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Hild S, Teigné D, Fairier D, Ruelle Y, Aubin-Auger I, Sidorkiewicz S, Citrini M, Gocko X, Cerisey C, Ferrat E, Rat C. Development and evaluation of a decision aid for women eligible for organized breast cancer screening according to international standards: A multi-method study. Breast 2024; 73:103613. [PMID: 38056169 PMCID: PMC10749284 DOI: 10.1016/j.breast.2023.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND and purpose: In France, women lack information to make a shared decision to start breast cancer screening. Decision aids are useful to facilitate this discussion, yet few meet international standards. The objective of this project was to build, validate and measure the quality of a decision aid for organized breast screening in France, in line with international standards, intended for both women and healthcare professionals. MATERIALS AND METHODS This mixed-methods study was conducted between January 2017 and June 2022. The prototype was developed from a qualitative study, systematic review and targeted literature review and alpha tested during two Delphi rounds. Readability was evaluated with the Flesch score and content with International Patient Decision Aid Standards Instrument (IPSASi). RESULTS An online decision aid, accessible at www.Discutons-mammo.fr, written in French was developed. The content included eligibility, information about breast screening the advantages and disadvantages of screening, patient preferences and a patient-based discussion guide using text, infographics, and videos. The Flesch readability test score was 65.4 and the IPDASi construct quality score was 176 out of 188. CONCLUSIONS This decision aid complies with IPDASi standards and could help women eligible for breast screening in France make a shared decision with a specialized healthcare professional about whether or not to participate in organized breast screening.
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Affiliation(s)
- Sandrine Hild
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France.
| | - Delphine Teigné
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; University Research Department, Nantes University Hospital, Nantes, France.
| | - Damien Fairier
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; University Research Department, Nantes University Hospital, Nantes, France.
| | - Yannick Ruelle
- Department of General Practice, Sorbonne University Paris Nord, UR 3412, DUMG, F-93430, Villetaneuse, France.
| | | | | | - Marie Citrini
- Patient Perspective, Sorbonne University, Paris, Nord, France.
| | - Xavier Gocko
- University Jean Monnet of Saint Etienne, Department of Medicine, Saint Etienne, France.
| | | | - Emilie Ferrat
- University Paris-Est Creteil, INSERM, IMRB, Equipe CEpiA, F-94010, Creteil, Paris, France.
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes University, 1, rue Gaston Veil, 44035, Nantes, France; National Institute for Health and Medical Research/INSERM U1302 Team 2, CRCINA, Nantes, France.
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Yilmaz D, Egorova AD, Schalij MJ, Spierenburg HAM, Verbunt RAM, van Erven L. The development of a decision aid for shared decision making in the Dutch implantable cardioverter defibrillator patient population: A novel approach to patient education. Front Cardiovasc Med 2022; 9:946404. [PMID: 36312281 PMCID: PMC9606344 DOI: 10.3389/fcvm.2022.946404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Counseling of Implantable Cardioverter-defibrillator (ICD) patients with regard to individual risks and benefits is challenging. An evidence-based decision aid tailored to the needs of Dutch ICD patients is not yet available. The objective of this pilot project was to structurally evaluate the current clinical practice in The Netherlands and the ICD patient experience, in order to develop an online decision aid to facilitate shared decision making in ICD procedures. Methods Between June 2016 and December 2017, a Dutch web-based decision aid was developed according to the Patient Decision Aid Standards (IPDAS) using the RAND-UCLA/multi-stepped Delphi model. Development process consisted of 5 stages in which the Dutch clinical practice was reviewed (stage 1), patients' needs and their history of decision making was structurally assessed (stages 2A and B) and a modified Delphi consensus process was performed with an expert panel consisting of representatives from different medical fields (stage 3). Results from stages 1-3 were used to design and structure the content of an online-based decision aid (stage 4) which was finally evaluated in a usability testing by patients in stage 5. Results and conclusion This study describes the evidence-based approach to the development of the Dutch ICD decision aid. In our population, levels of shared decision-making experience were low. The ICD decision aid was structurally developed for the Dutch ICD patient population. Our upcoming multicenter stepped wedge clustered randomized trial will further evaluate the ICD decision aid in clinical practice.
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Affiliation(s)
- Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Development of a measure to assess the quality of proxy decisions about research participation on behalf of adults lacking capacity to consent: the Combined Scale for Proxy Informed Consent Decisions (CONCORD scale). Trials 2022; 23:843. [PMID: 36195929 PMCID: PMC9531498 DOI: 10.1186/s13063-022-06787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recruitment of adults lacking the capacity to consent to trials requires the involvement of an alternative 'proxy' decision-maker, usually a family member. This can be challenging for family members, with some experiencing emotional and decisional burdens. Interventions to support proxy consent decisions in non-emergency settings are being developed. However, the ability to evaluate interventions is limited due to a lack of measures that capture outcomes of known importance, as identified through a core outcome set (COS). METHODS Using established measure development principles, a four-stage process was used to develop and refine items for a new measure of proxy decision quality: (1) findings from a recent scoping review and consensus study were reviewed to identify items for inclusion in the scale and any existing outcome measures, (2) assessment of content coverage by existing measures and identification of insufficiency, (3) construction of a novel scale, and (4) cognitive testing to explore comprehension of the scale and test its content adequacy through interviews with family members of people with impaired capacity. RESULTS A range of outcome measures associated with healthcare decision-making and informed consent decisions, such as the Decisional Conflict Scale, were identified in the scoping review. These measures were mapped against the key constructs identified in the COS to assess content coverage. Insufficient coverage of areas such as proxy-specific satisfaction and knowledge sufficiency by existing instruments indicated that a novel measure was needed. An initial version of a combined measure (the CONCORD scale) was drafted and tested during cognitive interviews with eleven family members. The interviews established comprehension, acceptability, feasibility, and content adequacy of the scale. Participants suggested re-phrasing and re-ordering some questions, leading to the creation of a revised version. CONCLUSIONS The CONCORD scale provides a brief measure to evaluate the quality of decisions made on behalf of an adult who lacks the capacity to consent in non-emergency settings, enabling the evaluation of interventions to improve proxy decision quality. Initial evaluation indicates it has content adequacy and is feasible to use. Further statistical validation work is being undertaken.
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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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Hommes S, Vromans R, Clouth F, Verbeek X, de Hingh I, Krahmer E. Communication in decision aids for stage I-III colorectal cancer patients: a systematic review. BMJ Open 2021; 11:e044472. [PMID: 33926980 PMCID: PMC8094367 DOI: 10.1136/bmjopen-2020-044472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted. DESIGN Systematic review. DATA SOURCES DAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources. ELIGIBILITY CRITERIA DAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I-III. DATA EXTRACTION AND SYNTHESIS After the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist. RESULTS In total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language. CONCLUSIONS Both instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.
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Affiliation(s)
- Saar Hommes
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Ruben Vromans
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Felix Clouth
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Xander Verbeek
- The Netherlands Comprehensive Cancer Organization, Department of Research & Development, IKNL, Eindhoven, The Netherlands
| | - Ignace de Hingh
- Catharina Cancer Institute, Colorectal Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Emiel Krahmer
- Tilburg center for Cognition and Communication (TiCC), Tilburg School of Humanities and Digital Sciences (TSHD), Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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Meyappan M, Loh WSA, Tan LY, Tan SFI, Ho PY, Poh YJ, Tan NC. Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study. Health Expect 2021; 24:431-443. [PMID: 33434401 PMCID: PMC8077153 DOI: 10.1111/hex.13184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gout treatment is not optimized globally, often due to therapeutic inertia by physicians or poor adherence to urate-lowering medications by patients. A patient decision aid (PDA) to facilitate shared decision making (SDM) in gout treatment may overcome these physician-patient barriers. OBJECTIVE The study explored the views of physicians and patients on a novel locally designed gout treatment PDA prototype. DESIGN Qualitative descriptive design was used to gather data from in-depth-interviews (IDI) and focus group discussions (FGD). Data analysis was via thematic analysis. Emergent themes shaped a revised version of the PDA. SETTING AND PARTICIPANTS Adult Asian patients with recent acute gout exacerbations and local Primary Care Physicians (PCP) in Singapore were purposefully chosen. 15 patients with gout and 11 PCPs participated across three IDIs and six FGDs, with the investigators exploring their views of a prototype gout treatment PDA. RESULTS Patients and physicians generally concurred with the content and design of the PDA prototype. However, while patients preferred fewer treatment details, the PCPs desired more information. Patients preferred the display of statistics, while PCPs felt that numbers were not relevant to patients. The latter were hesitant to include treatment options that were unavailable in primary care. Both stakeholders indicated that they would use the PDA during a consultation. PCPs would need further training in SDM, given a lack of understanding of it. CONCLUSION AND PATIENT CONTRIBUTION Patients will be the prime users of the PDA. While their views differed partially from the physicians, both have jointly developed the novel gout treatment PDA.
