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Naye F, Toupin-April K, de Wit M, LeBlanc A, Dubois O, Boonen A, Barton JL, Fraenkel L, Li LC, Stacey D, March L, Barber CEH, Hazlewood GS, Guillemin F, Bartlett SJ, Berthelsen DB, Mather K, Arnaud L, Akpabio A, Adebajo A, Schultz G, Sloan VS, Gill TK, Sharma S, Scholte-Voshaar M, Caso F, Nikiphorou E, Nasef SI, Campbell W, Meara A, Christensen R, Suarez-Almazor ME, Jull JE, Alten R, Morgan EM, El-Miedany Y, Singh JA, Burt J, Jayatilleke A, Hmamouchi I, Blanco FJ, Fernandez AP, Mackie S, Jones A, Strand V, Monti S, Stones SR, Lee RR, Nielsen SM, Evans V, Srinivasalu H, Gérard T, Demers JL, Bouchard R, Stefan T, Dugas M, Bergeron F, Beaton D, Maxwell LJ, Tugwell P, Décary S. OMERACT Core outcome measurement set for shared decision making in rheumatic and musculoskeletal conditions: a scoping review to identify candidate instruments. Semin Arthritis Rheum 2024; 65:152344. [PMID: 38232625 DOI: 10.1016/j.semarthrit.2023.152344] [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: 09/15/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES Shared decision making (SDM) is a central tenet in rheumatic and musculoskeletal care. The lack of standardization regarding SDM instruments and outcomes in clinical trials threatens the comparative effectiveness of interventions. The Outcome Measures in Rheumatology (OMERACT) SDM Working Group is developing a Core Outcome Set for trials of SDM interventions in rheumatology and musculoskeletal health. The working group reached consensus on a Core Outcome Domain Set in 2020. The next step is to develop a Core Outcome Measurement Set through the OMERACT Filter 2.2. METHODS We conducted a scoping review (PRISMA-ScR) to identify candidate instruments for the OMERACT Filter 2.2 We systematically reviewed five databases (Ovid MEDLINE®, Embase, Cochrane Library, CINAHL and Web of Science). An information specialist designed search strategies to identify all measurement instruments used in SDM studies in adults or children living with rheumatic or musculoskeletal diseases or their important others. Paired reviewers independently screened titles, abstracts, and full text articles. We extracted characteristics of all candidate instruments (e.g., measured construct, measurement properties). We classified candidate instruments and summarized evidence gaps with an adapted version of the Summary of Measurement Properties (SOMP) table. RESULTS We found 14,464 citations, read 239 full text articles, and included 99 eligible studies. We identified 220 potential candidate instruments. The five most used measurement instruments were the Decisional Conflict Scale (traditional and low literacy versions) (n=38), the Hip/Knee-Decision Quality Instrument (n=20), the Decision Regret Scale (n=9), the Preparation for Decision Making Scale (n=8), and the CollaboRATE (n=8). Only 44 candidate instruments (20%) had any measurement properties reported by the included studies. Of these instruments, only 57% matched with at least one of the 7-criteria adapted SOMP table. CONCLUSION We identified 220 candidate instruments used in the SDM literature amongst people with rheumatic and musculoskeletal diseases. Our classification of instruments showed evidence gaps and inconsistent reporting of measurement properties. The next steps for the OMERACT SDM Working Group are to match candidate instruments with Core Domains, assess feasibility and review validation studies of measurement instruments in rheumatic diseases or other conditions. Development and validation of new instruments may be required for some Core Domains.
