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Pel-Littel RE, Buurman BM, van de Pol MH, Twisk JWR, Tulner LR, Minkman MM, Scholte Op Reimer WJM, van Weert JCM. Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study. BMC Med Inform Decis Mak 2023; 23:42. [PMID: 36859287 PMCID: PMC9976432 DOI: 10.1186/s12911-023-02099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/03/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND To evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs). METHODS A pragmatic trial evaluated the effects of the SDMMCC intervention, existing of SDM training for nine geriatricians in two hospitals and a preparatory tool for patients. A prospective pre-intervention post-intervention multi-center clinical study was conducted in which an usual care group of older patients with MCC and their informal caregivers was included before the implementation of the intervention and a new cohort of patients and informal caregivers after the implementation of the intervention. SDM was observed using the OPTIONMCC during video-recorded consultations. Patient- and caregivers reported outcomes regarding their role in SDM, involvement, perceived SDM and decisional conflict were measured. The differences between groups regarding the level of observed SDM (OPTIONMCC) were analyzed with a mixed model analysis. Dichotomous patient-reported outcomes were analyzed with a logistic mixed model. RESULTS From two outpatient geriatric clinics 216 patients with MCCs participated. The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTIONMCC or in patient-reported outcomes. However, at item level the items discussing 'goals', 'options', and 'decision making' significantly improved after the intervention. The items discussing 'partnership' and 'evaluating the decision-making process' showed a significant decrease. Fifty-two percent of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations. CONCLUSION This study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. More attention should be paid to the integration of preparatory work in the consultation.
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Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Vilans, Center of Expertise for Long-Term Care, Utrecht, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marjolein H van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda R Tulner
- Department of Geriatric Medicine, OLVG, Amsterdam, The Netherlands
| | - Mirella M Minkman
- Vilans, Center of Expertise for Long-Term Care, Utrecht, The Netherlands
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, PO Box 15791, 1001 NG, Amsterdam, The Netherlands.
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Lewis A, Douka D, Koukoura A, Valla V, Smirthwaite A, Faarbaek SH, Vassiliadis E. Preference Testing in Medical Devices: Current Framework and Regulatory Gaps. MEDICAL DEVICES (AUCKLAND, N.Z.) 2022; 15:199-213. [PMID: 35822064 PMCID: PMC9271283 DOI: 10.2147/mder.s368420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022]
Abstract
Preference testing is a valuable source of information that can be provided by both healthcare professionals (HCPs) and patients (users). It can be used to improve the design and development of medical devices by feeding into device usability and, ultimately, risk management. Furthermore, it can aid with selecting the most appropriate clinical endpoints to be used in the clinical evaluation of a device and increase patient engagement by incorporating patient-relevant outcomes. Preference testing is widely conducted in the food industry but is not widespread in the medical field due to limited guidelines and a lack of regulatory framework. As such, manufacturers may be unaware of the benefits of preference testing and fail to take full advantage of it, or conversely, may use inappropriate methodology and/or analyses and consequently fail to collect meaningful data. In this position paper, we aim to highlight the benefits and uses of preference testing, along with potential methods that could be used for preference testing of medical devices. A key step towards the wider implementation of preference testing in medical devices is for the publication of international standards and guidelines for the collection, assessment, and implementation of preference data into the life cycle of a medical device.
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Ihrig A, Maatouk I, Friederich HC, Baunacke M, Groeben C, Koch R, Thomas C, Huber J. The Treatment Decision-making Preferences of Patients with Prostate Cancer Should Be Recorded in Research and Clinical Routine: a Pooled Analysis of Four Survey Studies with 7169 Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:675-682. [PMID: 32940881 PMCID: PMC9205804 DOI: 10.1007/s13187-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 05/13/2023]
Abstract
Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.
