durand MA. "Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'. BMC Med Inform Decis Mak 2017; 17:124. [PMID: 28821256 PMCID: PMC5562992 DOI: 10.1186/s12911-017-0517-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022] Open
Abstract
Background Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. Results ‘Coherent’ motivations were guided by financial incentives at CapitalCare, and by a ‘champion’ physician at HealthPartners. Nurses worked ‘collectively’ at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Conclusion Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0517-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Drive 5th floor, Lebanon, NH, 03756, USA
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Coylewright M, O'Neill ES, Dick S, Grande SW. PCI Choice: Cardiovascular clinicians' perceptions of shared decision making in stable coronary artery disease. PATIENT EDUCATION AND COUNSELING 2017; 100:1136-1143. [PMID: 28110953 DOI: 10.1016/j.pec.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Describe cardiovascular clinicians' perceptions of Shared Decision Making following use of a decision aid (DA) for stable coronary artery disease (CAD) "PCI Choice", in a randomized controlled trial. METHODS We conducted a semi-structured qualitative interview study with cardiologists and physician extenders (n=13) after using PCI Choice in practice. Interviews were transcribed then coded. Codes were organized into salient themes. Final themes were determined by consensus with all authors. RESULTS Most clinicians (70%) had no prior knowledge of SDM or DAs. Mixed views about the role of the DA in the visit were related to misconceptions of how patient education differed from SDM. Qualitative assessment of clinician perceptions generated three themes: 1) Gaps exist in clinician knowledge around SDM; 2) Clinicians are often uncomfortable with modifying baseline practice; and 3) Clinicians express interest in using DAs after initial exposure within a research setting. CONCLUSIONS Use of DAs by clinicians during clinic visits may improve understanding of SDM. Initial use is marked by a reluctance to modify established practice patterns. PRACTICE IMPLICATIONS As clinicians explore new approaches to benefit their patients, there is an opportunity for DAs that provide clinician instruction on core elements of SDM to lead to enhanced SDM in clinical practice.
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Affiliation(s)
- Megan Coylewright
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA; Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, USA.
| | - Elizabeth S O'Neill
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Stuart W Grande
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA
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Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail S, Dodd C, Brain K, Elwyn G, Thomson R. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ 2017; 357:j1744. [PMID: 28420639 PMCID: PMC6284240 DOI: 10.1136/bmj.j1744] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues
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Affiliation(s)
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Lynne Stobbart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Tomson
- Collingwood Surgery, North Shields, UK
- Collingwood Surgery, North Shields, UK
| | - Sheila Macphail
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Carole Dodd
- CK Health Consultancy, Newcastle upon Tyne, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Glyn Elwyn
- CK Health Consultancy, Newcastle upon Tyne, UK
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Wood F, Phillips K, Edwards A, Elwyn G. Working with interpreters: The challenges of introducing Option Grid patient decision aids. PATIENT EDUCATION AND COUNSELING 2017; 100:456-464. [PMID: 27745941 DOI: 10.1016/j.pec.2016.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/15/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. METHODS Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. RESULTS Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. CONCLUSION Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. PRACTICE IMPLICATIONS Option Grid decision aids are not being used as intended in interpreted consultations.
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Affiliation(s)
- Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Katie Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover NH USA
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Vortel MA, Adam S, Port-Thompson AV, Friedman JM, Grande SW, Birch PH. Comparing the ability of OPTION(12) and OPTION(5) to assess shared decision-making in genetic counselling. PATIENT EDUCATION AND COUNSELING 2016; 99:1717-1723. [PMID: 27085518 DOI: 10.1016/j.pec.2016.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES OPTION(12) is the most widely used tool to measure shared decision-making (SDM) in health care. A newer scale, OPTION(5), has been proposed as a more parsimonious measure that better addresses core concepts of SDM. This study compares OPTION(5) to OPTION(12) in prenatal genetic counselling. METHODS Two raters independently used OPTION(12) and OPTION(5) to score 27 clinical encounters between genetic counsellors (GC) and women with pregnancies at increased risk for genetic conditions. Global and item scores on the two instruments were compared to test concurrent validity and to identify usability in this context. Inter-rater reliability was also assessed for both instruments. RESULTS Mean scores for OPTION(12) were 43.8 (SD=9.7), and for OPTION(5) were=60.6 (SD=12.5). The correlation between OPTION(12) and OPTION(5) scores was r=0.70. Inter-rater reliability was 0.70 and 0.85 for OPTION(12) and OPTION(5) respectively, however mean inter-rater reliability for individual items was 0.31 and 0.63 for OPTION(12) and OPTION(5) respectively. CONCLUSIONS GCs exhibit SDM as measured by both OPTION instruments. OPTION(5) exhibits improved psychometric performance relative to OPTION(12), and more specifically targets the core constructs of SDM. However, refinement of OPTION instruments or manuals is needed to improve reliability and validity in GC assessment.
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Affiliation(s)
- Martina A Vortel
- Department of Medical Genetics, University of British Columbia. Vancouver, Canada.
| | - Shelin Adam
- Department of Medical Genetics, University of British Columbia. Vancouver, Canada.
| | | | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia. Vancouver, Canada.
| | - Stuart W Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| | - Patricia H Birch
- Department of Medical Genetics, University of British Columbia. Vancouver, Canada.
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Durand MA, Alam S, Grande SW, Elwyn G. 'Much clearer with pictures': using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer. BMJ Open 2016; 6:e010008. [PMID: 26839014 PMCID: PMC4746463 DOI: 10.1136/bmjopen-2015-010008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. DESIGN Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). SETTING Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. PARTICIPANTS In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. INTERVENTION The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). OUTCOME MEASURES We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. RESULTS After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. CONCLUSIONS AND RELEVANCE Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Shama Alam
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Stuart W Grande
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, New Hampshire, USA
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