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Meulenkamp B, Brillinger J, Fergusson D, Stacey D, Graham ID. Development and field testing of a patient decision aid for management of acute Achilles tendon rupture: a study protocol. BMC Med Inform Decis Mak 2021; 21:225. [PMID: 34303358 PMCID: PMC8310595 DOI: 10.1186/s12911-021-01589-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achilles tendon ruptures are common injuries in an otherwise healthy, active population. Several treatment options exist, with both surgical and non-surgical options. Each treatment option has a unique set of risks and harms, which may present patients with decisional conflict. The aim of the proposed study is to develop, alpha test and field test a patient decision aid for patients presenting with acute Achilles tendon ruptures. Methods This is a three-stage study protocol. First, we will assemble a multi-disciplinary steering group including patients, clinicians, educators, and researchers to develop the patient decision aid prototype using the Ottawa Decision Support Framework. Second, we will perform a mixed-methods alpha test of the decision aid prototype with patients and clinicians experienced in acute Achilles tendon ruptures. Outcomes measured will include acceptability and usability of the patient decision aid measured using validated outcome scales and semi-structured interviews. A minimum of three rounds of feedback will be obtained. Results will be analyzed using descriptive statistics, reviewed by the steering group, to guide revisions to decision aid prototype at each round. The third stage will be field testing the revised decision aid prototype in usual clinical care. A pre-/post-study will be performed with patients with acute Achilles tendon ruptures. Patients will be recruited from the emergency department and complete the pre-consultation decision aid prior to a one-week follow up with their surgeon. The primary outcome of field testing will be feasibility of implementing the decision aid in the clinical setting and will be measured with recruitment and completion metrics. Secondary outcomes include acceptability of the decision aid, knowledge, preparedness for decision making, and decisional conflict, measured using validated outcome measures. Statistical analysis will be performed using descriptive analysis for primary outcomes and a student t-test and Wilcoxon Rank-Sum test for secondary outcomes. Discussion This comprehensive study protocol outlines the development, alpha testing, and field testing of a patient decision aid for patients with acute Achilles tendon rupture. Systematic and transparent development and testing of patient decision aids is critical to improve decision aid quality. Trial registration Not Applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01589-5.
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Affiliation(s)
- Brad Meulenkamp
- Department of Medicine, University of Ottawa, Ottawa, Canada. .,Orthopaedic Trauma, Foot and Ankle Surgery, The Ottawa Hospital, Ottawa, Canada.
| | | | - Dean Fergusson
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Ian D Graham
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Martin RW, Brogård Andersen S, O'Brien MA, Bravo P, Hoffmann T, Olling K, Shepherd HL, Dankl K, Stacey D, Dahl Steffensen K. Providing Balanced Information about Options in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:780-800. [PMID: 34196241 DOI: 10.1177/0272989x211021397] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this International Patient Decision Aids Standard (IPDAS) review is to update and synthesize theoretical and empirical evidence on how balanced information can be presented and measured in patient decision aids (PtDAs). METHODS A multidisciplinary team conducted a scoping review using 2 search strategies in multiple electronic databases evaluating the ways investigators defined and measured the balance of information provided about options in PtDAs. The first strategy combined a search informed by the Cochrane Review of the Effectiveness of Decision Aids with a search on balanced information. The second strategy repeated the search published in the 2013 IPDAS update on balanced presentation. RESULTS Of 2450 unique citations reviewed, the full text of 168 articles was screened for eligibility. Sixty-four articles were included in the review, of which 13 provided definitions of balanced presentation, 8 evaluated mechanisms that may introduce bias, and 42 quantitatively measured balanced with methods consistent with the IPDAS criteria in PtDAs. The revised definition of balanced information is, "Objective, complete, salient, transparent, evidence-informed, and unbiased presentation of text and visual information about the condition and all relevant options (with important elements including the features, benefits, harms and procedures of those options) in a way that does not favor one option over another and enables individuals to focus attention on important elements and process this information." CONCLUSIONS Developers can increase the balance of information in PtDAs by informing their structure and design elements using the IPDAS checklist. We suggest that new PtDA components pertaining to balance be evaluated for cognitive bias with experimental methods as well by objectively evaluating patients' and content experts' beliefs from multiple perspectives.
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Affiliation(s)
- Richard W Martin
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
| | - Stina Brogård Andersen
- Department of Clinical Development, Odense University Hospital, Odense, Denmark.,Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.,Millennium Nucleus Center Authority and Power Asymmetries
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Sydney, Australia
| | - Kathrina Dankl
- Design School Kolding, Lab for Social Design, Kolding, Denmark
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Clinical Epidemiology Program.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Clinical Oncology, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
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3
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Leu GR, Links AR, Ryan MA, Walsh JM, Tunkel DE, Beach MC, Boss EF. Assessment of Parental Choice Predisposition for Tonsillectomy in Children. JAMA Otolaryngol Head Neck Surg 2021; 147:263-270. [PMID: 33377933 DOI: 10.1001/jamaoto.2020.5031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child's consultation is not known. Objective To identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent-clinician communication. Design, Setting, and Participants Observational cohort study conducted at 3 outpatient clinical sites (urban-based outpatient center, suburban off-site outpatient center, and community-based medical center) associated with a large academic center. A total of 149 parents of children undergoing their initial otolaryngology consultation for OSDB were identified through clinic scheduling records and deemed eligible for participation in this study. Of the 149 parents, a volunteer sample of 64 parents (42.9%) agreed to participate and have their consultation audiorecorded. Of these 64 participants, 12 parents were excluded because their child had previously been evaluated for OSDB by a specialist. Main Outcomes and Measures The primary outcomes and measures were treatment choice predisposition scale (a measure of the strength of a patient's treatment decision prior to entering a medical consultation), parent communication behaviors coded in consultation audiorecordings (substantive questions asked, introduced medical jargon, expression of treatment preference, and scores on the OSDB and Adenotonsillectomy Knowledge Scale for parents). Results A total of 52 parent participants were included in the final analysis. Most parent participants were female (n = 48; 92%); 50% (n = 26) of parents were non-Hispanic White, 37% (n = 19) were Black, 10% (n = 5) were Hispanic/Latino, and 4% (n = 2) self-reported race/ethnicity as "Other." Mean (range) choice predisposition was 6.84 (2-10), with 22 parents (42%) more predisposed to choose tonsillectomy. Parents more predisposed to choose tonsillectomy used more medical jargon during the consultation (odds ratio [OR], 3.95; 95% CI, 1.16-15.15) and were less likely to ask questions (OR, 0.22; 95% CI, 0.05-0.87). Parental predictors of greater predisposition toward choosing surgery were White race (OR, 7.31; 95% CI, 1.77-39.33) and prior evaluation by a pediatrician for OSDB (OR, 6.10; 95% CI, 1.44-33.34). Conclusions and Relevance In this cohort study of parents of children with OSDB, many parents were predisposed to choose treatment with tonsillectomy prior to initial surgical consultation, which may lessen engagement and influence 2-way communication. In this cohort, greater predisposition for tonsillectomy was observed in non-Hispanic White parents and parents of patients who had been previously evaluated by a pediatrician for OSDB. Understanding parent choice predisposition for surgery may promote improved communication and parental engagement during surgical consultations. It may also help direct education about sleep and tonsillectomy to nonsurgical forums.