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Affiliation(s)
- Florian Naye
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada; VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Olivia Dubois
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Caphri Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jennifer L Barton
- VA Portland Health Care System, Oregon Health & Science University, Portland, USA
| | - Liana Fraenkel
- Department of Internal Medicine, Yale University, New Haven, USA
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lyn March
- Department of Medicine, The University of Sydney, Sydney, Australia; Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Claire E H Barber
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University, Canada; Research Institute - McGill University Health Centre, Canada; Johns Hopkins Medicine Division of Rheumatology, Montreal, Canada
| | - Dorthe B Berthelsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, Odense & Department of Rehabilitation, Municipality of Guldborgsund, Odense University Hospital, University of Southern Denmark, Nykoebing, Denmark
| | | | - Laurent Arnaud
- Department of Rheumatology, CRMR RESO, University Hospitals of Strasbourg, France
| | | | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | | | - Victor S Sloan
- Sheng Consulting LLC, Flemington, NJ, USA; The Peace Corps, Washington, DC, USA
| | - Tiffany K Gill
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Marieke Scholte-Voshaar
- Patient Research Partner, Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Pharmacy, Radboud university medical center, Nijmegen
| | - Francesco Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, School of Immunology and Microbial Sciences, King's College London, UK; Rheumatology Department, King's College Hospital, London, UK
| | - Samah Ismail Nasef
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Willemina Campbell
- Patient research partner, Toronto Western Hospital, University Health Network, Canada
| | - Alexa Meara
- Division of Rheumatology, The Ohio State University, Columbus, USA
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, & Department of Rheumatology, Odense University Hospital, Denmark
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Rieke Alten
- Department of Internal Medicine II, Rheumatology Research Center, Rheumatology, Clinical Immunology, Osteology, Physical Therapy and Sports Medicine, Schlosspark-Klinik, Charité, University Medicine Berlin, Berlin, Germany
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Division of Rheumatology, Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | - Jennifer Burt
- Newfoundland and Labrador Health Services, St. Clare's Mercy Hospital, St John's, Newfoundland and Labrador, Canada
| | | | - Ihsane Hmamouchi
- Health Sciences Research Centre (CReSS), Faculty of Medicine, International University of Rabat (UIR), Rabat, Morocco
| | - Francisco J Blanco
- Departamento de Fisioterapia, Medicina y Ciencias Médicas, Universidad de A Coruña, A Coruña, Spain
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Stanford, California, USA
| | - Sara Monti
- Department of Rheumatology, Policlinico S. Matteo, IRCCS Fondazione, University of Pavia, Pavia, Italy
| | - Simon R Stones
- Patient research partner, Envision Pharma Group, Wilmslow, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Odense University Hospital, and University of Southern Denmark, Copenhagen, Demark, Copenhagen, Denmark
| | - Vicki Evans
- Patient Research Partner and Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, Australia
| | - Hemalatha Srinivasalu
- Pediatric Rheumatology, Children's National Hospital, Washington DC, USA; GW School of Medicine, Washington DC, USA
| | - Thomas Gérard
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | | | - Roxanne Bouchard
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Théo Stefan
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | - Michèle Dugas
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
| | | | | | - Lara J Maxwell
- Centre for Practice Changing Research, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Simon Décary
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada.
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Liu P, Geng X. Evaluation model of green supplier selection for coal enterprises with similarity measures of double-valued neutrosophic sets based on cosine function. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2023. [DOI: 10.3233/jifs-224123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Coal is a vital basic energy source for any economy in the world, and our country is no exception. Our coal resources are abundant, with high production and demand, not comparable to oil and natural gas. The coal supply chain plays an equally important role in economic production, but unfortunately, the current coal supply chain is not focused on greening while creating profits. Unfortunately, the current coal supply chain does not focus on green production and energy conservation and emission reduction while creating profits, which has caused irreversible harm and loss to resources and environment. This has caused irreversible damage and loss to resources and the environment. The green supplier selection for coal enterprises is affirmed as multiple attribute decision making (MADM). In such paper, motivated by the idea of cosine similarity measure (CSM), the CSMs are extended to DVNSs and four CSMs are created under DVNSs. Then, two weighted CSMs are built for MADM under DVNSs. Finally, a numerical example for Green supplier selection for coal enterprises is affirmed and some comparative algorithms are produced to affirm the built method.