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Affiliation(s)
| | - Wei Siong Aaron Loh
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore CitySingapore
| | - Li Yen Tan
- SingHealth PolyclinicsSingapore CitySingapore
| | | | - Pey Ying Ho
- SingHealth PolyclinicsSingapore CitySingapore
| | - Yih Jia Poh
- Rheumatology DepartmentSingapore General HospitalSingapore CitySingapore
| | - Ngiap Chuan Tan
- SingHealth PolyclinicsSingapore CitySingapore
- SingHealth‐Duke NUS Family Medicine Academic Clinical ProgrammeSingapore CitySingapore
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Shepherd V, Wood F, Griffith R, Sheehan M, Hood K. Development of a decision support intervention for family members of adults who lack capacity to consent to trials. BMC Med Inform Decis Mak 2021; 21:30. [PMID: 33509169 PMCID: PMC7842028 DOI: 10.1186/s12911-021-01390-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Informed consent is required for participation in clinical trials, however trials involving adults who lack capacity to consent require different enrolment processes. A family member usually acts as a proxy to make a decision based on the patient's 'presumed will', but these decisions can be challenging and families may experience an emotional and decisional burden. Decisions made on behalf of others are conceptually different from those made for ourselves. Innovations have been developed to improve informed consent processes for research, including a number of decision aids, however there are no interventions for proxies who are faced with more complex decisions. This article outlines the development of a novel decision aid to support families making decisions about research participation on behalf of an adult who lacks capacity to consent. METHODS Decision support interventions should be developed using rigorous and evidence-based methods. This intervention was developed using MRC guidance for the development of complex interventions, and a conceptual framework for the development and evaluation of decision aids for people considering taking part in a clinical trial. The intervention was informed by a systematic review and analysis of existing information provision. Previous qualitative research with families who acted as proxies enabled the development of a theoretical framework to underpin the intervention. The intervention was iteratively developed with the involvement of lay advisors and relevant stakeholders. RESULTS Previous research, theoretical frameworks, and decision aid development frameworks were used to identify and develop the intervention components. The decision aid includes information about the proxy's role and utilises a values clarification exercise and decision support methods to enable a more informed and better-quality decision. Stakeholders, including those representing implementers and receivers of the intervention, contributed to the design and comprehensibility of the decision aid to ensure that it would be acceptable for use. CONCLUSIONS Frameworks for the development of decision aids for people considering participating in a clinical trial can be used to develop interventions for family members acting as proxy decision-makers. The decision support tool is acceptable to users. Feasibility testing and outcome measure development is required prior to any evaluation of its effectiveness.
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Affiliation(s)
- Victoria Shepherd
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Fiona Wood
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Richard Griffith
- College of Human and Health Studies, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Mark Sheehan
- Ethox Centre, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Hild S, Johanet M, Valenza A, Thabaud M, Laforest F, Ferrat E, Rat C. Quality of decision aids developed for women at average risk of breast cancer eligible for mammographic screening: Systematic review and assessment according to the International Patient Decision Aid Standards instrument. Cancer 2020; 126:2765-2774. [PMID: 32267546 DOI: 10.1002/cncr.32858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/20/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
Abstract
Mammographic screening contributes to a reduction in specific mortality, but it has disadvantages. Decision aids are tools designed to support people's decisions. Because these aids influence patient choice, their quality is crucial. The objective of the current study was to conduct a systematic review of decision aids developed for women eligible for mammographic screening who have an average breast cancer risk and to assess the quality of these aids. The systematic review included articles published between January 1, 1997, and August 1, 2019, in the PubMed, Embase, Cochrane, and PsycInfo databases. The studies were reviewed independently by 2 reviewers. Any study containing a decision aid for women eligible for mammographic screening with an average breast cancer risk was included. Two double-blind reviewers assessed the quality of the selected decision aids using the International Patient Decision Aid Standards instrument, version 3 (IPDASi). Twenty-three decision aids were extracted. Classification of decision aid quality using the IPDASi demonstrated large variations among the decision aids (maximum IPDASi score, 188; mean ± SD score, 132.6 ± 23.8; range, 85-172). Three decision aids had high overall scores. The 3 best-rated dimensions were disclosure (maximum score, 8; mean score, 6.8), focusing on transparency; information (maximum score, 32; mean score, 26.1), focusing on the provision of sufficient details; and probabilities (maximum score, 32; mean score 25), focusing on the presentation of probabilities. The 3 lowest-rated dimensions were decision support technology evaluation (maximum score, 8; mean score, 4.3), focusing on the effectiveness of the decision aid; development (maximum score, 24; mean score, 12.6), evaluating the development process; and plain language (maximum score, 4; mean score, 1.9), assessing appropriateness for patients with low literacy. The results of this review identified 3 high-quality decision aids for breast cancer screening.
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Affiliation(s)
- Sandrine Hild
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Marion Johanet
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Anna Valenza
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Maïna Thabaud
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Flore Laforest
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Emilie Ferrat
- Primary Care Department, Faculty of Medicine, University of Paris-East Creteil, Creteil, France.,Clinical Epidemiology and Ageing Unit, University of Paris-Est Creteil, Creteil, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
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Muthulingam D, Bia J, Madden LM, Farnum SO, Barry DT, Altice FL. Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support. J Subst Abuse Treat 2019; 100:18-28. [PMID: 30898324 PMCID: PMC6432946 DOI: 10.1016/j.jsat.2019.01.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The opioid crisis requires rapid scale-up of evidence-based interventions to treat opioid use disorder (OUD), of which pharmacologic therapies with methadone, buprenorphine or long-acting naltrexone are most effective. With recently-developed formulations, there are unprecedented treatment options. Even when pharmacologic treatment is accessible, however, uptake remains low, suggesting individual-level barriers. Decision aids are an evidence-based strategy that may overcome these barriers. This study aims to inform such a tool by describing and rank-ordering patients' considerations when deciding whether to start medication and, if starting, choosing a medication. METHODS Adults with OUD (N = 81) attending an addiction treatment center or syringe exchange program completed focus groups using nominal group technique, a consensus method that generates and ranks response. The qualitative component generates a broad array of responses, followed by rank-ordering to prioritize responses. Responses to questions about starting any medications and the pros and cons of five specific medications were ranked and coded. RESULTS The decision to initiate pharmacologic therapy and choose among medications was influenced by six key attributes in decreasing priority: (1) benefits, (2) side effects of treatment, (3) medication delivery strategies, (4) convenience, (5) how expectations for treatment are met, and (6) how medication (especially methadone) can represents trading one addiction for another. CONCLUSIONS Pharmacologic properties, logistical factors, and managing expectations were important themes in decision-making for starting, choosing, and staying on medications, and to a lesser degree, negative views about medications, specifically OAT, as an addiction itself. Desire for more control over treatment persisted in all themes. This study identified specific knowledge gaps, expectations, and priorities which are important for developing a decision aid for OUD treatment relevant to the target group. Nominal group technique is an established mixed-methodology that we have applied to a new population and purpose, that of conducting needs assessment for decision aid development.
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Affiliation(s)
- Dharushana Muthulingam
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA.
| | - Joshua Bia
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Lynn M Madden
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Scott O Farnum
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA
| | - Declan T Barry
- APT Foundation, Inc, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA; APT Foundation, Inc, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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Urman RD, Southerland WA, Shapiro FE, Joshi GP. Concepts for the Development of Anesthesia-Related Patient Decision Aids. Anesth Analg 2019; 128:1030-1035. [DOI: 10.1213/ane.0000000000003804] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Wahl J, Apfelbacher C. [Quality of patient information leaflets on atopic eczema : An analysis using the DISCERN instrument]. Hautarzt 2018; 69:825-831. [PMID: 30112575 DOI: 10.1007/s00105-018-4247-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As in other chronic diseases, providing medical information plays a key role in the therapy of atopic eczema. It is already known that information leaflets often do not meet the criteria of evidence-based patient information (EBPI). OBJECTIVE Therefore, the aim of this study was to examine the quality of information leaflets on atopic eczema. MATERIAL AND METHODS A total of 35 leaflets were included in the study. They were collected from self-aid groups, from the internet, from general practitioners, from pediatricians and dermatologists as well as from pharmacies in Regensburg. The quality of information provided was assessed using the DISCERN instrument. RESULTS Almost all of the 35 patient information leaflets assessed had shortcomings, scoring only mid- or low-point in the analysis. None of the leaflets was of excellent quality. Only three leaflets were estimated to contain good quality information. CONCLUSION Most of the leaflets did not meet the criteria of evidence-based patient information. In conclusion, there may be a lack of quality information about atopic eczema. Improving the existing material and comparing the EBPI standards with the information needs of atopic eczema patients should be topics of future research.