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Affiliation(s)
- Grace R Leu
- Tufts University School of Medicine, Boston, Massachusetts
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chan KH, Misseri R, Carroll A, Frankel RM, Moore C, Cockrum B, Wiehe S. User testing of a hypospadias decision aid prototype at a pediatric medical conference. J Pediatr Urol 2020; 16:685.e1-685.e8. [PMID: 32919901 PMCID: PMC8788200 DOI: 10.1016/j.jpurol.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Based on our previous qualitative work, we created a web-based decision aid (DA) prototype to facilitate shared decision-making regarding hypospadias. OBJECTIVE The objective of this study was to obtain rapid feedback on the prototype as part of an iterative, human-centered design process. METHODS We conducted this study at a statewide, pediatric educational conference in May 2019, recruiting attendees by verbal/written announcements. The DA consisted of: hypospadias overview and surgery "storyboard," frequently asked questions, parent testimonials, and a values clarification exercise. Participants viewed the DA on a tablet as they participated in semi-structured, qualitative interviews covering website acceptability, usability, and preference for surgical photographs versus illustrations. Three coders used qualitative content analysis to identify themes and resolved disagreements by consensus. RESULTS Of 295 conference attendees, all 50 who approached us agreed to participate. Responses from 49 participants were available for analysis: 67% female, ages 20-69, 65% Caucasian, 55% MDs. 96% of participants thought the website design matched its purpose; 59.1% preferred surgical illustrations, 8.2% preferred photos, 30.6% preferred both and 2.0% did not like either. Participants recommended improvements in: a) usability/accessibility (e.g. site navigation, visual layout, page length), b) content coverage (e.g. epidemiology, consequences of no/delayed surgery, lifelong risks), c) parent-centeredness (e.g. reading level/writing style) and d) implementation (provider tools, printable handouts). The Extended Summary Figure shows a revised image of the first step of a hypospadias repair based on feedback about participants' preferences for illustrations rather than photographs. DISCUSSION The main strength of our study was the valuable feedback we obtained to inform critical revisions of the DA prototype. We also demonstrated the feasibility and efficacy of a conducting a usability evaluation of a web-based DA in a medical conference setting. One limitation of this study is that the relatively small population sampled limits generalizability and our findings may not reflect the views of all providers who care for hypospadias patients. CONCLUSIONS The vast majority of providers thought that the design of the Hypospadias Homepage matched its purpose and most preferred surgical illustrations rather than photos to demonstrate the steps of hypospadias surgery. Based on their feedback, we plan to focus our efforts in the following areas: 1) improvement of navigation/menus, 2) reduction in the amount of text per page, 3) expansion of specific content coverage and 4) inclusion of "parent-friendly" visuals such as infographics to represent quantitative data and colorful illustrations to depict hypospadias and its surgical repair.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aaron Carroll
- Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA.
| | - Richard M Frankel
- Department of Medicine, Indiana University School of Medicine, Indiana and Cleveland Clinic Learner Institute, Indianapolis, Cleveland, OH, USA.
| | - Courtney Moore
- Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
| | - Sarah Wiehe
- Children's Health Services Research Center, Indiana University School of Medicine, Indianapolis, IN, USA; Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA.
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5
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Bansback N, Chiu JA, Carruthers R, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Lynd LD, Traboulsee A. Development and usability testing of a patient decision aid for newly diagnosed relapsing multiple sclerosis patients. BMC Neurol 2019; 19:173. [PMID: 31325961 PMCID: PMC6642472 DOI: 10.1186/s12883-019-1382-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients often struggle with treatment decisions, in part due to the increasing number of approved disease modifying therapies, each with different characteristics, and also since physicians can struggle to identify which of these characteristics matter most to each individual patient. Decision uncertainty can contribute to late treatment initiation and treatment non-adherence-causes of 'undertreatment' in MS. An interactive online patient decision aid that informs patients of their options, considers their individual preferences and goals, and facilitates conversations with their physicians, could improve how patients with relapsing forms of MS make evidence-based treatment decisions. OBJECTIVE To develop and evaluate a prototype patient decision aid (PtDA) for first-line disease modifying therapies for relapsing-remitting multiple sclerosis. METHODS Informed by previous studies and International Patient Decision Aid Standards guidelines, a prototype PtDA was developed for patients with relapsing multiple sclerosis considering first line treatment. Patients with relapsing multiple sclerosis were recruited from the University of British Columbia's Multiple Sclerosis Clinic to participate in either an online survey or a focus group. Online survey participants completed the PtDA, followed by measures of acceptability, usability, and preparedness for decision-making, and provided general feedback. Focus group participants assessed usability of the revised PtDA. The analysis of qualitative and quantitative data led to improvements of the PtDA prototype. RESULTS The prototype PtDA received high ratings for acceptability and usability, and after its use, participants reported high-levels of preparedness for decision-making. Analysis of all qualitative data identified three key themes: the need for credible information; the usefulness of the PtDA; and the importance of normalizing and sharing experiences. Nine content areas were identified for revision. Overall, participants found the PtDA to be a valuable tool for facilitating treatment decisions. CONCLUSIONS This mixed methods study has led to the development of a PtDA that can support patients with RRMS as they make treatment decisions. Future studies will assess the feasibility of implementation and the impact of the PtDA on both the timely treatment initiation and longer-term adherence.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Judy A. Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Emmanuelle Lapointe
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Alice Schabas
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | | | - Larry D. Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
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6
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Li LC, Shaw CD, Lacaille D, Yacyshyn E, Jones CA, Koehn C, Hoens AM, Geldman J, Sayre EC, Macdonald GG, Leese J, Bansback N. Effects of a Web-Based Patient Decision Aid on Biologic and Small-Molecule Agents for Rheumatoid Arthritis: Results From a Proof-of-Concept Study. Arthritis Care Res (Hoboken) 2018; 70:343-352. [PMID: 28544648 DOI: 10.1002/acr.23287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/16/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the extent to which ANSWER-2, an interactive online patient decision aid, reduces patients' decisional conflict and improves their medication-related knowledge and self-management capacity. METHODS We used a pre-post study design. Eligible participants had a diagnosis of rheumatoid arthritis (RA), had been recommended to start using a biologic agent or small-molecule agent or to switch to a new one, and had internet access. Access to ANSWER-2 was provided immediately after enrollment. Outcome measures included 1) the Decisional Conflict Scale (DCS), 2) the Medication Education Impact Questionnaire (MeiQ), and 3) the Partners in Health Scale (PIHS). A paired t-test was used to assess differences pre- and postintervention. RESULTS The majority of the 50 participants were women (n = 40), and the mean ± SD age of participants was 49.6 ± 12.2 years. The median disease duration was 5 years (25th, 75th percentile: 2, 10 years). The mean ± SD DCS score was 45.9 ± 25.1 preintervention and 25.1 ± 21.8 postintervention (mean change of -21.2 of 100 [95% confidence interval (95% CI) -28.1, -14.4], P < 0.001). Before using ANSWER-2, 20% of participants had a DCS score of <25, compared to 52% of participants after the intervention. Similar results were observed in the PIHS (mean ± SD 25.3 ± 14.8 preintervention and 20.4 ± 13.0 postintervention; mean change of -3.7 of 88 [95% CI -6.3, -1.0], P = 0.009). Findings from the MeiQ were mixed, with statistically significant differences found only in the self-management subscales. CONCLUSION Patients' decisional conflict decreased and perceived self-management capacity improved after using ANSWER-2. Future research comparing the effectiveness of ANSWER-2 with that of educational material on biologic agents will provide further insight into its value in RA management.