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Affiliation(s)
- Peng Liu
- North China University of Science and Technology, Tangshan, Hebei, China
- University of Perpetual Help System Dalta, Alabang-Zapote Road, Pamplona 3, Las Piñas City, Las Piñas Campus, Republic of the Philippines
| | - Xiaonan Geng
- North China University of Science and Technology, Tangshan, Hebei, China
- University of Perpetual Help System Dalta, Alabang-Zapote Road, Pamplona 3, Las Piñas City, Las Piñas Campus, Republic of the Philippines
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Carpenter CR, Leggett J, Bellolio F, Betz M, Carnahan RM, Carr D, Doering M, Hansen JC, Isaacs ED, Jobe D, Kelly K, Morrow-Howell N, Prusaczyk B, Savage B, Suyama J, Vann AS, Rising KL, Hwang U, Shah MN. Emergency Department Communication in Persons Living With Dementia and Care Partners: A Scoping Review. J Am Med Dir Assoc 2022; 23:1313.e15-1313.e46. [PMID: 35940681 PMCID: PMC10802113 DOI: 10.1016/j.jamda.2022.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research. DESIGN Systematic scoping review. SETTINGS AND PARTICIPANTS PLWD and their care partners in the ED setting. METHODS Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for PLWD compared with persons without dementia? Are there specific communication strategies that improve the outcomes of ED care? Future research areas were prioritized. RESULTS From 5451 studies identified for PICO-1, 21 were abstracted. From 2687 studies identified for PICO-2, 3 were abstracted. None of the included studies directly evaluated communication differences between PLWD and other populations, nor the effectiveness of specific communication strategies. General themes emerging from the scoping review included perceptions by PLWD/care partners of rushed ED communication, often exacerbated by inconsistent messages between providers. Care partners consistently reported limited engagement in medical decision-making. In order, the research priorities identified included: (1) Barriers/facilitators of effective communication; (2) valid outcome measures of effective communication; (3) best practices for care partner engagement; (4) defining how individual-, provider-, and system-level factors influence communication; and (5) understanding how each member of ED team can ensure high-quality communication. CONCLUSIONS AND IMPLICATIONS Research exploring ED communication with PLWD is sparse and does not directly evaluate specific communication strategies. Defining barriers and facilitators of effective communication was the highest-ranked research priority, followed by validating outcome measures associated with improved information exchange.
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Affiliation(s)
- Christopher R Carpenter
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA.
| | - Jesseca Leggett
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MO, USA
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - David Carr
- Department of Medicine and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michelle Doering
- Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Eric D Isaacs
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah Jobe
- Person Living with Dementia, 2021-2022 Alzheimer's Association National Early Stage Advisory Group, St. Louis MO, USA
| | | | - Nancy Morrow-Howell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Beth Prusaczyk
- Department of Medicine, Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Bob Savage
- Person Living with Dementia, LiveWell Alliance, Plantsville, CT, USA
| | - Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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4
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Xu K, Nolan S, Mihic T, Ti L. Improving Opioid Stewardship Programs Through Shared Decision Making. J Am Pharm Assoc (2003) 2022; 62:697-700. [DOI: 10.1016/j.japh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
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5
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Chan SJ, Stamp LK, Liebergreen N, Ndukwe H, Marra C, Treharne GJ. Tapering Biologic Therapy for Rheumatoid Arthritis: A Qualitative Study of Patient Perspectives. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:225-234. [PMID: 31802391 DOI: 10.1007/s40271-019-00403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Biologic therapies are cost effective for active rheumatoid arthritis but have adverse effects and are costly. Tapering of biologics is emerging as an important consideration when sustained remission is achieved. Recent trials have highlighted the clinical feasibility of tapering, but there is little evidence on how proposed tapering would be received by patients. The aim of this study was to explore factors influencing hypothetical decisions of patients with rheumatoid arthritis on tapering their biologics and their perspectives on remission and flare when considering the possibility of tapering. METHODS Patients with rheumatoid arthritis with diverse experiences of biologics with different modes of administration were purposively sampled to participate in one of six focus groups (n = 43) or an individual interview (n = 2). Transcripts were analyzed using inductive thematic analysis. RESULTS Five overarching themes on what influences a participant's decision to taper their biologic were identified. First, participants were fearful of uncertain outcomes of tapering, especially flare and joint damage. Second, participants prioritized quality of life from continuing biologics over the risk of adverse effects. Third, tapering biologics was seen as providing relief from the inconvenience of taking biologics regularly. Fourth, participants wanted assurance of prompt access to healthcare if their rheumatoid arthritis were to flare when tapering. Fifth, preferences for involvement in decision making varied, but fulfilling information needs was desired to aid a patient's preferred role in decision making on tapering. CONCLUSIONS This study provides novel insight into the perspectives of patients with rheumatoid arthritis on tapering biologics when sustained remission is achieved at a crucial juncture in global affordability for healthcare systems. These patient perspectives can inform the planning of decision aids and clinical trials of decision-making processes when tapering is proposed.
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Affiliation(s)
- Suz Jack Chan
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Liebergreen
- School of Pharmacy, University of Otago, Dunedin, New Zealand.,Faculty of Law, University of Otago, Dunedin, New Zealand
| | - Henry Ndukwe
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Carlo Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Grant EV, Summapund J, Matlock DD, Vaughan Dickson V, Iqbal S, Patel S, Katz SD, Chaudhry SI, Dodson JA. Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction. Med Decis Making 2021; 40:279-288. [PMID: 32428431 DOI: 10.1177/0272989x20912293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients' and cardiologists' perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients' and cardiologists' perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients' age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as "the only choice," whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.