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Affiliation(s)
- J Wahl
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Dr.-Gessler-Str. 17, Regensburg, Deutschland.
| | - C Apfelbacher
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Dr.-Gessler-Str. 17, Regensburg, Deutschland
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Feldman-Stewart D, Tong C, Brundage M, Bender J, Robinson J. Making their decisions for prostate cancer treatment: Patients' experiences and preferences related to process. Can Urol Assoc J 2018; 12:337-343. [PMID: 29989912 DOI: 10.5489/cuaj.5113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine the experiences and preferences of prostate cancer patients related to the process of making their treatment decisions, and to the use of decision support. METHODS Population surveys were conducted in four Canadian provinces in 2014-2015. Each provincial cancer registry mailed surveys to a random sample of their prostate cancer patients diagnosed in late 2012. Three registries' response rates were 46-55%; the fourth used a different recruiting strategy, producing a response rate of 13% (total n=1366). RESULTS Overall, 90% (n=1113) of respondents reported that they were involved in their treatment decisions. Twenty-three percent (n=247) of respondents wanted more help with the decision than they received and 52% of them (n=128) reported feeling well-informed. Only 51% (n=653) of all respondents reported receiving any decision support, but an additional 34% (n=437) would want to if they were aware of its existence. A quarter (25%, n=316) of respondents found it helpful to use a decision aid, a type of decision support that provides assistance to decision processes and provides information, but 64% (n=828) reported never having heard of decision aids; 26% (n=176) of those who had never heard of decision aids wanted more help with the decision than they received compared to 13% (n=36) of those who had used a decision aid. CONCLUSIONS The majority of respondents wanted to participate in their treatment decisions, but a portion wanted more help than they received. Half of those who wanted more help felt well-informed, thus, needed support beyond information. Decision aids have potential to provide information and support to the decision process.
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Affiliation(s)
- Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Christine Tong
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Jackie Bender
- ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, University Health Network, Toronto, ON, Canada
| | - John Robinson
- Department of Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
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Ager B, Jansen J, Porter D, Phillips KA, Glassey R, Butow P. Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy. Breast 2018; 40:156-164. [PMID: 29857282 DOI: 10.1016/j.breast.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/23/2018] [Accepted: 05/18/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). METHODS The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. RESULTS Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. CONCLUSION The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. PRACTICE IMPLICATIONS Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions.
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Affiliation(s)
- B Ager
- School of Psychology, The University of Sydney, Australia
| | - J Jansen
- Sydney Medical School, The University of Sydney, Australia; Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia
| | - D Porter
- Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - K A Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - R Glassey
- Medical School, The University of Western Australia, Perth, Australia
| | | | - P Butow
- Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia; Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia.
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Bunzli S, Nelson E, Scott A, French S, Choong P, Dowsey M. Barriers and facilitators to orthopaedic surgeons' uptake of decision aids for total knee arthroplasty: a qualitative study. BMJ Open 2017; 7:e018614. [PMID: 29133333 PMCID: PMC5695436 DOI: 10.1136/bmjopen-2017-018614] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons. DESIGN A qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators. SETTING One tertiary hospital in Australia. PARTICIPANTS Twenty orthopaedic surgeons performing TKA. OUTCOME MEASURES Beliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids. RESULTS While prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one's patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid. CONCLUSIONS Multifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.
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Affiliation(s)
- Samantha Bunzli
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Nelson
- Department of Orthopaedics, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Anthony Scott
- Faculty of Business and Economics, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon French
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Peter Choong
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, The University of Melbourne, St Vincent’s Hospital, Melbourne, Victoria, Australia
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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: 95] [Impact Index Per Article: 13.6] [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
Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is "polyvalent", a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes - social marketing and the hospitality industry - are identified.
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Affiliation(s)
- Mike Slade
- Institute of Mental Health, School of Health Sciences, University of NottinghamNottinghamUK
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17
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Kirkscey R. Patient Decision Aids for Prenatal Genetic Testing: Probability, Embodiment, and Problematic Integration. HEALTH COMMUNICATION 2017; 32:568-577. [PMID: 27326827 DOI: 10.1080/10410236.2016.1140500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patient decision aids (PDAs) are documents that attempt to support patient participation in biomedical decision making by discussing information and options. Scholars have called for further elaboration and application of communication theory relating to the construction and uses of PDAs. This article analyzes gateway documents, a genre of PDAs that includes texts from noncommercial websites returned during an initial inquiry for decision-making information. Problematic integration theory informs and extends a meaning of balance in a sample of four PDAs for prenatal genetic testing. The study addresses several communication opportunities, including discussions of benefits, disadvantages, providers' scientific knowledge, and patients' embodied knowledge. The PDA authors' emphases on statistical risk without more inclusive considerations of embodied knowledge highlight a conclusion that the documents in the sample are imbalanced. This research serves to introduce a theoretical communication context for analysis of PDAs that may assist scholars in further contributions to the interdisciplinary field of biomedical communication.
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Clifford AM, Ryan J, Walsh C, McCurtin A. What information is used in treatment decision aids? A systematic review of the types of evidence populating health decision aids. BMC Med Inform Decis Mak 2017; 17:22. [PMID: 28231790 PMCID: PMC5322640 DOI: 10.1186/s12911-017-0415-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
Background Patient decision aids (DAs) are support tools designed to provide patients with relevant information to help them make informed decisions about their healthcare. While DAs can be effective in improving patient knowledge and decision quality, it is unknown what types of information and evidence are used to populate such decision tools. Methods Systematic methods were used to identify and appraise the relevant literature and patient DAs published between 2006 and 2015. Six databases (Academic Search Complete, AMED, CINAHL, Biomedical Reference Collection, General Sciences and MEDLINE) and reference list searching were used. Articles evaluating the effectiveness of the DAs were appraised using the Cochrane Risk of Bias tool. The content, quality and sources of evidence in the decision aids were evaluated using the IPDASi-SF and a novel classification system. Findings were synthesised and a narrative analysis was performed on the results. Results Thirteen studies representing ten DAs met the inclusion criteria. The IPDASI-SF score ranged from 9 to 16 indicating many of the studies met the majority of quality criteria. Sources of evidence were described but reports were sometimes generic or missing important information. The majority of DAs incorporated high quality research evidence including systematic reviews and meta-analyses. Patient and practice evidence was less commonly employed, with only a third of included DAs using these to populate decision aid content. The quality of practice and patient evidence ranged from high to low. Contextual factors were addressed across all DAs to varying degrees and covered a range of factors. Conclusions This is an initial study examining the information and evidence used to populate DAs. While research evidence and contextual factors are well represented in included DAs, consideration should be given to incorporating high quality information representing all four pillars of evidence based practice when developing DAs. Further, patient and expert practice evidence should be acquired rigorously and DAs should report the means by which such evidence is obtained with citations clearly provided. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0415-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda M Clifford
- Department of Clinical Therapies, Health Sciences Building, University of Limerick, Limerick, Ireland
| | - Jean Ryan
- Department of Clinical Therapies, Health Sciences Building, University of Limerick, Limerick, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Arlene McCurtin
- Department of Clinical Therapies, Health Sciences Building, University of Limerick, Limerick, Ireland.
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Frencher SK, Sharma AK, Teklehaimanot S, Wadzani D, Ike IE, Hart A, Norris K. PEP Talk: Prostate Education Program, "Cutting Through the Uncertainty of Prostate Cancer for Black Men Using Decision Support Instruments in Barbershops". JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:506-513. [PMID: 26123763 DOI: 10.1007/s13187-015-0871-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to investigate the effectiveness of using decision support instruments (DSI) to assist African-American (AA) men in making a prostate cancer (CaP) screening decision. This nonrandomized pretest-posttest comparison study assessed two DSI that were either culturally tailored or culturally nonspecific. CaP knowledge, intention to screen, and preferences were assessed before and after exposure to DSI using a convenience sample of 120 AA men aged 40 years and above. Participants interested in screening were referred to healthcare providers through a community-based patient navigator to obtain prostate-specific antigen (PSA) testing. We followed up 3 months after to determine if participants screened for CaP. CaP knowledge increased following exposure to both DSI in equivalent proportions. While similar proportions of men ultimately intended on having a PSA test following both DSI, bivariate analysis revealed that the culturally tailored DSI demonstrated a statistically significant increase in intention to screen. Participants' degree of certainty in their decision-making process with regard to CaP screening increased following the culturally tailored DSI (p < .001). The majority of participants planned on discussing CaP screening with a healthcare provider upon completion of the study. Barbershop-based health education can change the knowledge, preferences, intentions, and behaviors of this at-risk population. At 3 months follow-up, half (n = 58) of the participants underwent PSA testing, which led to the diagnosis of CaP in one participant. Community-led interventions for CaP, such as cluster-randomized designs in barbershops, are needed to better assess the efficacy of DSI in community settings.