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Affiliation(s)
- Linda C Li
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | | | | | - Alison M Hoens
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | | | | | - Graham G Macdonald
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | - Jenny Leese
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, Canada, and Arthritis Research Canada, Richmond, Canada
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Payne O, Pillai A, Wise M, Stone P. Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable? Aust N Z J Obstet Gynaecol 2017; 57:609-616. [DOI: 10.1111/ajo.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 04/30/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Olivia Payne
- Department of Obstetrics and Gynaecology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Avinesh Pillai
- Department of Statistics; The University of Auckland; Auckland New Zealand
| | - Michelle Wise
- Department of Obstetrics and Gynaecology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology; Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
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McGrath A, Sharpe L, Lah S, Parratt K. Evaluation of a Decision Aid for Women with Epilepsy Who Are Considering Pregnancy: A Randomized Controlled Trial. Med Decis Making 2017; 37:589-599. [PMID: 28590833 DOI: 10.1177/0272989x17697304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND For many women with epilepsy (WWE), decision making about pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs, offspring risk of epilepsy, seizure occurrence during pregnancy, and the challenges of parenting amidst poorly controlled seizures. OBJECTIVE This proof-of-concept, randomized controlled trial aimed to evaluate a decision aid (DA) developed to help WWE decide if they should start or enlarge their families. METHODS Seventy-nine WWE of childbearing age were recruited from Epilepsy Action Australia between October and November 2013 and randomized to receive the intervention (the DA) or not, and to complete a set of questionnaires pre- and post- intervention. The DA, delivered as a PDF booklet, provided balanced evidence-based information about options, risks and benefits, including probabilities; as well as steps for clarifying values and considering options within one's personal situation. RESULTS Compared with the control group, the DA group had statistically significant improvements in knowledge about pregnancy and epilepsy (Cohen's d = 1.24; 95%CI = 0.77 to 1.83) and reduced decisional conflict (Cohen's d = 0.59; 95%CI = 0.21 to 0.99). Changes in decision self-efficacy, certainty of choice, patient-practitioner communication abilities and value congruence with choice were comparable between the DA and control group. Importantly, women's decisions about motherhood were not biased towards either direction, and there were no adverse effects on depression or anxiety. All women who received the DA indicated they would recommend it to other WWE. CONCLUSIONS The DA has the potential to serve as a useful support tool for WWE who are considering motherhood. Future research is needed to test the DA in clinical settings with guidance from a health professional. The trial was registered with the Australian New Zealand Clinical Trials Registry (ID ACTRN12613001082796).
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Affiliation(s)
- Amanda McGrath
- The School of Psychology, University of Sydney (AM, LS, SL)
| | - Louise Sharpe
- The School of Psychology, University of Sydney (AM, LS, SL)
| | - Suncica Lah
- The School of Psychology, University of Sydney (AM, LS, SL)
- ARC Centre of Excellence in Cognition and its Disorders (SL)
| | - Kaitlyn Parratt
- Comprehensive Epilepsy Service, Royal Prince Alfred Hospital (KP)
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Tiller K, Meiser B, Gaff C, Kirk J, Dudding T, Phillips KA, Friedlander M, Tucker K. A Randomized Controlled Trial of a Decision Aid for Women at Increased Risk of Ovarian Cancer. Med Decis Making 2016; 26:360-72. [PMID: 16855125 DOI: 10.1177/0272989x06290486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. Methods. This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. Participants. 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. Outcome measures. Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. Results. Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. Conclusion. This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk.
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Affiliation(s)
- K Tiller
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.
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Brown L, Gardner G, Bonner A. A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease. J Adv Nurs 2016; 72:1191-202. [PMID: 26880541 DOI: 10.1111/jan.12921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial. BACKGROUND Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited. DESIGN A multisite single blinded pragmatic randomized controlled trial is proposed. METHODS Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014. CONCLUSION This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.
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Affiliation(s)
- Leanne Brown
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Queensland, Australia
| | - Glenn Gardner
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Queensland, Australia.,Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Witteman HO, Scherer LD, Gavaruzzi T, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Design Features of Explicit Values Clarification Methods. Med Decis Making 2016; 36:453-71. [DOI: 10.1177/0272989x15626397] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Background. Values clarification is a recommended element of patient decision aids. Many different values clarification methods exist, but there is little evidence synthesis available to guide design decisions. Purpose. To describe practices in the field of explicit values clarification methods according to a taxonomy of design features. Data Sources. MEDLINE, all EBM Reviews, CINAHL, EMBASE, Google Scholar, manual search of reference lists, and expert contacts. Study Selection. Articles were included if they described 1 or more explicit values clarification methods. Data Extraction. We extracted data about decisions addressed; use of theories, frameworks, and guidelines; and 12 design features. Data Synthesis. We identified 110 articles describing 98 explicit values clarification methods. Most of these addressed decisions in cancer or reproductive health, and half addressed a decision between just 2 options. Most used neither theory nor guidelines to structure their design. “Pros and cons” was the most common type of values clarification method. Most methods did not allow users to add their own concerns. Few methods explicitly presented tradeoffs inherent in the decision, supported an iterative process of values exploration, or showed how different options aligned with users’ values. Limitations. Study selection criteria and choice of elements for the taxonomy may have excluded values clarification methods or design features. Conclusions. Explicit values clarification methods have diverse designs but can be systematically cataloged within the structure of a taxonomy. Developers of values clarification methods should carefully consider each of the design features in this taxonomy and publish adequate descriptions of their designs. More research is needed to study the effects of different design features.
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Affiliation(s)
- Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Laura D. Scherer
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Teresa Gavaruzzi
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Arwen H. Pieterse
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Andrea Fuhrel-Forbis
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nicole Exe
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Valerie C. Kahn
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Deb Feldman-Stewart
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nananda F. Col
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Alexis F. Turgeon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Angela Fagerlin
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
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12
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Li LC, Adam PM, Backman CL, Lineker S, Jones CA, Lacaille D, Townsend AF, Yacyshyn E, Yousefi C, Tugwell P, Leese J, Stacey D. Proof-of-Concept Study of a Web-Based Methotrexate Decision Aid for Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2014; 66:1472-81. [DOI: 10.1002/acr.22319] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/25/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Linda C. Li
- University of British Columbia and Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | - Paul M. Adam
- Mary Pack Arthritis Program and Vancouver Coastal Health; Vancouver, British Columbia Canada
| | - Catherine L. Backman
- University of British Columbia and Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | | | | | - Diane Lacaille
- University of British Columbia and Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | - Anne F. Townsend
- University of British Columbia and Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | | | - Charlene Yousefi
- Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | | | - Jenny Leese
- Arthritis Research Centre of Canada; Vancouver, British Columbia Canada
| | - Dawn Stacey
- University of Ottawa and Ottawa Hospital Research Institute; Ottawa, Ontario Canada
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Abstract
Background. Advances in genetic science and biotechnology accumulated huge knowledge of genes and various genetic tests and diagnostic tools for healthcare providers including nurses. Genetic counseling became important to assist patients making decisions about obtaining genetic testing or preventive measures. Method. This review was conducted to describe the counseling topics, various interventions adopted in genetic counseling, and their effectiveness. Experimental studies (N=39) published between 1999 and 2012 were synthesized. Results. The most frequently covered topic was benefits and limitations of genetic testing on breast cancer ovarian and colorectal cancers. Most of researchers focused on evaluating cognitive aspect and psychological well-being. Conclusion. No single intervention was consistently reported to be effective. Decision aids enhanced with information technologies have potential to improve the outcomes of genetic counseling by providing tailored information and facilitating active engagement of patients in information uptake. Clinical Implication. When nurses are familiar with topics and interventions of genetic counseling, they are well positioned to provide genetic/genomic information to the patient and families.