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Affiliation(s)
- Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - I Maatouk
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - H C Friederich
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital of Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - M Baunacke
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Groeben
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - R Koch
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Thomas
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - J Huber
- Department of Urology, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Basak R, Usinger DS, Chen RC, Shen X. Patient Decision-Making Factors in Aggressive Treatment of Low-Risk Prostate Cancer. JNCI Cancer Spectr 2022; 6:6506527. [PMID: 35699497 PMCID: PMC8857916 DOI: 10.1093/jncics/pkac003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Active surveillance (AS) is underutilized for low-risk prostate cancer. This study examines decision-making factors associated with AS vs aggressive treatment in a population-based cohort of low-risk patients. Methods Newly diagnosed patients (n = 599) were enrolled through the North Carolina Central Cancer Registry from 2011 to 2013 and surveyed regarding 5 factors that may impact treatment decision making: perceived cancer aggressiveness, aggressiveness of treatment intent, most important goal (eg, cure, quality of life), primary information source, and primary decision maker. We examined the association between treatment decision-making factors with patient choice for AS vs aggressive treatment using multivariable logistic regression analysis. Results This is a sociodemographically diverse cohort reflective of the population-based design, with 37.6% overall (47.6% among very low-risk patients) choosing AS. Aggressive treatment intent (odds ratio [OR] = 7.09, 95% confidence interval [CI] = 4.57 to 11.01), perceived cancer aggressiveness (OR = 4.93, 95% CI = 2.71 to 8.97), most important goal (cure vs other, OR = 1.72, 95% CI = 1.12 to 2.63), and primary information source (personal and family vs physician, OR = 1.76, 95% CI = 1.10 to 2.82) were associated with aggressive treatment. Overall, 88.4% of patients (92.2% among very low-risk) who indicated an intent to treat the cancer “not very aggressively” chose AS. Conclusions These data from the patient’s perspective shed new light on potentially modifiable factors that can help further increase AS uptake among low-risk patients. Helping more low-risk patients feel comfortable with a “not very aggressive” treatment approach may be especially important, which can be facilitated through patient education interventions to improve the understanding of the cancer diagnosis and AS having a curative intent.
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Affiliation(s)
- Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Usinger
- University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Ronald C Chen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
| | - Xinglei Shen
- University of Kansas Medical Center, Department of Radiation Oncology, Kansas City, KS, USA
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Roydhouse JK, Gutman R, Wilson IB, Kehl KL, Keating NL. Patient and proxy reports regarding the experience of treatment decision-making in cancer care. Psychooncology 2020; 29:1943-1950. [PMID: 32840909 DOI: 10.1002/pon.5528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Shared decision-making, including the elicitation of patient preferences regarding treatment decisions, is considered part of high-quality cancer care. However, patients may not be able to self-report due to illness, and therefore proxy reports may be used. We sought to determine the difference between proxy and patient reports about patient decisions and preferences among patients who received or were scheduled for chemotherapy using data from a large, population-based survey of patients with incident lung or colorectal cancer. METHODS Of 3573 patients who received or were scheduled for chemotherapy, 3108 self-reported and 465 had proxies reporting on their behalf about preferred and actual decision roles regarding this treatment. Preferred and actual decision roles were assessed using the Control Preferences Scale, and categorized as shared, patient-controlled, or doctor-controlled. Multivariable logistic regression models were used to assess the association between patient and proxy responses and whether preferences were met. The models adjusted for sociodemographic and clinical variables and patient/proxy-reported health status. RESULTS Sixty-three percent of all respondents reported actual roles in decisions that matched their preferred roles (role attainment). Proxies and patients were similarly likely to report role attainment (65% vs 63%). In adjusted analyses, proxies were more likely report role attainment (OR = 1.27, 95%CI = 1.02-1.59), but this difference was smaller if health variables were excluded from the model (OR = 1.14, 95%CI = 0.92-1.41). CONCLUSION Most patients' preferences for treatment participation were met. Surveys from proxies appear to yield small differences on the reports of attainment of preferred treatment decision-making roles in cancer care vs surveys from patients.