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Affiliation(s)
- Eleonore V Grant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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7
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Platts-Mills TF, McLean SA, Weinberger M, Stearns SC, Bush M, Teresi BB, Hurka-Richardson K, Kroenke K, Kerns RD, Weaver MA, Keefe FJ. Brief educational video plus telecare to enhance recovery for older emergency department patients with acute musculoskeletal pain: study protocol for the BETTER randomized controlled trial. Trials 2020; 21:615. [PMID: 32631400 PMCID: PMC7336469 DOI: 10.1186/s13063-020-04552-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (MSP) affects more than 40% of adults aged 50 years and older and is the leading cause of disability in the USA. Older adults with chronic MSP are at risk for analgesic-related side effects, long-term opioid use, and functional decline. Recognizing the burden of chronic MSP, reducing the transition from acute to chronic pain is a public health priority. In this paper, we report the protocol for the Brief EducaTional Tool to Enhance Recovery (BETTER) trial. This trial compares two versions of an intervention to usual care for preventing the transition from acute to chronic MSP among older adults in the emergency department (ED). METHODS Three hundred sixty patients from the ED will be randomized to one of three arms: full intervention (an interactive educational video about pain medications and recovery-promoting behaviors, a telecare phone call from a nurse 48 to 72 h after discharge from the ED, and an electronic communication containing clinical information to the patient's primary care provider); video-only intervention (the interactive educational video but no telecare or primary care provider communication); or usual care. Data collection will occur at baseline and at 1 week and 1, 3, 6, and 12 months after study enrollment. The primary outcome is a composite measure of pain severity and interference. Secondary outcomes include physical function, overall health, opioid use, healthcare utilization, and an assessment of the economic value of the intervention. DISCUSSION This trial is the first patient-facing ED-based intervention aimed at helping older adults to better manage their MSP and reduce their risk of developing chronic pain. If effective, future studies will examine the effectiveness of implementation strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT04118595 . Registered on 8 October 2019.
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Affiliation(s)
- Timothy F. Platts-Mills
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Samuel A. McLean
- Department of Anesthesiology, University of North Carolina Hospitals, Chapel Hill, NC USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Brittni B. Teresi
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Karen Hurka-Richardson
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Houpt Bldg, 170 Manning Dr, Chapel Hill, NC 27599 USA
| | - Kurt Kroenke
- Regenstrief Institute and Department of Medicine, Indiana University, Indianapolis, IN USA
| | | | - Mark A. Weaver
- Department of Mathematics and Statistics, Elon University, Elon, NC USA
| | - Francis J. Keefe
- Department of Psychology and Neuroscience, Duke University, Durham, NC USA
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Allen KAM, Dittmann KR, Hutter JA, Chuang C, Donald ML, Enns AL, Hovanec N, Hunt AW, Kellowan RS, Linkewich EA, Patel AS, Rehmtulla A, McEwen SE. Implementing a shared decision-making and cognitive strategy-based intervention: Knowledge user perspectives and recommendations. J Eval Clin Pract 2020; 26:575-581. [PMID: 31828869 DOI: 10.1111/jep.13329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to employ knowledge user perspectives to develop recommendations that facilitate implementation of a complex, shared decision-making (SDM)-based intervention in an interprofessional setting. This study was part of a larger knowledge translation (KT) study in which interprofessional teams from five freestanding, academically affiliated, rehabilitation hospitals were tasked with implementing a cognitive strategy-based intervention approach that incorporates SDM known as Cognitive Orientation to daily Occupational Performance (CO-OP) to treat survivors of stroke. At the end of the 4-month CO-OP KT implementation support period, 10 clinicians, two from each site, volunteered as CO-OP site champions. A semi-structured focus group was conducted with 10 site champions 3 months following the implementation support period. To meet the study objective, an exploratory qualitative research design was used. The focus group session was audio-recorded, transcribed verbatim and analyzed through the lens of the integrated promoting action on research implementation in health services (iPARIHS) framework. The focus group participants (n = 8) consisted of occupational therapists, physical therapists, and speech language pathologists. Ten recommendations for CO-OP implementation were extracted and co-constructed from the focus group transcript. The recommendations reflected all four iPARHIS constructs: Facilitation, Context, Innovation, and Recipients. Implementation recommendations, from the knowledge user perspective, highlight that context-specific facilitation is key to integrating a novel, complex intervention into interprofessional practice. Facilitators should lay out a framework for training, communication and implementation that is structured but still provides flexibility for iterative learning and active problem-solving within the relevant practice context.