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14
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Grinshpun-Cohen J, Miron-Shatz T, Ries-Levavi L, Pras E. Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age. Health Expect 2014; 18:2306-17. [PMID: 24816429 DOI: 10.1111/hex.12200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Risk for foetal Down syndrome (DS) increases as maternal age increases. Non-invasive screening (maternal serum triple test) for DS is routinely offered to pregnant women to provide risk estimates and suggest invasive amniocentesis for definitive pre-natal diagnosis to high-risk women. OBJECTIVE We examined women's decision process with regard to pre-natal screening, and specifically, the degree to which they take into account triple serum screening results when considering whether or not to undergo amniocentesis. DESIGN Semi-structured phone interviews were conducted to assess recall of DS screening results, understanding of risk estimates and their effect on women's decision whether to undergo amniocentesis. The study included 60 pregnant Israeli women (half younger than 35 and half advanced maternal age - AMA), with normal DS screening results and no known ultrasound abnormalities. RESULTS Age appeared to determine the decision process. The vast majority of AMA women had amniocentesis, many of them before receiving their DS screening results. Most AMA participants knew that their risk estimate was 'normal', but still considered themselves at high risk due to their age. Procedure-related risk (miscarriage) and other factors only had a minor effect on their decision. A minority of younger women had amniocentesis. Younger women mentioned procedure-related risk and having normal screening results as the main factors affecting their decision not to have amniocentesis. CONCLUSION Age 35 is an anchor for the pre-determination regarding performing or avoiding amniocentesis. AMA women mention 'age' as their main reason to have amniocentesis and considered it an independent risk factor.
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Affiliation(s)
- Julia Grinshpun-Cohen
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,Sakler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel.,Center for Medicine in the Public Interest, New York, NY, USA
| | - Liat Ries-Levavi
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Elon Pras
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel.,Sakler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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van Agt HME, Korfage IJ, Essink-Bot ML. Interventions to enhance informed choices among invitees of screening programmes-a systematic review. Eur J Public Health 2014; 24:789-801. [PMID: 24443115 DOI: 10.1093/eurpub/ckt205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Informed decision making about participation has become an explicit purpose in invitations for screening programmes in western countries. An informed choice is commonly defined as based on: (i) adequate levels of knowledge of the screening and (ii) agreement between the invitee's values towards own screening participation and actual (intention to) participation. METHODS We systematically reviewed published studies that empirically evaluated the effects of interventions aiming at enhancing informed decision making in screening programmes targeted at the general population. We focused on prenatal screening and neonatal screening for diseases of the foetus/new-born and screening for breast cancer, cervical cancer and colorectal cancer. The Medline, EMBASE and Cochrane databases were searched for studies published till April 2012, using the terms 'informed choice', 'decision making' and 'mass screening' separately and in combination and terms referring to the specific screening programmes. RESULTS Of the 2238 titles identified, 15 studies were included, which evaluated decision aids (DAs), information leaflets, film, video, counselling and a specific screening visit for informed decision making in prenatal screening, breast and colorectal cancer screening. Most of the included studies evaluated DAs and showed improved knowledge and informed decision making. Due to the limited number of studies the results could not be synthesized. CONCLUSION The empirical evidence regarding interventions to improve informed decision making in screening is limited. It is unknown which strategies to enhance informed decision making are most effective, although DAs are promising. Systematic development of interventions to enhance informed choices in screening deserves priority, especially in disadvantaged groups.
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Affiliation(s)
- Heleen M E van Agt
- 1 Department of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Ida J Korfage
- 1 Department of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Marie-Louise Essink-Bot
- 2 Department of Public Health, Academic Medical Center / University of Amsterdam, the Netherlands
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16
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Abhyankar P, Volk RJ, Blumenthal-Barby J, Bravo P, Buchholz A, Ozanne E, Vidal DC, Col N, Stalmeier P. Balancing the presentation of information and options in patient decision aids: an updated review. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S6. [PMID: 24625214 PMCID: PMC4044010 DOI: 10.1186/1472-6947-13-s2-s6] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals’ knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. Methods A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration’s review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. Results A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined “balance”; the definition of “balance” that emerged is as follows: “The complete and unbiased presentation of the relevant options and the information about those options—in content and in format—in a way that enables individuals to process this information without bias”. Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users’ or patients’ perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was associated with more respondents (ranging from 70% to 96%) judging the information as “balanced”. Conclusion There is a need for comparative studies investigating different ways to improve and measure balance in the presentation of information and options in patient decision aids.
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17
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Genetic counseling as a tool for type 2 diabetes prevention: a genetic counseling framework for common polygenetic disorders. J Genet Couns 2013; 21:684-91. [PMID: 22302620 DOI: 10.1007/s10897-012-9486-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 01/18/2012] [Indexed: 12/29/2022]
Abstract
Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.
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18
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Patel SR, Wisner KL. Decision making for depression treatment during pregnancy and the postpartum period. Depress Anxiety 2011; 28:589-95. [PMID: 21681871 PMCID: PMC3128653 DOI: 10.1002/da.20844] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To explore women's perspectives about the treatment decision-making process for depression during pregnancy and after birth. METHOD One hundred pregnant and postpartum women completed an anonymous web-based surveys regarding treatment decision making for depression. RESULTS Survey data reveal that most women in this sample prefer an active collaborative role in treatment decision making for depression. Sixty-five percent of the sample made a decision for treatment of their major depressive disorder, including a decision for no treatment, and 34% reported not having made a decision or feeling unsure about their decision. More than half of the sample preferred combination treatment with medications and counseling (55%) followed by counseling (22%), no treatment (8%), and medications (8%). Overall, respondents in this sample had low levels of decisional conflict (uncertainty) with younger women in the sample reporting higher levels of decisional conflict. CONCLUSIONS Treatment decision making for depression during the perinatal period is complex. Asking women about their preferences for participation in decision making, their treatment preferences and their decision making needs during the clinical encounter may lead to improved communication, decision making and quality of care.