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Affiliation(s)
- Stanley K Frencher
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA.
| | - Arun K Sharma
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA
| | - Senait Teklehaimanot
- Department of Research - Life Sciences Institute, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Dennis Wadzani
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Ijeoma E Ike
- Mervyn M. Dymally School of Nursing, Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - Alton Hart
- Crater Health District, Virginia Department of Health, Richmond, 1501 West City Point Road, Hopewell, VA, 23860, USA
| | - Keith Norris
- David Geffen School of Medicine, University of California, Los Angeles, 650 Charles E Young Dr. South, 66-115 CHS, Los Angeles, CA, 90095, USA
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Baldacchino A, Crocamo C, Humphris G, Neufeind J, Frisher M, Scherbaum N, Carrà G. Decision support in addiction: The development of an e-health tool to assess and prevent risk of fatal overdose. The ORION Project. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 133:207-216. [PMID: 27393811 DOI: 10.1016/j.cmpb.2016.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 05/22/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The application of e-health technology to the field of substance use disorders is at a relatively early stage, and methodological quality is still variable. Few have explored the extent of utilization of communication technology in exploring risk perception by patients enrolled in substance abuse services. The Overdose RIsk InfOrmatioN (ORION) project is a European Commission funded programme, aimed to develop and pilot an e-health psycho-educational tool to provide information to drug using individuals about the risks of suffering a drug overdose. METHODS In this article, we report on phase 1 (risk estimation), phase 2 (design), and phase 3 (feasibility) of the ORION project. RESULTS The development of ORION e-health tool underlined the importance of an evidence-based intervention aimed in obtaining reliable evaluation of risk. The ORION tool supported a decision making process aimed at influencing the substance users' self-efficacy and the degree to which the substance users' understand risk factors. Therefore, its innovative power consisted in translating risks combination into a clear estimation for the user who will then appear more likely to be interested in his/her risk perception. CONCLUSION Exploratory field testing and validation confirmed the next stage of evaluation, namely, collection of routine patient samples in study clinics. The associations between risk perception of overdose, engagement with the ORION tool and willingness to alter overdose risk factors, in a clinical setting across various EU member states will further confirm the ORION tool's generalisability and effectiveness.
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Affiliation(s)
- A Baldacchino
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom.
| | - C Crocamo
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy
| | - G Humphris
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom
| | - J Neufeind
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom; Playfield Institute, Startheden Hospital, Cupar, Fife KY15 5RR, United Kingdom
| | - M Frisher
- Faculty of Health, School of Pharmacy, Hornbeam Building, Keele, Staffordshire ST5 5BG, United Kingdom
| | - N Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - G Carrà
- Department of Mental Health, San Gerardo University Hospital, Via Pergolesi, 33-20900 Monza, Italy
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Slover J, Alvarado C, Nelson C. Shared Decision Making in Total Joint Replacement. JBJS Rev 2016; 2:01874474-201402030-00001. [PMID: 27490756 DOI: 10.2106/jbjs.rvw.m.00044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James Slover
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1616, New York, NY 10003
| | - Carlos Alvarado
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1616, New York, NY 10003
| | - Colin Nelson
- Foundation for Informed Decision Making, 40 Court Street, Boston, MA 02108
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22
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Dowsey MM, Spelman T, Choong PFM. Development of a Prognostic Nomogram for Predicting the Probability of Nonresponse to Total Knee Arthroplasty 1 Year After Surgery. J Arthroplasty 2016; 31:1654-60. [PMID: 26935945 DOI: 10.1016/j.arth.2016.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Indications for total knee arthroplasty (TKA) currently depend on clinical judgment. Up to one fifth of those who undergo primary TKA do not report a clinically meaningful improvement in pain and function after surgery. Our aim was to develop and internally validate a prognostic tool for predicting the probability of nonresponse to surgery at 12 months. METHODS Patients from 1 center who underwent primary TKA (N = 615) between 2012 and 2013. The Western Ontario and McMaster Universities Arthritis Index was collected pre- and 12 months after TKA from which nonresponse to surgery was determined using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria. Using independent prognostic correlates of postoperative nonresponse observed in adjusted modeling, we derived a prognostic nomogram to estimate the probability of nonresponse to TKA based on this suite of explanatory variables. RESULTS A total of 90/615 (15%) cases were nonresponders to TKA. The degree of contribution (odds ratio, 95% confidence interval) of each explanatory factor to nonresponse nomogram points was body mass index ≥40 kg/m(2) (3.48; 1.97-6.12), Kellgren and Lawrence <4 (2.59; 1.58-4.24), mental disability on Short Form Health Survey (SF-12) mental component score (3.30; 1.44-7.58), and every 10-point increase in preoperative Western Ontario and McMaster Universities Arthritis Index score (0.81; 0.68-0.97). The concordance index for this model was 0.74. CONCLUSION We have created a prognostic nomogram that displays the predictive probabilities of nonresponse to TKA as a source of decision support for clinicians and patients, about their likely functional outcome from TKA. Although our own internal validation suggested good nomogram performance, external validation in a comparable surgical population is required to confirm generalizability of the nomogram.
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Affiliation(s)
- Michelle M Dowsey
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tim Spelman
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Peter F M Choong
- The University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedics, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Butow P, Tesson S, Boyle F. A systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast 2016; 26:31-45. [PMID: 27017240 DOI: 10.1016/j.breast.2015.12.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023] Open
Abstract
Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.
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Affiliation(s)
- Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Stephanie Tesson
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia
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Ng CJ, Mathers N, Bradley A, Colwell B. A 'combined framework' approach to developing a patient decision aid: the PANDAs model. BMC Health Serv Res 2014; 14:503. [PMID: 25341370 PMCID: PMC4210601 DOI: 10.1186/s12913-014-0503-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 10/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background There is a lack of practical research frameworks to guide the development of patient decision aids [PtDAs]. This paper described how a PtDA was developed using the International Patient Decision Aids (IPDAS) guideline and UK Medical Research Council (UKMRC) frameworks to support patients when making treatment decisions in type 2 diabetes mellitus. Methods This study used mixed methods to develop a PtDA for use in a UK general practice setting. A 10-member expert panel was convened to guide development and patients and clinicians were also interviewed individually using semi-structured interview guides to identify their decisional needs. Current literature was reviewed systematically to determine the best available evidence. The Ottawa Decision Support Framework was used to guide the presentation of the information and value clarification exercise. An iterative draft-review-revise process by the research team and review panel was conducted until the PtDA reached content and format ‘saturation’. The PtDA was then pilot-tested by users in actual consultations to assess its acceptability and feasibility. The IPDAS and UKMRC frameworks were used throughout to inform the development process. Results The PANDAs PtDA was developed systematically and iteratively. Patients and clinicians highlighted the needs for information, decisional, emotional and social support, which were incorporated into the PtDA. The literature review identified gaps in high quality evidence and variations in patient outcome reporting. The PtDA comprised five components: background of the treatment options; pros and cons of each treatment option; value clarification exercise; support needs; and readiness to decide. Conclusions This study has demonstrated the feasibility of combining the IPDAS and the UKMRC frameworks for the development and evaluation of a PtDA. Future studies should test this model for developing PtDAs across different decisions and healthcare contexts. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0503-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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Chabrera C, Font A, Caro M, Areal J, Zabalegui A. Developing a decision aid to support informed choices for newly diagnosed patients with localized prostate cancer. Cancer Nurs 2014; 38:E55-60. [PMID: 24831045 DOI: 10.1097/ncc.0000000000000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decision aids (DAs) have been developed in several health disciplines to support decision making informed by evidence, such as the benefits and risks of different treatment options. Decision aids can improve the decision-making process by reducing decisional conflict and helping patients to participate in decision making. OBJECTIVE The aim of this study was to design and develop a DA for treatment decision making in localized prostate cancer in Spain with regard to surgery, radiotherapy, or watchful waiting. INTERVENTIONS/METHODS We developed a DA based on the principles of the International Patient Decision Aid Standards Collaboration and according to the Ottawa Decision Support Framework. The structural development process involved DA developers, expert feedback, use of the Delphi method, and patient feedback. We conducted a pilot test on 34 men with localized prostate cancer. RESULTS The DA is a structured booklet. According to the International Patient Decision Aid Standards checklist, the DA scored 22 of 27 points (81.48%). The development process section scored 22 of 24 points (91.6%), and the effectiveness of the decision-making process section scored 6 of 6 (100%). The clinical pilot test yielded positive feedback regarding the design, images, understandability, usability, explanations, and amount of information in the DA. CONCLUSIONS We developed a Spanish DA with a strong quality score to help patients make an informed choice regarding their prostate cancer treatment. Future research will assess the impact of the DA and its association with improved decision making. IMPLICATIONS FOR PRACTICE This tool provides information about the risks and benefits of different treatment options and helps patients to understand the importance of their own values for informing treatment choices.