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Affiliation(s)
- Jessica K Roydhouse
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kenneth L Kehl
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Younger E, Jones RL, Desar IME, Peckitt C, van der Graaf WTA, Husson O. Health-related quality Of Life In patients with advanced Soft TIssue sarcomas treated with Chemotherapy (The HOLISTIC study): protocol for an international observational cohort study. BMJ Open 2020; 10:e035171. [PMID: 32487574 PMCID: PMC7265010 DOI: 10.1136/bmjopen-2019-035171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Chemotherapy is the mainstay of treatment for patients with advanced soft tissue sarcomas (STS). Treatment intent is usually palliative, aiming to improve symptoms, stabilise or reduce tumour burden and extend life. Clinical trials have traditionally used radiological response, time to progression and survival as measures of treatment efficacy. Health-related quality of life (HRQoL) is at least equally important or more important than survival for many patients with advanced cancer. Systematically collecting HRQoL data during chemotherapy can provide greater insight into treatment efficacy from the patient perspective.The primary aims of this study are to evaluate HRQoL in patients with advanced STS treated with chemotherapy over time, explore the decision-making process and patient reflection post-treatment. METHODS AND ANALYSIS This is an observational, international cohort study for 132 patients aged ≥18 years with advanced STS treated at eight centres (three in the UK, five in the Netherlands). Patients will be recruited prior to starting first-line or third-line chemotherapy and invited to complete questionnaires using the Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship registry (PROFILES); an established international registry for collection of cancer patient-reported outcomes. Online (or paper) questionnaires will be completed at baseline, each cycle of chemotherapy and 2-3 monthly during follow-up. The questionnaire package includes the Decisional Conflict Scale, Control Preferences Scale, Quality-Quantity Questionnaire, treatment expectations, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), EORTC financial toxicity items, Work Ability Index, Functional Assessment of Cancer Therapy-General (FACT-G) items and Decisional Regret Scale. Clinical data will be extracted from patient records and linked with questionnaire responses. The primary outcome measure is the change in global HRQoL from baseline to after cycle 4 of first-line chemotherapy (based on published data showing that patients with advanced STS complete a median number of four cycles of first-line chemotherapy). ETHICS AND DISSEMINATION Heath Research Authority and Research Ethics Committee (REC 17/NI/0197). Results from the Health-related quality Of Life In patients with advanced Soft TIssue sarcomas treated with Chemotherapy (HOLISTIC) study will be published in peer-reviewed journals and disseminated at local, national and international conferences. We will also present our findings at any appropriate patient meetings and involve patients in study-related publications. TRIAL REGISTRATION NUMBER NCT03621332.
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Affiliation(s)
- Eugenie Younger
- Sarcoma Unit, Royal Marsden Hospital NHS Trust, London, UK
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital NHS Trust, London, UK
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Ingrid M E Desar
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Clare Peckitt
- Sarcoma Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Winette T A van der Graaf
- Sarcoma Unit, Royal Marsden Hospital NHS Trust, London, UK
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
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Jerofke-Owen T, Garnier-Villarreal M, Fial A, Tobiano G. Systematic review of psychometric properties of instruments measuring patient preferences for engagement in health care. J Adv Nurs 2020. [PMID: 32350898 DOI: 10.1111/jan.14402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
AIM To identify, critically appraise, and summarize instruments that measure patients' preferences for engagement in health care. DESIGN Psychometric systematic literature review. DATA SOURCES PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019. REVIEW METHODS Three reviewers independently evaluated the 'methodological quality' and the 'measurement properties' of the included instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253). RESULTS A total of 16 studies evaluating 8 instruments measuring patients' preferences for engagement in health care were included. All instruments were downgraded for their 'methodological quality' or 'measurement properties', or a combination of both. Common concerns were lack of theoretical basis, absence of patient input during development, incorrect usage and reporting of validity measures and absence of a priori hypotheses to test validity. CONCLUSIONS There were no identified instruments that demonstrated adequate evidence for all measurement properties. The Patient Preferences for Patient Participation Scale (4Ps) and 10-item Decisional Engagement Scale (DES-10) had the highest overall GRADE scores; however, each had some underlying developmental or methodological issues. IMPACT Assessing how patients prefer to engage in their care is a critical first step to truly individualize engagement interventions to meet patient expectations. Systematic reviews of measures of patient experience with engagement in health care have been undertaken but none are available on measures of patient preferences for engagement. The results highlight the need to further develop and test instruments that measure patients' preferences for engagement in health care within a framework for consumerism. Involving the consumer in the instrument development process will ensure that engagement strategies used by healthcare providers are relevant and individualized to consumer preferences.