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Affiliation(s)
- Sapana R. Patel
- New York State Psychiatric Institute Columbia University, College of Physicians and Surgeons
| | - Katherine L. Wisner
- Women's Behavioral HealthCARE Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine
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19
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Caleshu C, Shiloh S, Price C, Sapp J, Biesecker B. Invasive prenatal testing decisions in pregnancy after infertility. Prenat Diagn 2010; 30:575-81. [PMID: 20509160 DOI: 10.1002/pd.2529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assessed decisional conflict about invasive prenatal testing among women pregnant after infertility. METHODS We surveyed 180 pregnant women with a history of infertility using a mixed methods cross-sectional design. Difficulty in deciding whether to have prenatal testing was measured using the Decisional Conflict Scale. RESULTS A minority of women (31%) chose to have invasive prenatal testing. Most participants (72%) reported low decisional conflict (score < 25; mean = 22.1; standard deviation = 23.2; range: 0-100). Half (53%) of the participants said that infertility made the testing decision easier. Qualitative data suggest that infertility makes the decision easier by clarifying relevant values and priorities. Most infertility characteristics studied were not significantly associated with decisional conflict. Variables associated with higher decisional conflict included infertility distress due to rejection of a childfree lifestyle, disagreement with others about testing, and choosing to have invasive testing after having had treatment for infertility. CONCLUSIONS For some women, infertility may make the invasive prenatal testing decision easier. Women with the greatest need for decisional support were those who have had treatment and choose invasive testing, who disagree with others about their testing choice, or who are particularly distressed about being childless.
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Affiliation(s)
- Colleen Caleshu
- Division of Medical Genetics, University of California, San Francisco, CA 94143-0794, USA.
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20
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Vandemheen KL, O'Connor A, Bell SC, Freitag A, Bye P, Jeanneret A, Berthiaume Y, Brown N, Wilcox P, Ryan G, Brager N, Rabin H, Morrison N, Gibson P, Jackson M, Paterson N, Middleton P, Aaron SD. Randomized Trial of a Decision Aid for Patients with Cystic Fibrosis Considering Lung Transplantation. Am J Respir Crit Care Med 2009; 180:761-8. [DOI: 10.1164/rccm.200903-0421oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Li LC, Adam P, Townsend AF, Stacey D, Lacaille D, Cox S, McGowan J, Tugwell P, Sinclair G, Ho K, Backman CL. Improving healthcare consumer effectiveness: an Animated, Self-serve, Web-based Research Tool (ANSWER) for people with early rheumatoid arthritis. BMC Med Inform Decis Mak 2009; 9:40. [PMID: 19695086 PMCID: PMC2733893 DOI: 10.1186/1472-6947-9-40] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 08/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with rheumatoid arthritis (RA) should use DMARDs (disease-modifying anti-rheumatic drugs) within the first three months of symptoms in order to prevent irreversible joint damage. However, recent studies report the delay in DMARD use ranges from 6.5 months to 11.5 months in Canada. While most health service delivery interventions are designed to improve the family physician's ability to refer to a rheumatologist and prescribe treatments, relatively little has been done to improve the delivery of credible, relevant, and user-friendly information for individuals to make treatment decisions. To address this care gap, the Animated, Self-serve, Web-based Research Tool (ANSWER) will be developed and evaluated to assist people in making decisions about the use of methotrexate, a type of DMARD. The objectives of this project are: 1) to develop ANSWER for people with early RA; and 2) to assess the extent to which ANSWER reduces people's decisional conflict about the use of methotrexate, improves their knowledge about RA, and improves their skills of being 'effective healthcare consumers'. METHODS/DESIGN Consistent with the International Patient Decision Aid Standards, the development process of ANSWER will involve: 1.) creating a storyline and scripts based on the best evidence on the use of methotrexate and other management options in RA, and the contextual factors that affect a patient's decision to use a treatment as found in ERAHSE; 2.) using an interactive design methodology to create, test, analyze and refine the ANSWER prototype; 3.) testing the content and user interface with health professionals and patients; and 4.) conducting a pilot study with 51 patients, who are diagnosed with RA in the past 12 months, to assess the extent to which ANSWER improves the quality of their decisions, knowledge and skills in being effective consumers. DISCUSSION We envision that the ANSWER will help accelerate the dissemination of knowledge and skills necessary for people with early RA to make informed choices about treatment and to manage their health. The latest in animation and online technology will ensure ANSWER fills a knowledge translation gap, focusing on the next generation of people living with RA.
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Affiliation(s)
- Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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22
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Eden KB, Dolan JG, Perrin NA, Kocaoglu D, Anderson N, Case J, Guise JM. Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats. J Clin Epidemiol 2009; 62:415-424.e3. [DOI: 10.1016/j.jclinepi.2008.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 03/14/2008] [Accepted: 05/05/2008] [Indexed: 11/29/2022]
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23
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Potter BK, O'Reilly N, Etchegary H, Howley H, Graham ID, Walker M, Coyle D, Chorny Y, Cappelli M, Boland I, Wilson BJ. Exploring informed choice in the context of prenatal testing: findings from a qualitative study. Health Expect 2008; 11:355-65. [PMID: 18798759 PMCID: PMC5060463 DOI: 10.1111/j.1369-7625.2008.00493.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study explored whether and how a sample of women made informed choices about prenatal testing for foetal anomalies; its aim was to provide insights for future health policy and service provision. METHODS We conducted semi-structured interviews with 38 mothers in Ottawa, Ontario, all of whom had been offered prenatal tests in at least one pregnancy. Using the Multi-dimensional Measure of Informed Choice as a general guide to analysis, we explored themes relevant to informed choice, including values and knowledge, and interactions with health professionals. RESULTS Many, but not all, participants seemed to have made informed decisions about prenatal testing. Values and knowledge were interrelated and important components of informed choice, but the way they were discussed differed from the way they have been presented in scientific literature. In particular, 'values' related to expressions of women's moral views or ideas about 'how life should be lived' and 'knowledge' related to the ways in which women prioritized and interpreted factual information, through their own and others' experiences and in 'thinking through' the personal implications of testing. While some women described non-directive discussions with health professionals, others perceived testing as routine or felt pressured to accept it. CONCLUSIONS Our findings suggest a need for maternity care providers to be vigilant in promoting active decision making about prenatal testing, particularly around the consideration of personal implications. Further development of measures of informed choice may be necessary to fully evaluate decision support tools and to determine whether prenatal testing programmes are meeting their objectives.
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Affiliation(s)
- Beth K Potter
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, ON, Canada.
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Durand M, Boivin J, Elwyn G. A review of decision support technologies for amniocentesis. Hum Reprod Update 2008; 14:659-68. [DOI: 10.1093/humupd/dmn037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Payne K, Nicholls S, McAllister M, Macleod R, Donnai D, Davies LM. Outcome measurement in clinical genetics services: a systematic review of validated measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:497-508. [PMID: 18489673 DOI: 10.1111/j.1524-4733.2007.00259.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This systematic review aimed to inform researchers and policymakers about what validated outcome measures are available to evaluate clinical genetics services (CGS) and the need for new measures. METHODS Validated outcome measures used to evaluate CGS were identified from a systematic literature review. Subjective outcome measures were assumed to have been validated only if some form of psychometric assessment was reported. RESULTS A total of 1688 titles and abstracts were identified, and 61 articles met the inclusion criteria for the final review, which covered 67 validated outcome measures. There were 37 nongenetics-specific and 30 genetics-specific measures identified. No single validated outcome measure encompassed all potential patient benefits from using a CGS. A variety of different domains were identified, including anxiety and depression, coping, decision-making, distress, family environment, health status, knowledge, mood, perception of risk, perceived personal control, psychological impact, quality of life, satisfaction and expectations, self-esteem, spiritual well-being, and worry. Some important aspects of patient benefit from CGS are not covered by existing outcome measures. CONCLUSIONS New research is necessary to develop the array of outcome measures required to quantify the benefits CGS offer patients living with the effects of genetic conditions. These need to be suitable for use in prospective evaluation studies to provide robust evidence for decision-makers to inform service development and commissioning. This includes prioritization of the existing validated outcome measures in terms of their usefulness and relevance to the measurement and valuation of patient benefits from a CGS.