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Affiliation(s)
- Carolina Chabrera
- Author Affiliations: School of Health Science-TecnoCampus, Department of Nursing, University Pompeu Fabra, Mataró (Ms Chabrera); Department of Oncology, Catalan Institute of Oncology, Badalona (Ms Chabrera and Dr Font); Department of Radiation Oncology, Oncology Catalan Institute, Badalona (Dr Caro); Department of Urology, Germans Trias i Pujol University Hospital, Badalona (Dr Areal); and Hospital Clinic, Barcelona, Spain (Dr Zabalegui)
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Carmody J, Potter J, Lewis K, Bhargava S, Traynor V, Iverson D. Development and pilot testing of a decision aid for drivers with dementia. BMC Med Inform Decis Mak 2014; 14:19. [PMID: 24642051 PMCID: PMC3999924 DOI: 10.1186/1472-6947-14-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/11/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures. METHODS A mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid. RESULTS Twelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use. CONCLUSIONS This decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool.
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Affiliation(s)
- John Carmody
- Department of Neurology, Wollongong Hospital, Wollongong, NSW 2500, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Jan Potter
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
- Department of Aged Care, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Kate Lewis
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Sanjay Bhargava
- Department of Aged Care, Wollongong Hospital, Wollongong, NSW 2500, Australia
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
| | - Don Iverson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, NSW 2522, Australia
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Volk RJ, Llewellyn-Thomas H, Stacey D, Elwyn G. Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S1. [PMID: 24624947 PMCID: PMC4044280 DOI: 10.1186/1472-6947-13-s2-s1] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In 2003, the International Patient Decision Aid Standards (IPDAS) Collaboration was established to enhance the quality and effectiveness of patient decision aids by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation. Over this 10 year period, the Collaboration has established: a) the background document on 12 core dimensions to inform the original modified Delphi process to establish the IPDAS checklist (74 items); b) the valid and reliable IPDAS instrument (47 items); and c) the IPDAS qualifying (6 items), certifying (6 items + 4 items for screening), and quality criteria (28 items). The objective of this paper is to describe the evolution of the IPDAS Collaboration and discuss the standardized process used to update the background documents on the theoretical rationales, evidence and emerging issues underlying the 12 core dimensions for assessing the quality of patient decision aids.
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Feldman-Stewart D, O’Brien MA, Clayman ML, Davison BJ, Jimbo M, Labrecque M, Martin RW, Shepherd H. Providing information about options in patient decision aids. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S4. [PMID: 24625127 PMCID: PMC4042380 DOI: 10.1186/1472-6947-13-s2-s4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Legal, ethical, and psychological arguments indicate that patients need to receive information about their health situations before their care decisions are made. Patient decision aids (PtDAs) are designed to help patients make decisions; therefore, they should provide information that results in patients understanding their health situation. We reviewed studies that assessed the impact of PtDAs on patient knowledge and on their feeling of being uninformed. METHODS Our data sources were a published Cochrane Collaboration review that included randomized controlled trials (RCTs) published before 2010 and a systematic review we conducted of RCTs published in 2010. We included trials that compared 1) PtDAs to usual care, and 2) PtDAs with simple information to PtDAs with more detailed information. Outcomes included patients' knowledge and their feeling of being uninformed. Data were analyzed quantitatively and qualitatively. Meta-analyses of similar studies estimated the size of differences. RESULTS Thirty-nine RCTs compared a PtDA to usual care and all showed higher knowledge scores for patients in the PtDA groups; a meta-analysis estimated the advantage at 14 (of 100) points. Sixteen (of 39) studies used the Feeling Uninformed subscale; a meta-analysis estimated a reduction of 7 (of 100) points in the PtDA group over usual care. Twenty-one studies compared simple- to more-detailed information in PtDAs. There was a small overall advantage for more detailed information on knowledge scores; a meta-analysis estimated the advantage at 5 (of 100) points. Only one study found higher mean knowledge scores for simpler information. Nine (of 21) studies reported using the Feeling Uninformed subscale and a meta-analysis suggested a reduction of 3 (of 100) points for the more-detailed PtDAs over those with simpler information. Only one study found that simpler information resulted in patients feeling more informed. CONCLUSIONS It appears that PtDAs result in patients having higher knowledge scores and in reduced feelings of being uninformed over patients who receive usual care. It also appears that PtDAs with more detailed information generally result in slightly higher knowledge and lower "Feeling Uninformed" scores than those with simpler information, but the differences are small and can be reversed under some circumstances.
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Affiliation(s)
- Deb Feldman-Stewart
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Level 2, 10 Stuart St. Kingston, Ontario K7L 3N6, Canada
| | - Mary Ann O’Brien
- Knowledge Translation Research Network (KT-Net), Health Services Research Program, Cancer Care Ontario and Ontario Institute for Cancer Research and Department of Family and Community Medicine, 500 University Avenue, Fifth Floor, Toronto, Ontario M5G 1V7, Canada
| | - Marla L Clayman
- Division of General Internal Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, Illinois 60611, USA
| | - B Joyce Davison
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Masahito Jimbo
- Department of Family Medicine, University of Michigan, 1500 E Medical Center Drive, Spc 5474, Ann Arbor, MI 48104, USA
| | - Michel Labrecque
- Research Center of the Centre hospitalier universitaire de Québec, Saint-François d'Assise Hospital, 10 rue de l'Espinay, D6-728, Quebec City (QC), G1L 3L5, Canada
| | - Richard W Martin
- College of Human Medicine, Michigan State University, 1155 East Paris Ave SE Suite 100, Grand Rapids, MI 49546, USA
| | - Heather Shepherd
- Sydney School of Public Health, The University of Sydney, Sydney NSW 2006, Australia
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Bekker HL, Winterbottom AE, Butow P, Dillard AJ, Feldman-Stewart D, Fowler FJ, Jibaja-Weiss ML, Shaffer VA, Volk RJ. Do personal stories make patient decision aids more effective? A critical review of theory and evidence. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S9. [PMID: 24625283 PMCID: PMC4044102 DOI: 10.1186/1472-6947-13-s2-s9] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources.
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Montori VM, LeBlanc A, Buchholz A, Stilwell DL, Tsapas A. Basing information on comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence: a quality dimension of the International Patient Decision Aid Standards. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S5. [PMID: 24625191 PMCID: PMC4044946 DOI: 10.1186/1472-6947-13-s2-s5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Patients and clinicians expect patient decision aids to be based on the best available research evidence. Since 2005, this expectation has translated into a quality dimension of the International Patient Decision Aid Standards. Methods We reviewed the 2005 standards and the available literature on the evidence base of decision aids as well as searched for parallel activities in which evidence is brought to bear to inform clinical decisions. In conducting this work, we noted emerging and research issues that require attention and may inform this quality dimension in the future. Results This dimension requires patient decision aids to be based on research evidence about the relevant options and the nature and likelihood of their effect on outcomes that matter to patients. The synthesis of evidence should be comprehensive and up-to-date, and the evidence itself subject to critical appraisal. Ethical (informed patient choice), quality-of-care (patient-centered care), and scientific (evidence-based medicine) arguments justify this requirement. Empirical evidence suggests that over two thirds of available decision aids are based on high-quality evidence syntheses. Emerging issues identified include the duties of developers regarding the conduct of systematic reviews, the impact of comparative effectiveness research, their link with guidelines based on the same evidence, and how to present the developers’ confidence in the estimates to the end-users. Systematic application of the GRADE system, common in contemporary practice guideline development, could enhance satisfaction of this dimension. Conclusions While theoretical and practical issues remained to be addressed, high-quality patient decision aids should adhere to this dimension requiring they be based on comprehensive and up-to-date summaries of critically appraised evidence.
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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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Feldman-Stewart D, Madarnas Y, Mates M, Tong C, Grunfeld E, Verma S, Carolan H, Brundage M. Information needs of post-menopausal women with hormone receptor positive early-stage breast cancer considering adjuvant endocrine therapy. PATIENT EDUCATION AND COUNSELING 2013; 93:114-121. [PMID: 23747087 DOI: 10.1016/j.pec.2013.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 02/01/2013] [Accepted: 03/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To identify questions that post-menopausal women with receptor-positive early-stage breast cancer want answered before their adjuvant-endocrine-therapy decision is made. METHODS We surveyed patients eligible for adjuvant-endocrine therapy in the previous 3-18 months. Participants rated the importance of getting each of 95 questions answered before the decision is made (options: essential/desired/not important or no opinion/avoid). For each question rated "essential"/"desired", the participant also identified the purpose(s) for the answer: to help her understand, decide, plan, or other reason(s). RESULTS The response rate was 55% (188/343). Participants rated a mean of 57 (range: 1-95) questions "essential", 80 (range: 1-95) "essential" or "desired", and 2 (range: 0-27) "avoid". Every question was "essential" to ≥31% of participants, and "essential"/"desired" to ≥63%. All but eleven questions were rated as "avoid" by ≥1 participant. The most frequent purposes for "essential" questions were to: understand their situations (mean 45, range: 0-95), decide (mean 18, range: 0-94), and plan (mean 13, range: 0-95). CONCLUSION Many patients want a lot of information before this decision is made but there is wide variation within the group in both the number and in which questions they want answered. PRACTICE IMPLICATIONS Patient education in this setting needs to be tailored to the needs of the individual patient.