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Affiliation(s)
- Kay-Ann M Allen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Katherine R Dittmann
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer A Hutter
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Kinesiology, McMaster University, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Michelle L Donald
- Health System Planning & Engagement, Central Local Health Integration Network, Toronto, ON, Canada
| | - Amie L Enns
- Neurological Rehabilitation Services, West Park Healthcare Centre, Toronto, ON, Canada
| | - Nina Hovanec
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anne W Hunt
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Richard S Kellowan
- Bridgepoint Active Healthcare, Sinai Health System, Toronto, ON, Canada.,Stroke & Neuro Rehab, Providence Healthcare, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Elizabeth A Linkewich
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Alexandra S Patel
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Sara E McEwen
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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9
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Muscat DM, Shepherd HL, Hay L, Shivarev A, Patel B, McKinn S, Bonner C, McCaffery K, Jansen J. Discussions about evidence and preferences in real-life general practice consultations with older patients. PATIENT EDUCATION AND COUNSELING 2019; 102:879-887. [PMID: 30578105 DOI: 10.1016/j.pec.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. METHODS Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION5 scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. RESULTS Overall, Observer OPTION5 and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. CONCLUSION We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. PRACTICE IMPLICATIONS Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.
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Affiliation(s)
- Danielle Marie Muscat
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Louise Hay
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Alex Shivarev
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Bindu Patel
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Australia; The George Institute for Global Health, University of New South Wales, Australia
| | - Shannon McKinn
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Carissa Bonner
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Kirsten McCaffery
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Jesse Jansen
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia.
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10
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Preference for opioids in emergency department patients with acute musculoskeletal pain. Am J Emerg Med 2019; 37:730-732. [PMID: 30612779 DOI: 10.1016/j.ajem.2018.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/28/2018] [Accepted: 12/28/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Public awareness of the opioid epidemic is increasing nationally, emphasizing the need to develop methods to reduce opioid use. We determined patient preference for analgesics before and after a brief educational intervention informing them of the risks and benefits of opioids versus non-steroidal anti-inflammatory drugs (NSAID's). We hypothesized 50% of patients would prefer opioids pre-intervention and that this would be reduced by the intervention by at least 15%. METHODS Study Design-Before and after study. Setting-Suburban ED with annual census of 110,000. Patients-English-speaking adult ED patients with acute musculoskeletal pain. Interventions-An anonymous survey was administered by an investigator not involved in the patient's clinical care prior to physician evaluation, before and after a video describing the risks and benefits of opioids versus NSAID's. Patients were asked if they desired analgesics. Data Analysis-Descriptive statistics were used to summarize the data. Univariate analysis and logistic regression were used to predict patient demographics and pain characteristics associated with desire for analgesics. RESULTS Of all 94 patients, 48 (51% [95% CI 41-62%]) desired an analgesic pre-intervention. Of these 48 patients, 10 (11% [5-19%]) specifically preferred an opioid. Of the 10 patients who preferred an opioid pre-intervention, one had no preference for analgesic post-intervention. CONCLUSIONS Many adult ED patients with acute musculoskeletal pain do not desire any analgesics and few specifically prefer opioids. This knowledge can prove helpful to ED physicians across the country in discussing pain management options with patients as we attempt to combat the opioid epidemic.
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11
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Veilleux S, Noiseux I, Lachapelle N, Kohen R, Vachon L, Guay BW, Bitton A, Rioux JD. Patients' perception of their involvement in shared treatment decision making: Key factors in the treatment of inflammatory bowel disease. PATIENT EDUCATION AND COUNSELING 2018; 101:331-339. [PMID: 28760459 DOI: 10.1016/j.pec.2017.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study aims to characterize the relationships between the quality of the information given by the physician, the involvement of the patient in shared decision making (SDM), and outcomes in terms of satisfaction and anxiety pertaining to the treatment of inflammatory bowel disease (IBD). METHODS A Web survey was conducted among 200 Canadian patients affected with IBD. The theoretical model of SDM was adjusted using path analysis. SAS software was used for all statistical analyses. RESULTS The quality of the knowledge transfer between the physician and the patient is significantly associated with the components of SDM: information comprehension, patient involvement and decision certainty about the chosen treatment. In return, patient involvement in SDM is significantly associated with higher satisfaction and, as a result, lower anxiety as regards treatment selection. CONCLUSIONS This study demonstrates the importance of involving patients in shared treatment decision making in the context of IBD. PRACTICE IMPLICATIONS Understanding shared decision making may motivate patients to be more active in understanding the relevant information for treatment selection, as it is related to their level of satisfaction, anxiety and adherence to treatment. This relationship should encourage physicians to promote shared decision making.