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Affiliation(s)
- Katherine Payne
- Nowgen, The North West Genetics Knowledge Park, Manchester, UK.
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Durand MA, Stiel M, Boivin J, Elwyn G. Where is the theory? Evaluating the theoretical frameworks described in decision support technologies. PATIENT EDUCATION AND COUNSELING 2008; 71:125-35. [PMID: 18242040 DOI: 10.1016/j.pec.2007.12.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 12/04/2007] [Accepted: 12/06/2007] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify and describe the extent to which theory or theoretical frameworks informed the development and evaluation of decision support technologies (DSTs). METHODS The analysis was based on the decision technologies used in studies included in the Cochrane systematic review of patient decision aids for people facing health screening or treatment decisions. The assumption was made that DSTs evaluated by randomized controlled trials, and therefore included in the updated Cochrane review have been the most rigorously developed. RESULTS Of the 50 DSTs evaluated only 17 (34%) were based on a theoretical framework. Amongst these, 11 decision-making theories were described but the extent to which theory informed the development, field-testing and evaluation of these interventions was highly variable between DSTs. The majority of the 17 DSTs that relied on a theory was not explicit about how theory had guided their design and evaluation. Many had superficial descriptions of the theory or theories involved. Furthermore, based on the analysis of those 17 DSTs, none had reported field-testing prior to evaluation. CONCLUSION The use of decision-making theory in DST development is rare and poorly described. The lack of theoretical underpinning to the design and development of DSTs most likely reflects the early development stage of the DST field. PRACTICE IMPLICATIONS The findings clearly indicate the need to give more attention to how the most important decision-making theories could be better used to guide the design of key decision support components and their modes of action.
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Affiliation(s)
- Marie-Anne Durand
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
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Kasparian NA, Wakefield CE, Meiser B. Assessment of Psychosocial Outcomes in Genetic Counseling Research: An Overview of Available Measurement Scales. J Genet Couns 2007; 16:693-712. [PMID: 17694397 DOI: 10.1007/s10897-007-9111-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/18/2007] [Indexed: 11/24/2022]
Abstract
The aim of the present paper was to describe and evaluate many of the measurement scales currently used in genetic counseling outcomes research. A team of three researchers reviewed the available literature and selected a variety of validated instruments suitable for measurement of genetic counseling outcomes. There are numerous scales to assess each of the following outcomes among counselees: satisfaction with genetic counseling; knowledge; decision-making; psychological adjustment; coping; perceived personal control; perceptions of disease risk; and family communication about genetic risk. However, the strengths and limitations inherent to each instrument warrant careful consideration prior to implementation. In the genetic counseling context, scale selection should be undertaken with thought directed towards the characteristics of the research sample (e.g. levels of literacy, culture, medical condition), the practicalities of the research setting (e.g. available funding and resources, time restrictions, researcher expertise), the purpose of the research (i.e. the specific aspect of the genetic counseling experience to be studied), and the science underlying the scale (e.g. theoretical framework, psychometric properties).
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Affiliation(s)
- Nadine A Kasparian
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Level 3 Dickinson Building, 2031, Randwick, Australia.
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Case AP, Ramadhani TA, Canfield MA, Wicklund CA. Awareness and attitudes regarding prenatal testing among Texas women of childbearing age. J Genet Couns 2007; 16:655-61. [PMID: 17674167 DOI: 10.1007/s10897-007-9103-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 05/03/2007] [Indexed: 11/28/2022]
Abstract
Despite increased visibility and availability of prenatal testing procedures, very little is known about the attitudes among the populace toward these procedures. Using a computer assisted telephone interview of pregnant and non-pregnant women of childbearing age we analyze awareness and attitudes regarding prenatal tests among a diverse group of women of childbearing age in Texas. We also examine maternal characteristics associated with awareness and the willingness to undergo these procedures. While 89% were aware that such tests are available, younger, black and less educated women were less likely to know about prenatal tests for birth defects. Seventy-two percent of respondents said they would want their baby tested while Hispanic and black women were significantly more likely to express an interest than non-Hispanic whites. This study demonstrates the variability of knowledge and beliefs and confirms the importance of taking time to understand an individual's personal beliefs, knowledge and attitudes about prenatal diagnosis.
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Affiliation(s)
- Amy P Case
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX 78756, USA.
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Nassar N, Roberts CL, Raynes-Greenow CH, Barratt A. Development and pilot-testing of a decision aid for women with a breech-presenting baby. Midwifery 2007; 23:38-47. [PMID: 16843575 DOI: 10.1016/j.midw.2005.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 09/01/2005] [Accepted: 09/29/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop a decision aid for pregnant women with a breech presentation at term, and to assess its acceptability. METHODS The external cephalic version (ECV) decision aid was developed using the Ottawa Decision Support Framework and a systematic review of the evidence to provide probabilistic information about the benefits and risks of options. It incorporates a workbook supplemented by a CD and worksheet, and these were evaluated in a pilot study using self-administered questionnaires. PARTICIPANTS 19 women with a breech presentation attending antenatal clinics at a local obstetric hospital and 11 recently pregnant women. FINDINGS Of 30 women surveyed, nearly all found the decision aid clear and easy to understand, and thought that enough information was provided for them to make a decision. Women experienced increased knowledge, reduced decisional conflict, increased satisfaction and participation in decision making without increased anxiety. Participants also found the tool helpful and would recommend it to others. KEY CONCLUSIONS The ECV decision aid was well accepted and helpful for pregnant women with a breech presenting baby. We are currently evaluating the decision aid in a randomised trial to assess cognitive, affective and health outcomes.
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Affiliation(s)
- Natasha Nassar
- Centre for Perinatal Health Services Research, QEII Building DO2, University of Sydney, NSW 2006, Australia.
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Feldman-Stewart D, Brennenstuhl S, McIssac K, Austoker J, Charvet A, Hewitson P, Sepucha KR, Whelan T. A systematic review of information in decision aids. Health Expect 2007; 10:46-61. [PMID: 17324194 PMCID: PMC5060377 DOI: 10.1111/j.1369-7625.2006.00420.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate. SEARCH STRATEGY DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: 'decision aid'; shared decision making' and 'patients'; 'multimedia or leaflets or pamphlets or videos and patients and decision making'. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006. DATA EXTRACTION Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences. MAIN RESULTS 68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patients' guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide false-positive than false-negative rates. CONCLUSIONS The review led us to be concerned about completeness, balance and accuracy of information included in DAs.
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Affiliation(s)
- Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada.