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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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Garcia-Retamero R, Cokely ET. Communicating Health Risks With Visual Aids. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2013. [DOI: 10.1177/0963721413491570] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informed decision making requires that people understand health risks. Unfortunately, many people are not risk literate and are biased by common risk communication practices. In this article, we review a collection of studies investigating the benefits of visual aids for communicating health risks to diverse vulnerable people (e.g., varying in abilities, ages, risk characteristics, and cultural backgrounds). These studies show that appropriately designed visual aids are often highly effective, transparent, and ethically desirable tools for improving decision making, changing attitudes, and reducing risky behavior. Theoretical mechanisms, open questions, and emerging applications are discussed.
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Affiliation(s)
| | - Edward T. Cokely
- Max Planck Institute for Human Development
- Michigan Technological University
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Abstract
The May 2012 Sackler Colloquium on "The Science of Science Communication" brought together scientists with research to communicate and scientists whose research could facilitate that communication. The latter include decision scientists who can identify the scientific results that an audience needs to know, from among all of the scientific results that it would be nice to know; behavioral scientists who can design ways to convey those results and then evaluate the success of those attempts; and social scientists who can create the channels needed for trustworthy communications. This overview offers an introduction to these communication sciences and their roles in science-based communication programs.
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Affiliation(s)
- Baruch Fischhoff
- Department of Engineering and Public Policy, and Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213-3890, USA.
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Foulon BL, Ginis KAM. The effects of physical activity vignettes on physical activity-related social cognitions among people with spinal cord injury. Disabil Rehabil 2013; 35:2073-80. [PMID: 23763469 DOI: 10.3109/09638288.2013.800916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to explore the effectiveness of informational portrait vignettes for enhancing physical activity-related psychosocial cognitions in adults with spinal cord injury (n = 90). METHODS Using the Health Action Process Approach (HAPA), participants were classified as being in the motivational or volitional phase of behavior change. Half of the participants were randomly allocated to read an experimental vignette, which described the physical activity behaviours, thoughts, and feelings of a character demographically similar to the reader. The remainder read a control vignette. Social cognitions were measured one-week before, and immediately after reading the vignette. RESULTS Analyses revealed no significant effects of the vignettes on social cognitions (p > 0.05). CONCLUSIONS Informational portrait vignettes describing a physically active person with SCI and targeting multiple HAPA-based social cognitions are not recommended as a physical activity promotional strategy for people with SCI. The effectiveness of other types of vignettes should be examined. IMPLICATIONS FOR REHABILITATION Until further research is completed to determine whether social comparison strategies play a meditational role in accounting for the impact of a tailored informational portrait vignette to alter leisure time physical activity among those with spinal cord injury, these types of informational intervention should not be utilized in a rehabilitation, or real-world, setting. Although informational portrait vignettes may not be effective in altering leisure time physical activity social cognitions among those with spinal cord injury, different types of vignettes, such as composite vignettes, should be explored.
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Affiliation(s)
- Brianne L Foulon
- Department of Kinesiology, McMaster University , Ontario , Canada
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Dillard AJ, Main JL. Using a health message with a testimonial to motivate colon cancer screening: associations with perceived identification and vividness. HEALTH EDUCATION & BEHAVIOR 2013; 40:673-82. [PMID: 23355445 DOI: 10.1177/1090198112473111] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research suggests that testimonials, or first-person narratives, influence health behavior and health-related decision making, but few studies have examined conceptual factors that may be responsible for these effects. In the current study, older adults who were due for colorectal cancer screening read a message about screening that included a testimonial from a similar other who had previously made the screening decision. We assessed participants' identification with the testimonial character and the degree to which they found the message to be vivid. We explored associations between these factors and participants' knowledge following the message, mood, certainty about screening, and their behavioral intentions to look for more information about screening and to have a test in the next year. In bivariate analyses, identification and vividness were both significantly, positively associated with knowledge and behavioral intentions to have screening in the next year. However, multivariate analyses revealed that only vividness remained significantly associated with knowledge and intentions to be screened.
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Peate M, Friedlander ML. Using decision aids to improve treatment choices for women with breast cancer. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.12.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Breast cancer is the most frequently diagnosed cancer in women worldwide and decision-making regarding treatment options can be complex; however, patients often desire to be involved in health-related decisions. There has been a growing body of research into decision-support tools such as decision aids (DAs). Generally, DAs outperform standard care over a range of decision-making outcomes and there are some that have been developed for use with breast cancer patients across the treatment trajectory, which have been evaluated for use in practice. There is scope for developing additional DAs for cancer patients, however, there are some limitations and barriers that need to be overcome as part of the implementation process. Consideration for the mechanisms for maintaining relevancy of materials and ease of accessibility is also needed.
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Affiliation(s)
- Michelle Peate
- Psycho-oncology Co-operative Research Group (PoCoG), Transient Building (F12), The University of Sydney, Sydney, 2006, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of NSW, Randwick, NSW, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
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Jayadev C, Khan T, Coulter A, Beard DJ, Price AJ. Patient decision aids in knee replacement surgery. Knee 2012; 19:746-50. [PMID: 22386538 DOI: 10.1016/j.knee.2012.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 02/05/2012] [Accepted: 02/07/2012] [Indexed: 02/07/2023]
Abstract
Arthroplasty is an effective intervention for symptomatic knee osteoarthritis refractory to conservative therapy. However, recent data highlights regional variations in service provision unrelated to disease severity and a low, but not insignificant, rate of patient dissatisfaction. The variation in knee arthroplasty provision is in part also due to the clinical decision-making of orthopaedic surgeons. The management of osteoarthritis is an example of a preference-sensitive clinical pathway, and possible explanations for poor patient satisfaction include unrealistic expectations and poor perception of potential benefits and risks. In addition to the individual impact, this represents an inefficient use of resources by healthcare providers during a challenging economic period. Improved shared-decision making between patients and clinicians would potentially address these issues. Patient decision aids provide relevant personalized evidence-based information to facilitate the shared decision-making process. Orthopaedic surgeons are receptive to the use of patient decision aids to support shared decision-making, but there are a number of issues to overcome before they are routinely adopted. The number of decision aids and the literature supporting their effectiveness is growing rapidly. NHS Direct has launched online patient decision support for knee osteoarthritis. The use of patient decision aids in clinical practice is gathering pace and may soon become the ethical and legal standard. This article provides a narrative review of patient decision aids in the context of knee replacement surgery from a UK perspective.
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Affiliation(s)
- Chethan Jayadev
- NIHR Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Science, University of Oxford, United Kingdom
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Ameling JM, Auguste P, Ephraim PL, Lewis-Boyer L, DePasquale N, Greer RC, Crews DC, Powe NR, Rabb H, Boulware LE. Development of a decision aid to inform patients' and families' renal replacement therapy selection decisions. BMC Med Inform Decis Mak 2012. [PMID: 23198793 PMCID: PMC3560257 DOI: 10.1186/1472-6947-12-140] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few educational resources have been developed to inform patients' renal replacement therapy (RRT) selection decisions. Patients progressing toward end stage renal disease (ESRD) must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients' treatment and support patients' decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function. METHODS We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in "stages." For the video, stages included (1) directed interviews with culturally appropriate patients and families and preliminary script development, (2) video production, and (3) screening the video with patients and their families. For the handbook, stages comprised (1) preliminary content design, (2) a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3) screening the handbook with patients and their families. RESULTS The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals' testimonials regarding various considerations that might influence patients' and families' treatment selections. The handbook was comprised of written words, pictures of patients and health care providers, and diagrams describing the findings and quality of scientific studies comparing treatments. The handbook text was written at a 4th to 6th grade reading level. Pilot study results demonstrated that a majority of patients could understand information presented in the handbook. Patient and families screening the nearly completed video and handbook reviewed the materials favorably. CONCLUSIONS This rigorously designed decision aid may help patients and families make informed decisions about their treatment options for RRT that are well aligned with their values.