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Zomorodbakhsch B, Keinki C, Seilacher E, Huebner J. Cancer Patients Numeracy and Preferences for Information Presentation-a Survey Among German Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:22-27. [PMID: 30338481 DOI: 10.1007/s13187-018-1435-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Numeracy is highly relevant for therapy safety and effective self-management. Worse numeracy leads to poor health outcome. Most medical information is expressed in numbers. Considering the complexity of decisions, more information on the patient's ability to understand information is needed. We used a standardized questionnaire. Content was self-perception of numeracy, preferences regarding decision-making with respect to medical issues, and preferred content of information from four possible answers on side effect of cancer therapies (insomnia) within two scenarios. Overall, 301 participants answered the questionnaire. Presentation of facts in numbers was rated as helpful or very helpful (59.4%). Higher numeracy was associated with higher appreciation for presentation in numbers (p = 0.002). Although participants indicated presentation of facts in numbers as helpful in general, the favored answer in two concrete scenarios was verbal and descriptive instead of numerical. Numeracy is highly relevant for therapy safety and effective self-management. Health professionals need more knowledge about patient's ability and preferences with respect to presentation of health information. An individualized patient communication might be the best strategy to discuss treatment plans. We need to understand in which situations patients benefit from numerical presentation and how managing numerical data might influence decision processes.
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Affiliation(s)
- Bijan Zomorodbakhsch
- Department of Oncology, Paracelsus-Clinic at Sea, 37581, Bad Gandersheim, Germany
| | - Christian Keinki
- Department of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | | | - Jutta Huebner
- Department of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
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Soekhai V, Whichello C, Levitan B, Veldwijk J, Pinto CA, Donkers B, Huys I, van Overbeeke E, Juhaeri J, de Bekker-Grob EW. Methods for exploring and eliciting patient preferences in the medical product lifecycle: a literature review. Drug Discov Today 2019; 24:1324-1331. [PMID: 31077814 DOI: 10.1016/j.drudis.2019.05.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 05/02/2019] [Indexed: 01/13/2023]
Abstract
Preference studies are becoming increasingly important within the medical product decision-making context. Currently, there is limited understanding of the range of methods to gain insights into patient preferences. We developed a compendium and taxonomy of preference exploration (qualitative) and elicitation (quantitative) methods by conducting a systematic literature review to identify these methods. This review was followed by analyzing prior preference method reviews, to cross-validate our results, and consulting intercontinental experts, to confirm our outcomes. This resulted in the identification of 32 unique preference methods. The developed compendium and taxonomy can serve as an important resource for assessing these methods and helping to determine which are most appropriate for different research questions at varying points in the medical product lifecycle.
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Affiliation(s)
- Vikas Soekhai
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Department of Public Health, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40, 3000 CA Rotterdam
| | - Chiara Whichello
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Bennett Levitan
- Janssen Research & Development, 1125 Trenton-Harbourton Road, PO Box 200, Titusville, NJ, 08560, USA
| | - Jorien Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Cathy Anne Pinto
- Merck, Sharpe & Dome, 2000 Galloping Hill Rd., Kenilworth, NJ, 07033, USA
| | - Bas Donkers
- Department of Business Economics, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, Leuven, 3000 Belgium
| | - Eline van Overbeeke
- Clinical Pharmacology and Pharmacotherapy, University of Leuven, Herestraat 49 Box 521, Leuven, 3000 Belgium
| | | | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands.
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Jabbour J, Dhillon HM, Shepherd HL, Sundaresan P, Milross C, Clark JR. The relationship between role preferences in decision-making and level of psychological distress in patients with head and neck cancer. PATIENT EDUCATION AND COUNSELING 2018; 101:1736-1740. [PMID: 29866431 DOI: 10.1016/j.pec.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/20/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Is there a relationship between decision-making preferences and psychological distress? METHODS Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire. RESULTS Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28). Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01). CONCLUSION HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females. PRACTICE IMPLICATIONS Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support.
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Affiliation(s)
- Joe Jabbour
- St Vincent's Hospital, Sydney, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia.