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Légaré F, O'Connor AM, Graham ID, Saucier D, Côté L, Blais J, Cauchon M, Paré L. Primary health care professionals' views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice. PATIENT EDUCATION AND COUNSELING 2006; 63:380-90. [PMID: 17010555 DOI: 10.1016/j.pec.2006.04.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Revised: 04/24/2006] [Accepted: 04/25/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To describe primary health care professionals' views on barriers and facilitators for implementing the Ottawa Decision Support Framework (ODSF) in their practice. METHODS Thirteen focus groups with 118 primary health care professionals were performed. A taxonomy of barriers and facilitators to implementing clinical practice guidelines was used to content-analyse the following sources: reports from each workshop, field notes from the principal investigator and written materials collected from the participants. RESULTS Applicability of the ODSF to the practice population, process outcome expectation, asking patients about their preferred role in decision making, perception that the ODSF was modifiable, time issues, familiarity with the ODSF and its practicability were the most frequently identified both as barriers as well as facilitators. Forgetting about the ODSF, interpretation of evidence, challenge to autonomy and total lack of agreement with using the ODSF in general were identified only as barriers. Asking about values, health professional's outcome expectation, compatibility with the patient-centered approach or the evidence-based approach, ease of understanding and implementation, and ease of communicating the ODSF were identified only as facilitators. CONCLUSION These results provide insight on the type of interventions that could be developed in order to implement the ODSF in academic primary care practice. PRACTICE IMPLICATIONS Interventions to implement the ODSF in primary care practice will need to address a broad range of factors at the levels of the health professionals, the patients and the health care system.
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Affiliation(s)
- France Légaré
- Department of Family Medicine, Université Laval and Research center of Centre Hospitalier, Universitaire de Quebec, Canada
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Laupacis A, O'Connor AM, Drake ER, Rubens FD, Robblee JA, Grant FC, Wells PS. A decision aid for autologous pre-donation in cardiac surgery--a randomized trial. PATIENT EDUCATION AND COUNSELING 2006; 61:458-66. [PMID: 16024212 DOI: 10.1016/j.pec.2005.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2004] [Revised: 05/23/2005] [Accepted: 05/24/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVES The objective of this randomized, controlled study was to determine the usefulness of a decision aid on pre-donation of autologous blood before elective open heart surgery. METHODS The decision aid (DA) group received a tape and booklet which described the options for peri-operative transfusion in detail. The no decision aid (NDA) group received information usually given to patients about autologous donation. RESULTS A total of 120 patients were randomized. The DA group rated themselves better prepared for decision making and showed significant improvements in knowledge (p = 0.001) and realistic risk perceptions (p = 0.001). In both groups there was an increase in the proportion of patients choosing allogeneic blood between baseline and follow-up (p = 0.001). Patients in the DA group were significantly more satisfied with the amount of information they received, how they were treated and with the decision they made, than patients in the NDA group. CONCLUSION The decision aid is useful in preparing patients for decision making. PRACTICE IMPLICATIONS The next stage is to explore strategies to make it available to all appropriate patients.
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Affiliation(s)
- A Laupacis
- Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, Ont., Canada M4N 3M5.
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Hunter AGW, Cappelli M, Humphreys L, Allanson JE, Chiu TT, Peeters C, Moher D, Zimak A. A randomized trial comparing alternative approaches to prenatal diagnosis counseling in advanced maternal age patients. Clin Genet 2005; 67:303-13. [PMID: 15733266 DOI: 10.1111/j.1399-0004.2004.00405.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prenatal diagnosis (PND) is offered routinely as part of pregnancy care to a large number of women at increased risk of fetal anomalies. Despite an extraordinary growth in the use of PND and significant resource allocation, few studies have examined outcomes of PND counseling, and virtually no research has evaluated the relative efficacy of various approaches to genetic counseling. This study was a randomized trial that compared which counseling methods - individual, group, and use of a decision aid - are effective in PND counseling for women of advanced maternal age (>/=35 years) and their partners. Three hundred and fifty-two women and 225 partners completed pre- and post-intervention questionnaires assessing changes in knowledge, decisional conflict, state anxiety, satisfaction, use of PND, and pregnancy outcomes. All participants showed a significant increase in knowledge and a decrease in decisional conflict post intervention. Those in the group intervention showed a significantly greater increase in knowledge than those in the individual counseling intervention. While high levels of satisfaction were reported by all, those in individual counseling were significantly more satisfied than those receiving group counseling or the decision aid. This study has shown unique benefits with each type of intervention such that women and their partners preferred individual genetic counseling, while they learned best in group-counseling sessions, and experienced the least decisional conflict regarding genetic testing with a decision aid.
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Affiliation(s)
- A G W Hunter
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.
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Jaques AM, Bell RJ, Watson L, Halliday JL. People who influence women's decisions and preferred sources of information about prenatal testing for birth defects. Aust N Z J Obstet Gynaecol 2004; 44:233-8. [PMID: 15191448 DOI: 10.1111/j.1479-828x.2004.00225.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND More than half of Victorian pregnant women are undergoing prenatal testing for birth defects, although little is known about the factors that are influencing their decisions. AIMS To examine whom women perceived as influencing their decision about prenatal testing for birth defects, with whom they would have liked to talk more, and what sources of information they preferred. METHODS A total of 737 pregnant women aged 37 years and over, who either had or had not undergone prenatal testing (screening and/or diagnosis) completed a questionnaire in 18 hospitals throughout Victoria. RESULTS Over 90% reported that they themselves had a strong influence on their decision, and 70% reported their partner as strongly influencing their decision. Approximately 30% of women who had both screening and diagnosis and more than 20% of women who had no prenatal testing, would like to have discussed prenatal testing with women who had previously had testing. Face-to-face counselling with a doctor or counsellor was the preferred source of information, followed by a pamphlet as the second choice. CONCLUSIONS Given that both tested and untested women felt so strongly that they were responsible for their own decisions about prenatal testing, it is unlikely that universal acceptance and uptake will occur, even in this group of women of advanced maternal age. A support network of women who have already had testing could supplement existing sources of support. However, there continues to be a need for face-to-face sessions with a doctor or counsellor in combination with printed material.
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Affiliation(s)
- Alice M Jaques
- Public Health Genetics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
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Rostant K, Steed L, O'Leary P. Survey of the knowledge, attitudes and experiences of Western Australian women in relation to prenatal screening and diagnostic procedures. Aust N Z J Obstet Gynaecol 2004; 43:134-8. [PMID: 14712969 DOI: 10.1046/j.0004-8666.2003.00041.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the knowledge, attitudes and experiences of women in Western Australia (WA) regarding prenatal procedures. DESIGN A self-administered mail survey. SAMPLE The survey was sent to all women who gave birth during July 2001 (n = 1801). The participants were 633 women aged 15-45. RESULTS The mean total knowledge score was 16 out of a possible 26 (62%). The average score for all three attitude factors was four, 'agree', on a Likert scale of five. Women who reported they had private health insurance and women in the metropolitan area had significantly higher knowledge levels and had significantly more positive attitudes towards the adequacy of information. Those who did not have a screening test had less positive attitudes towards the value of the tests and had less confidence in results. Those with higher educational attainments had higher knowledge and less positive attitudes towards the value of the tests. CONCLUSIONS Women felt positive towards the value of the tests, were confident in their results and felt positive towards the adequacy of information; however, their understanding of this information seems to be poor. It seems that the choice to undergo testing is not well informed. It was clear women need more support, information, explanations, and more time to absorb the information.