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Affiliation(s)
- Jessica M Ameling
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Lenz M, Buhse S, Kasper J, Kupfer R, Richter T, Mühlhauser I. Decision aids for patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:401-8. [PMID: 22778792 PMCID: PMC3389744 DOI: 10.3238/arztebl.2012.0401] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/16/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients want to be more involved in medical decision-making. To this end, some decision aids are now available. METHODS We present an overview of this subject, in which we explain the terms "shared decision-making", "decision aid", and "evidence-based patient information" and survey information on the available decision aids in German and other languages on the basis of a literature search in MEDLINE, EMBASE and PsycInfo and a current Cochrane Review. We also searched the Internet for providers of decision aids in Germany. RESULTS Decision aids exist in the form of brochures, decision tables, videos, and computer programs; they address various topics in the prevention, diagnosis, and treatment of disease. They typically contain information on the advantages and disadvantages of the available options, as well as guidance for personal decision-making. They can be used alone or as a part of structured counseling or patient education. Minimal quality standards include an adequate evidence base, completeness, absence of bias, and intelligibility. Our search revealed 12 randomized controlled trials (RCTs) of decision aids in German and 106 RCTs of decision aids in other languages. These trials studied the outcome of the use of decision aids not just with respect to clinical developments, but also with respect to patient knowledge, adherence to treatment regimens, satisfaction, involvement in decision-making, autonomy preference, and decisional conflicts. CONCLUSION Only a small fraction of the available decision aids were systematically developed and have been subjected to systematic evaluation. Patients are still not receiving the help in decision-making to which medical ethics entitles them. Structures need to be put in place for the sustainable development, evaluation and implementation of high-quality decision aids.
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Affiliation(s)
- Matthias Lenz
- Hamburg University, School of Mathematics, Informatics and Natural Sciences, Hamburg, Germany.
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Abstract
Knee-replacement surgery is frequently done and highly successful. It relieves pain and improves knee function in people with advanced arthritis of the joint. The most common indication for the procedure is osteoarthritis. We review the epidemiology of and risk factors for knee replacement. Because replacement is increasingly considered for patients younger than 55 years, improved decision making about whether a patient should undergo the procedure is needed. We discuss assessment of surgery outcomes based on data for revision surgery from national joint-replacement registries and on patient-reported outcome measures. Widespread surveillance of existing implants is urgently needed alongside the carefully monitored introduction of new implant designs. Developments for the future are improved delivery of care and training for surgeons and clinical teams. In an increasingly ageing society, the demand for knee-replacement surgery will probably rise further, and we predict future trends. We also emphasise the need for new strategies to treat early-stage osteoarthritis, which will ultimately reduce the demand for joint-replacement surgery.
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MESH Headings
- Age Factors
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Body Mass Index
- Decision Making
- Humans
- Knee Prosthesis
- Osteoarthritis, Knee/surgery
- Outcome Assessment, Health Care
- Patient Selection
- Quality-Adjusted Life Years
- Registries
- Reoperation/statistics & numerical data
- Sex Factors
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Affiliation(s)
- Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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D'Alimonte L, Angus J, Wong J, Paszat L, Soren B, Szumacher E. Working Toward a Decision: The Development and First Impressions of a Decision Aid for Older Women with Early-stage Breast Cancer. J Med Imaging Radiat Sci 2012; 43:60-65. [PMID: 31052023 DOI: 10.1016/j.jmir.2011.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/17/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of decision aids (DAs) have been advocated in cancer decisions to help patients understand treatment options and to promote patient involvement in the treatment decision. Although the challenges of involving older patients in treatment decision making have been highlighted, decisional support for older early-stage breast cancer patients has not been established yet. This study reports on the development of a DA prototype and the initial assessment of it. OBJECTIVE To conduct a preliminary testing of the DA prototype to ensure that the format and information presented is clear and acceptable to patients. RESEARCH DESIGN Twelve one-on-one interviews were conducted with women over the age of 70 diagnosed with Stage I breast cancer after radiation therapy from an academic cancer centre. RESULTS The overall impression of the DA prototype was favorable with all participants rating the tool as extremely acceptable. All participants felt that this tool would be helpful for older women with early-stage breast cancer making decisions about treatments and would recommend its use in clinical practice. CONCLUSION Similar to previous literature, we found that older breast cancer patients experienced difficulties expressing their concerns and found it challenging to participate in treatment decisions. These findings led to the next steps in the development of a DA for older early-stage breast cancer patients.
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Affiliation(s)
- Laura D'Alimonte
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jan Angus
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Wong
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Larry Paszat
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Soren
- Education Independent Consultant, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Yun YH, Lee MK, Park S, Lee JL, Park J, Choi YS, Lim YK, Kim SY, Jeong HS, Kang JH, Oh HS, Park JC, Kim SY, Song HS, Ro J, Lee KS, Heo DS, Hong YS. Use of a Decision Aid to Help Caregivers Discuss Terminal Disease Status With a Family Member With Cancer: A Randomized Controlled Trial. J Clin Oncol 2011; 29:4811-9. [DOI: 10.1200/jco.2011.35.3870] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We tested whether a decision aid explaining how to discuss the approach of death with a family member with cancer would help family caregivers decide to discuss a terminal prognosis. Patients and Methods We randomly assigned caregivers of terminally ill patients with cancer to a group that received a video and a companion workbook that showed either how they can discuss the prognosis with their patient (experimental arm) or how cancer pain can be controlled (control arm). At baseline and 1 month, we evaluated the decision to discuss terminal prognosis as the primary outcome. At 0, 1, 3, and 6 months, we assessed the caregivers' decisional conflict and satisfaction as secondary outcomes using a Decision Conflict Scale (DCS). Results We found no difference in changes in the decision to discuss terminal prognosis between the two groups. Conflict (P = .003), uncertainty (P = .019), and value clarity (P = .007) subscale scores and total DCS score (P = .008) improved from baseline to 1 month significantly more in the experimental arm than in the control arm. Over 6 months, the significant between-group differences continued for the conflict (P = .031), uncertainty (P = .014), and value clarity (P = .039) subscale scores and total DCS score (P = .040). Conclusion Decision aids can help caregivers, with the aid of trained professionals, to communicate with patients about their terminal illness.
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Affiliation(s)
- Young Ho Yun
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Myung Kyung Lee
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Sohee Park
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Jung Lim Lee
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Jeanno Park
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Youn Seon Choi
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Yeun Keun Lim
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Sam Yong Kim
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Hyun Sik Jeong
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Jung Hun Kang
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Ho-Suk Oh
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Ji Chan Park
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Si-Young Kim
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Hong Suk Song
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Jungsil Ro
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Keun Seok Lee
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Dae Seog Heo
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
| | - Young Seon Hong
- Young Ho Yun, Myung Kyung Lee, Sohee Park, Jungsil Ro, and Keun Seok Lee, National Cancer Center, Goyang; Jung Lim Lee, Fatima Hospital; Hong Suk Song, Keimyung University Dongsan Medical Center, Daegu; Jeanno Park, Bobath Memorial Hospital, Bundang; Youn Seon Choi, Korea University Guro Hospital; Si-Young Kim, Kyunghee University Hospital; Dae Seog Heo, Seoul National University Hospital and College of Medicine; Young Seon Hong, The Catholic University of Korea, Seoul St Mary's Hospital, Seoul; Yeun
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Bakitas M, Kryworuchko J, Matlock DD, Volandes AE. Palliative medicine and decision science: the critical need for a shared agenda to foster informed patient choice in serious illness. J Palliat Med 2011; 14:1109-16. [PMID: 21895453 PMCID: PMC3236099 DOI: 10.1089/jpm.2011.0032] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2011] [Indexed: 12/25/2022] Open
Abstract
Assisting patients and their families in complex decision making is a foundational skill in palliative care; however, palliative care clinicians and scientists have just begun to establish an evidence base for best practice in assisting patients and families in complex decision making. Decision scientists aim to understand and clarify the concepts and techniques of shared decision making (SDM), decision support, and informed patient choice in order to ensure that patient and family perspectives shape their health care experience. Patients with serious illness and their families are faced with myriad complex decisions over the course of illness and as death approaches. If patients lose capacity, then surrogate decision makers are cast into the decision-making role. The fields of palliative care and decision science have grown in parallel. There is much to be gained in advancing the practices of complex decision making in serious illness through increased collaboration. The purpose of this article is to use a case study to highlight the broad range of difficult decisions, issues, and opportunities imposed by a life-limiting illness in order to illustrate how collaboration and a joint research agenda between palliative care and decision science researchers, theorists, and clinicians might guide best practices for patients and their families.
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Affiliation(s)
- Marie Bakitas
- Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, New Hampshire 03756, USA.