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Heather L Shepherd
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Puma Sundaresan
- Central Clinical School, University of Sydney, NSW, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Chris Milross
- Central Clinical School, University of Sydney, NSW, Australia; Department of Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, University of Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; South West Clinical School, University of New South Wales, NSW, Australia
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Shared Decision Making in Prostate Cancer Care-Encouraging Every Patient to be Actively Involved in Decision Making or Ensuring the Patient Preferred Level of Involvement? J Urol 2018; 200:582-589. [PMID: 29501555 DOI: 10.1016/j.juro.2018.02.3091] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The aims of this study were to 1) describe preferred and experienced roles in treatment decision making among patients with localized prostate cancer, 2) identify how often the roles experienced by patients matched their preferred roles and 3) determine whether active involvement in decision making regardless of role preferences or concordance between preferred and experienced roles would be the strongest predictor of more favorable patient reported outcomes. MATERIALS AND METHODS In this prospective, multicenter, observational study we obtained serial questionnaire data from 454 patients with newly diagnosed, localized prostate cancer (cT1-cT2, or Gleason 7 or less and prostate specific antigen 20 ng/ml or less). Questionnaires were completed prior to treatment and at the 3, 6 and 12-month posttreatment followups. Clinical data were obtained from the patient medical records. Active involvement and role concordance were operationalized using the CPS (Control Preferences Scale). ANOVA and effect sizes (small and medium Cohen d = 0.2 and 0.5, respectively) were used to compare patient knowledge of prostate cancer, decision conflict, decision regret and overall health related quality of life. RESULTS Of the patients 393 (87%) reported having been actively involved in treatment decision making. However, 78 patients (17%) indicated having had less or more involvement than preferred. Active involvement was significantly associated with more prostate cancer knowledge (d = 0.30), less decision conflict (d = 0.52) and less decision regret (d = 0.34). Role concordance was also but less strongly associated with less decision conflict (d = 0.41). CONCLUSIONS Our findings support a policy of encouraging all patients with localized prostate cancer regardless of their stated role preferences to be actively involved in the treatment decision.
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Mueck KM, Leal IM, Wan CC, Goldberg BF, Saunders TE, Millas SG, Liang MK, Ko TC, Kao LS. Shared decision-making during surgical consultation for gallstones at a safety-net hospital. Surgery 2017; 163:680-686. [PMID: 29223328 DOI: 10.1016/j.surg.2017.10.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/04/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Understanding patient perspectives regarding shared decision-making is crucial to providing informed, patient-centered care. Little is known about perceptions of vulnerable patients regarding shared decision-making during surgical consultation. The purpose of this study was to evaluate whether a validated tool reflects perceptions of shared decision-making accurately among patients seeking surgical consultation for gallstones at a safety-net hospital. METHODS A mixed methods study was conducted in a sample of adult patients with gallstones evaluated at a safety-net surgery clinic between May to July 2016. Semi-structured interviews were conducted after their initial surgical consultation and analyzed for emerging themes. Patients were administered the Shared Decision-Making Questionnaire and Autonomy Preference Scale. Univariate analyses were performed to identify factors associated with shared decision-making and to compare the results of the surveys to those of the interviews. RESULTS The majority of patients (N = 30) were female (90%), Hispanic (80%), Spanish-speaking (70%), and middle-aged (45.7 ± 16 years). The proportion of patients who perceived shared decision-making was greater in the Shared Decision-Making Questionnaire versus the interviews (83% vs 27%, P < .01). Age, sex, race/ethnicity, primary language, diagnosis, Autonomy Preference Scale score, and decision for operation was not associated with shared decision-making. Contributory factors to this discordance include patient unfamiliarity with shared decision-making, deference to surgeon authority, lack of discussion about different treatments, and confusion between aligned versus shared decisions. CONCLUSION Available questionnaires may overestimate shared decision-making in vulnerable patients suggesting the need for alternative or modifications to existing methods. Furthermore, such metrics should be assessed for correlation with patient-reported outcomes, such as satisfaction with decisions and health status.
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Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX.
| | - Isabel M Leal
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Charlie C Wan
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Braden F Goldberg
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Tamara E Saunders
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Stefanos G Millas
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Mike K Liang
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX
| | - Tien C Ko
- Department of Surgery, University of Texas Health Science Center, Houston, TX
| | - Lillian S Kao
- Department of Surgery, University of Texas Health Science Center, Houston, TX; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, TX
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Sustersic M, Gauchet A, Foote A, Bosson J. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expect 2017; 20:531-542. [PMID: 27669682 PMCID: PMC5512995 DOI: 10.1111/hex.12487] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. OBJECTIVE To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. METHODOLOGY We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. RESULTS Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. DISCUSSION Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. CONCLUSION PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.