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Affiliation(s)
- Kristie Rostant
- Genomics Branch, Department of Health, Perth, Western Australia, Australia
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Shiell A, Hawe P, Fletcher M. Reliability of health utility measures and a test of values clarification. Soc Sci Med 2003; 56:1531-41. [PMID: 12614703 DOI: 10.1016/s0277-9536(02)00154-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examines the test-retest reliability of two methods of establishing health preference weights and assesses the effectiveness of a brief values-clarification exercise. Survey participants were randomly allocated to one of two groups and received either a standard protocol for eliciting health preferences (comparison group) or an augmented protocol designed to encourage reflection and deliberation (intervention group). Preferences were elicited on three occasions over 5 weeks. The results show that the two valuation methods each had acceptable levels of test-retest reliability. No significant differences were found in preference weights over time or between intervention and comparison groups. The values-clarification exercise had some impact on individual answers, but the changes cancelled each other out at the group level. There was no discernable intervention effect at the group level. It is premature to draw conclusions from one study about why, or even how, a person's valuations might change over time, but our results support the use of current valuation techniques for group-level analyses.
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Affiliation(s)
- Alan Shiell
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Alta., T2N 4N1, Calgary, Canada.
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Stacey D, O'Connor AM, DeGrasse C, Verma S. Development and evaluation of a breast cancer prevention decision aid for higher-risk women. Health Expect 2003; 6:3-18. [PMID: 12603624 PMCID: PMC5060163 DOI: 10.1046/j.1369-6513.2003.00195.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. DESIGN Pre-test-post-test study using decision aid alone and in combination with counselling. SETTING Breast Cancer Risk Assessment Clinic. PARTICIPANTS Twenty-seven women aged 50-69 with 1.66% or higher 5-year risk of breast cancer. INTERVENTION Self-administered breast cancer prevention decision aid. MAIN OUTCOME MEASURES Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life-style practices; psychological distress; and satisfaction with preparation for consultation. RESULTS The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life-style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. CONCLUSION The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.
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Affiliation(s)
- Dawn Stacey
- Population Health Program, University of Ottawa, Ottawa, Canada.
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Tiller K, Meiser B, Reeson E, Tucker M, Andrews L, Gaff C, Kirk J, Phillips KA, Friedlander M. A decision aid for women at increased risk for ovarian cancer. Int J Gynecol Cancer 2003; 13:15-22. [PMID: 12631214 DOI: 10.1046/j.1525-1438.2003.13018.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper reviews changes that have occurred within and without the medical profession that have fostered an increasing demand for decision aids as adjuncts to practitioners' counseling to prepare patients for decision making. In the absence of data on the efficacy of ovarian cancer screening and prophylactic strategies, decisions about optimal care are difficult for both women and their doctors. Because surveillance and preventive options are an area of great uncertainty, a decision aid has been developed specifically aimed at facilitating decisions involving ovarian cancer risk management options. This was achieved by reviewing and integrating the available literature on models of medical decision making, patient preferences for information and involvement in decision making, the utility of decision aids, and management options for ovarian cancer risk. Findings indicate that patients wish to be informed participants in the decision-making process and that decision aids are an acceptable and effective method of providing quality information in a format that facilitates an inclusive model of shared decision making. A decision aid designed for women at increased risk of ovarian cancer that facilitates informed decision making may be a valuable addition to patient support. A randomized controlled trial of this type of educational material will provide timely and much needed evidence on its acceptability and efficacy.
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Affiliation(s)
- K Tiller
- Hereditary Cancer Clinic, Prince of Wales Hospital,
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O'Connor AM, Jacobsen MJ, Stacey D. An evidence-based approach to managing women's decisional conflict. J Obstet Gynecol Neonatal Nurs 2002; 31:570-81. [PMID: 12353737 DOI: 10.1111/j.1552-6909.2002.tb00083.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Women who face difficult health decisions are likely to experience decisional conflict. To date, women have been supported in their decision making through informal counseling and client education. The Ottawa Decision Support Framework guides practitioners in assessing decision-making needs in clinical practice, providing support for client decision making, and evaluating the effectiveness of their interventions. Several evidence-based decision support tools were derived from this framework, including practitioner-administered and client self-administered decision guides, condition-specific decision aids, and the Decisional Conflict Scale.
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Halliday JL, Warren R, McDonald G, Rice PL, Bell RJ, Watson LF. Prenatal diagnosis for women aged 37 years and over: to have or not to have. Prenat Diagn 2001; 21:842-7. [PMID: 11746126 DOI: 10.1002/pd.153] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Forty percent of pregnant women aged 37 years and over do not have prenatal diagnosis despite being eligible for a free test. The present study aimed to determine how often, and which, untested women were making a choice about this, how many declined an offer and why. A questionnaire was given to untested women, aged 37 years and over, at no less than 24 weeks gestation. A total of 375 (81.5%) women declined, 72 (16%) were not offered a test and 13 presented too late antenatally. There was a three-fold increased likelihood (OR 3.10 95% CI 1.44, 6.65) of no offer for urban non-English speaking background women, compared with the reference group (metropolitan, English speaking). Unpartnered women were also significantly less likely to receive an offer (OR 3.18, 95% CI 1.19, 8.46). Risk to the baby was the main reason for declining. When offered non-invasive prenatal screening, most decliners of prenatal diagnosis accepted, even those who declined because they were opposed to abortion. We estimate that overall 33% of older pregnant women were being offered and declining amniocentesis and/or chorion villus sampling (CVS). Only 6% were not offered a test, but this small proportion is over-represented by minority groups who must be given equal opportunity to make this choice.
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Affiliation(s)
- J L Halliday
- Epidemiology and Genetics Unit, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia.
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Carrère M, Moumjid‐Ferdjaoui N, Charavel M, Brémond A. Eliciting patients' preferences for adjuvant chemotherapy in breast cancer: development and validation of a bedside decision-making instrument in a French Regional Cancer Centre. Health Expect 2000; 3:97-113. [PMID: 11281917 PMCID: PMC5080957 DOI: 10.1046/j.1369-6513.2000.00086.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In developed countries, the physician-patient relationship is moving from a paternalistic model to new decision-making models that take patient preferences into account. OBJECTIVES: Our aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results. METHODS: A working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across-time consistency of the DB on healthy volunteers. RESULTS: The DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (>/=87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across-time consistency was appraised using the test-retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97. DISCUSSION-CONCLUSION: Due to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients' reactions will tell us which type of decision-making model is at work. Further research is needed in order to explore the shared decision-making process and clarify the concept.
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Affiliation(s)
- Marie‐Odile Carrère
- GRESAC (CNRS‐UMR 5823), France
- Centre Léon Bérard, Lyon, France
- Université Claude Bernard Lyon 1, France
| | | | - Marie Charavel
- GRESAC (CNRS‐UMR 5823), France
- Université Pierre Mendès‐France Grenoble 2, France
| | - Alain Brémond
- GRESAC (CNRS‐UMR 5823), France
- Centre Léon Bérard, Lyon, France
- Université Claude Bernard Lyon 1, France
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