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Lins S, Icks A, Meyer G. Understanding, comprehensibility and acceptance of an evidence-based consumer information brochure on fall prevention in old age: a focus group study. BMC Geriatr 2011; 11:26. [PMID: 21599943 PMCID: PMC3118104 DOI: 10.1186/1471-2318-11-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 05/20/2011] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-based patient and consumer information (EBPI) is an indispensable component of the patients' decision making process in health care. Prevention of accidental falls in the elderly has gained a lot of public interest during preceding years. Several consumer information brochures on fall prevention have been published; however, none fulfilled the criteria of an EBPI. Little is known about the reception of EBPI by seniors. Therefore we aimed to evaluate a recently developed EBPI brochure on fall prevention with regard to seniors' acceptance and comprehensibility in focus groups and to explore whether the participants' judgements differed depending on the educational background of the study participants. Methods Seven focus groups were conducted with 40 seniors, aged 60 years or older living independently in a community. Participants were recruited by two gatekeepers. A discussion guide was used and seniors were asked to judge the EBPI brochure on fall prevention using a Likert scale 1-6. The focus group discussions were tape recorded, transcribed verbatim, and analysed using content analysis. Results The participants generally accepted the EBPI brochure on fall prevention. Several participants expressed a need for more practical advice. The comprehensibility of the brochure was influenced positively by brief chapter summaries. Participants dismissed the statistical illustrations such as confidence intervals or a Fagan nomogram and only half of them agreed with the meta-information presented in the first chapter. The detailed information about fall prevalence was criticised by some seniors. The use of a case story was well tolerated by the majority of participants. Conclusion Our findings indicate that the recently developed EBPI brochure on fall prevention in old age was generally well accepted by seniors, but some statistical descriptions were difficult for them to understand. The brochure has to be updated. However, not all issues raised by the participants will be taken into account since some of them are contrary to the principles of EBPI.
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Affiliation(s)
- Sabine Lins
- University of Witten/Herdecke, Stockumer Straße 12, Witten, Germany
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Elwyn G, Kreuwel I, Durand MA, Sivell S, Joseph-Williams N, Evans R, Edwards A. How to develop web-based decision support interventions for patients: a process map. PATIENT EDUCATION AND COUNSELING 2011; 82:260-265. [PMID: 20627644 DOI: 10.1016/j.pec.2010.04.034] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 04/18/2010] [Accepted: 04/28/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Significant advances have been made in the development of decision support interventions, also called decision aids, for patients facing difficult or uncertain decisions. However, challenges related to the definition, the theoretical underpinnings, the relative contribution of different components and how to migrate these tools to the Internet, remain unresolved. We propose a systematic process map for others to consider as they develop web-based, perhaps multimedia, decision support interventions and to examine the future challenges faced by developers. METHODS Based on our experiences of developing and evaluating web-based decision support interventions, we outline a process map to illustrate the general principles of content specification followed by creative design and tailoring to the target audience. RESULTS Content specification is fundamental and it should go beyond the traditional emphasis on scientific evidence in order to ensure patients' perspectives on the proposed options. The creative design phase aims to develop a medium to achieve three fundamental tasks: present information; achieve accurate affective forecasting; provide a basis for preference construction. This phase should be an open to experimentation and, where empirical work may be difficult or not yet available, guided by consultation with users, using an iterative method of trial and adaptation. CONCLUSION There is little empirical research on how best to achieve these tasks. The guiding principle needs to be one of customising the delivery, based on close consultation with the target users and an iterative development process until the intervention is deemed accessible and useful. PRACTICE IMPLICATIONS The process map provides a basis for further developments and outlines areas where remaining challenges need further investigation.
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Affiliation(s)
- Glyn Elwyn
- Decision Laboratory, Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
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Feldman-Stewart D, Capirci C, Brennenstuhl S, Tong C, Abacioglu U, Gawkowska-Suwinska M, van Gils F, Heyda A, Igdem S, Macias V, Grillo IM, Moynihan C, Pijls-Johannesma M, Parker C, Pimentel N, Wördehoff H. Information for Decision Making by Patients With Early-Stage Prostate Cancer. Med Decis Making 2011; 31:754-66. [DOI: 10.1177/0272989x10395029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe decisional roles of patients with early-stage prostate cancer in 9 countries and to compare the information they rated important for decision making (DM). Method: A survey of recently treated patients was conducted in Canada, Italy, England, Germany, Poland, Portugal, Netherlands, Spain, and Turkey. Participants indicated their decisional role in their actual decision and the role they would prefer now. Each participant also rated (essential/desired/no opinion/avoid) the importance of obtaining answers, between diagnosis and treatment decision, to each of 92 questions. For each essential/desired question, participants specified all purposes for that information (to help them: understand/decide/plan/not sure/other). Results: A total of 659 patients participated with country-specific response rates between 58%-77%. Between 83%-96% of each country’s participants recalled actually taking an active decisional role and, in most countries, that increased slightly if they were to make the decision today; there were no significant differences among countries. There was a small reliable difference in the mean number of questions rated essential for DM across countries. More striking, however, was the wide variability within each country: no question was rated essential for DM by even 50% of its participants but almost every question was rated essential by some. Conclusions: Almost all participants from each country want to participate in their treatment decisions. Although there are country-specific differences in the amount of information required, wide variation within each country suggests that information that patients feel is essential or desired for DM should be addressed on an individual basis in all countries.
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Affiliation(s)
- Deb Feldman-Stewart
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Carlo Capirci
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Sarah Brennenstuhl
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Christine Tong
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Ufuk Abacioglu
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Marzena Gawkowska-Suwinska
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Francis van Gils
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Alicja Heyda
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Sefik Igdem
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Victor Macias
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Isabel Monteiro Grillo
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Clare Moynihan
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Madelon Pijls-Johannesma
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Chris Parker
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Nuno Pimentel
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
| | - Herbert Wördehoff
- Queen’s University, Kingston, Canada (DFS, SB, CT)
- Azienda ULSS 18, Rovigo, Italy (CC)
- Marmara University Hospital, Istanbul, Turkey (UA)
- Maria Skłodowska-Curie, Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland (MGS, AH)
- Department of Radiation Oncology (MAASTRO Clinic), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands (FvG, MPJ)
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48
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Caldon LJM, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G. Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. Health Expect 2010; 14:133-46. [PMID: 21029281 DOI: 10.1111/j.1369-7625.2010.00633.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. OBJECTIVE To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. METHODS As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. RESULTS A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. CONCLUSIONS The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice.
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Affiliation(s)
- Lisa J M Caldon
- Department of Oncology, University of Sheffield, Sheffield, UK.
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49
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Frisher M, Short D, Bashford J. Determining patient characteristics for decision analysis support systems using anonymized electronic patient records. Health Informatics J 2010; 16:49-57. [PMID: 20413412 DOI: 10.1177/1460458209353559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While decision analysis has the potential to improve treatment decisions, the quality of patient specific data has hindered its development. Experience with the General Practice Research Database (GPRD) indicated the possibility of generating such data. The example developed concerns the probability of recurrent stroke and the risks and benefits of treatment with aspirin. Eight criteria were systematically applied to identify suitable patients from the 664,241 cohort of patients in the West Midlands GPRD. The risk of recurrent stroke was estimated using survival analysis, yielding multivariate hazard ratios for 960 patient profiles. These were used to populate a decision analysis model. The study highlights how decision analysis can introduce evidence-based information into the consultation. Data can be transformed into information for the increasingly complex world of general practice. This can clarify the risks and benefits of prescribing, assist GP-patient dialogue and promote shared decision-making.
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Affiliation(s)
- Martin Frisher
- School of Pharmacy, Keele University, Staffordshire ST5 5BG, UK.
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50
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Bekker HL. The loss of reason in patient decision aid research: do checklists damage the quality of informed choice interventions? PATIENT EDUCATION AND COUNSELING 2010; 78:357-364. [PMID: 20171821 DOI: 10.1016/j.pec.2010.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 01/14/2010] [Accepted: 01/17/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To discuss whether using the International Patient Decision Aids Standards (IPDAS) Collaboration checklist as a gold standard to judge interventions' quality is premature and potentially detrimental to the validity of resources designed to help patients make treatment choices. METHODS Conceptual review integrating the science behind individuals' decision making with the demands of designing complex, healthcare interventions. RESULTS Patient decision aids are promoted as interventions to help professionals engage in shared and/or patient-centred care. The IPDAS domains were informed by experts' opinions of best practice. Decision scientists study how individuals make decisions, what biases their choices and how best to support decisions. There is debate from decision scientists about which component parts are the active ingredients that help people make decisions. CONCLUSIONS Interventions to help patients make choices have different purposes, component parts and outcomes to those facilitating professional-patient communications. The IPDAS checklist will change to respond to new evidence from the decision sciences. PRACTICE IMPLICATIONS Adhering uncritically to the IPDAS checklist may reduce service variation but is not sufficient to ensure interventions enable good patient decision making. Developers must be encouraged to reason about the IPDAS checklist to identify those component parts that do (not) meet their intervention's purpose.
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Affiliation(s)
- Hilary L Bekker
- Research About Patients Informed Decisions (R.A.P.I.D.) Group, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
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