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Affiliation(s)
- Mélanie Sustersic
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Groupe Hospitalier Mutualiste de Grenoble (GHM)GrenobleFrance
| | - Aurélie Gauchet
- LIP/LPC2S, EA 4145University of Grenoble AlpesGrenobleFrance
| | - Alison Foote
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
| | - Jean‐Luc Bosson
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
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Abstract
BACKGROUND In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. METHODS In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). RESULTS Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. CONCLUSIONS Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.
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Sak G, Rothenfluh F, Schulz PJ. Assessing the predictive power of psychological empowerment and health literacy for older patients' participation in health care: a cross-sectional population-based study. BMC Geriatr 2017; 17:59. [PMID: 28219334 PMCID: PMC5319152 DOI: 10.1186/s12877-017-0448-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has confirmed a positive link between patient involvement in decision-making and improvements in health outcomes. The objective of this study was to examine the roles of psychological empowerment and health literacy on the elderly's willingness to engage in treatment decisions. METHODS A self-administered questionnaire was completed by a randomly selected sample of Swiss adults aged 65-80 years old (N = 826). Multivariate logistic regression was applied to determine the contribution of health literacy, psychological empowerment, and trust in physician on participants' preference to be active, collaborative or passive in decision-making. RESULTS Most of the survey respondents preferred some participation in dealing with health related decisions (collaborative: 51%, and active: 35.6%). More than two-thirds of the sample was satisfied with their current involvement in medical decision-making (72.7%). Roughly one-fifth (18.8%) wished to attain a more active engagement than currently experienced, and the remainder of the sample preferred the opposite (8.5%). Due to higher reported levels of psychological empowerment and health literacy, Swiss-German seniors significantly preferred and assumed higher participation in medical decisions than Swiss-Italians. Psychological empowerment correlated with older adults' preferred and perceived involvement in medical decision-making. However, health literacy only predicted actual involvement in the last treatment decision that had to be made, differentiating only the active from the passive involvement group. Additionally, this research showed that health literacy mediated the relationship between psychological empowerment and the actual involvement in the last treatment decision that had to be made by the participant. Trust in physician and age appeared to be barriers to involvement, whereas education served as a facilitator. CONCLUSIONS As older adults' health literacy plays a role in individuals' willingness to attain an active role in health care decision-making, public health efforts should aim at developing programs and appropriate information that facilitate this process, especially for individuals with moderate or lower levels of health literacy. The current investigation showed that adequate health literacy levels are essential (but not sufficient) in order to reach higher rates of participation in the healthcare context. This research complements past evidence by adding knowledge on the psychosocial antecedents, and their combined effects on patients' involvement in healthcare.
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Affiliation(s)
- Gabriele Sak
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
| | - Fabia Rothenfluh
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
| | - Peter J. Schulz
- Institute of Communication and Health (ICH), Università della Svizzera italiana (USI), Via G. Buffi 13, 6900 Lugano, Switzerland
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Santema TBK, Stoffer EA, Kunneman M, Koelemay MJW, Ubbink DT. What are the decision-making preferences of patients in vascular surgery? A mixed-methods study. BMJ Open 2017; 7:e013272. [PMID: 28188153 PMCID: PMC5306515 DOI: 10.1136/bmjopen-2016-013272] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Shared decision-making (SDM) has been advocated as the preferred method of choosing a suitable treatment option. However, patient involvement in treatment decision-making is not yet common practice in the field of vascular surgery. The aim of this mixed-methods study was to explore patients' decision-making preferences and to investigate which facilitators and barriers patients perceive as important for the application of SDM in vascular surgery. DESIGN AND SETTING Patients were invited to participate after visiting the vascular surgical outpatient clinic of an Academic Medical Center in the Netherlands. A treatment decision was made during the consultation for an abdominal aortic aneurysm or peripheral arterial occlusive disease. Patients filled in a number of questionnaires (quantitative part) and a random subgroup of patients participated in an in-depth interview (qualitative part). RESULTS A total of 67 patients participated in this study. 58 per cent of them (n=39) indicated that they preferred a shared role in decision-making. In more than half of the patients (55%; n=37) their preferred role was in disagreement with what they had experienced. 31 per cent of the patients (n=21) preferred a more active role in the decision-making process than they had experienced. Patients indicated a good patient-doctor relationship as an important facilitator for the application of SDM. CONCLUSIONS The vast majority of vascular surgical patients preferred, but did not experience a shared role in the decision-making process, although the concept of SDM was insufficiently clear to some patients. This emphasises the importance of explaining the concept of SDM and implementing it in the clinical encounter.
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Affiliation(s)
| | - E Anniek Stoffer
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark J W Koelemay
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Lechner S, Herzog W, Boehlen F, Maatouk I, Saum KU, Brenner H, Wild B. Control preferences in treatment decisions among older adults - Results of a large population-based study. J Psychosom Res 2016; 86:28-33. [PMID: 27302543 DOI: 10.1016/j.jpsychores.2016.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Older adults appear to be a specifically vulnerable group that could benefit considerably from the assessment of their decision-making preferences. The aim of this study was to estimate prevalence rates and to explore characteristics of control preferences in a population-based sample of older adults. METHODS Data was derived from the 8-year follow-up of the ESTHER study - a German epidemiological study in the elderly population. n=3124 participants ages 57 to 84 were visited at home by trained medical doctors for a comprehensive assessment regarding various aspects of their life. The German version of the Control Preferences Scale (CPS) was used to assess decision-making. RESULTS Most of the participants reported a preference for an active role in the decision-making process (46%, 95% CI [44.3; 47.9]), while 30.0% [28.4; 31.5] preferred a collaborative role, and 23.9% [22.4; 25.5] a passive role. Participants aged ≤65years preferred a more passive role in decision-making compared to persons aged <65years. Participants with clinically significant depression symptoms (CSD) preferred significantly more often a passive role compared to those without CSD. Similarly, multimorbid patients preferred a passive role compared to people with none or one chronic disease. Conversely, in groups with active or collaborative control preferences the morbidity index was lower compared to the group with passive control preferences. CONCLUSION Results indicate that physical and mental health in the elderly are associated with the preference role. It should, however, be investigated whether multimorbidity or mental diseases influence the treatment preference of older adults.
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Affiliation(s)
- Sabine Lechner
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Friederike Boehlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Ngadimon IW, Islahudin F, Hatah E, Mohamed Shah N, Makmor-Bakry M. Antibiotic and shared decision-making preferences among adolescents in Malaysia. Patient Prefer Adherence 2015; 9:665-73. [PMID: 25999702 PMCID: PMC4437597 DOI: 10.2147/ppa.s82844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to establish baseline information on the current level of knowledge about, attitude toward, and experience with antibiotic usage, and preferences for shared decision making among adolescents in Malaysia. METHODS A cross-sectional survey, involving 1,105 respondents who were aged between 13 and 17 years and who lived in Malaysia, was conducted using a validated questionnaire. The survey assessed knowledge, attitude, and experience with regard to antibiotic usage, and adolescents' preferences for the style of shared decision-making process. RESULTS The majority (n=786 [71.13%]) of the respondents had a low level of knowledge, 296 (26.79%) had a moderate level of knowledge, and 23 (2.08%) had a high level of knowledge. Further, they demonstrated a slightly negative attitude mean score of 3.30±0.05 (range: 0-8 points) but a positive experience mean score of 2.90±0.029 (range: 0-4 points). There was a positive correlation between knowledge and attitude scores, with a higher knowledge level associated with a more positive attitude toward antibiotic usage (r=0.257, P<0.001). Higher knowledge scores were associated with a more negative experience with antibiotic usage (r=-0.83, P=0.006). When assessing preference in shared decision making, more adolescents preferred an active role (n=408 [37%]) compared with collaborative (n=360 [32.6%]) or passive (n=337 [30.5%]) (P=0.028) roles. CONCLUSION Current health care settings should involve adolescents in the decision-making process. Education packages can be introduced to improve adolescents' knowledge of and practice of taking antibiotics, as well as to encourage their participation in decision making, in an attempt to reduce misuse of antibiotics.
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Affiliation(s)
- Irma Wati Ngadimon
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Farida Islahudin, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia, Tel +603 9289 7689, Email
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Arthritis patients' motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement. Clin Rheumatol 2014; 35:1225-35. [PMID: 25392118 DOI: 10.1007/s10067-014-2820-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/06/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated.
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