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Affiliation(s)
| | | | | | - Rita Kohen
- Division of Gastroenterology, McGill University Health Centre, Montreal, Canada
| | | | | | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, Canada
| | - John D Rioux
- Department of Medicine, Université de Montréal & Montreal Heart Institute, Montreal, Canada
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12
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Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J 2018; 12:1-14. [PMID: 29456779 PMCID: PMC5806202 DOI: 10.2174/1874434601812010001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/16/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. OBJECTIVE To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. METHODS An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. RESULTS Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. CONCLUSION A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.
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Affiliation(s)
- Marie Truglio-Londrigan
- Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA
| | - Jason T. Slyer
- Clinical Assistant Professor, Pace University, College of Health Professions, Lienhard School of Nursing 163 William Street, 5 Floor New York, NY 10036, USA
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13
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Platts-Mills TF, Hollowell AG, Burke GF, Zimmerman S, Dayaa JA, Quigley BR, Bush M, Weinberger M, Weaver MA. Randomized controlled pilot study of an educational video plus telecare for the early outpatient management of musculoskeletal pain among older emergency department patients. Trials 2018; 19:10. [PMID: 29304831 PMCID: PMC5756407 DOI: 10.1186/s13063-017-2403-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023] Open
Abstract
Background Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older patients, often have difficulty controlling their pain and managing analgesic side effects. We conducted a pilot study of an educational video about pain management with and without follow-up telephone support for older adults presenting to the ED with musculoskeletal pain. Methods ED patients aged 50 years and older with musculoskeletal pain were randomized to: (1) usual care, (2) a brief educational video only, or (3) a brief educational video plus a protocol-guided follow-up telephone call from a physician 48–72 hours after discharge (telecare). The primary outcome was the change from the average pain severity before the ED visit to the average pain severity during the past week assessed one month after the ED visit. Pain was assessed using a 0–10 numerical rating scale. Results Of 75 patients randomized (mean age 64 years), 57 (76%) completed follow up at one month. Of the 18 patients lost to follow up, 12 (67%) had non-working phone numbers. Among patients randomized to the video (arms 2 and 3), 46/50 viewed the entire video; among the 25 patients randomized to the video plus telecare (arm 3), 23 were reached for telecare. Baseline pain scores for the usual care, video, and video plus telecare groups were 7.3, 7.1, and 7.5. At one month, pain scores were 5.8, 4.9, and 4.5, corresponding to average decreases in pain of -1.5, -2.2, and -3.0, respectively. In the pairwise comparison between intervention groups, the video plus telecare group had a 1.7-point (95% CI 1.2, 2.1) greater decrease in pain compared to usual care, and the video group had a 1.1-point (95% CI 0.6, 1.6) greater decrease in pain compared to usual care after adjustment for baseline pain, age, and gender. At one month, clinically important differences were also observed between the video plus telecare and usual care groups for analgesic side effects, ongoing opioid use, and physical function. Conclusion Results of this pilot trial suggest the potential value of an educational video plus telecare to improve outcomes for older adults presenting to the ED with musculoskeletal pain. Changes to the protocol are identified to increase retention for assessment of outcomes. Trials registration ClinicalTrials.gov, NCT02438384. Registered on 5 May 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2403-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine and Division of Geriatrics, Department of Medicine, University of North Carolina Chapel Hill, 101 Manning Drive, CB #7010, Chapel Hill, NC, 27599-7010, USA.
| | - Allison G Hollowell
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary F Burke
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheryl Zimmerman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph A Dayaa
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin R Quigley
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Montika Bush
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Morris Weinberger
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Weaver
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Newton EH. Addressing overuse in emergency medicine: evidence of a role for greater patient engagement. Clin Exp Emerg Med 2017; 4:189-200. [PMID: 29306268 PMCID: PMC5758625 DOI: 10.15441/ceem.17.233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/05/2017] [Accepted: 06/30/2017] [Indexed: 01/01/2023] Open
Abstract
Overuse of health care refers to tests, treatments, and even health care settings when used in circumstances where they are unlikely to help. Overuse is not only wasteful, it threatens patient safety by exposing patients to a greater chance of harm than benefit. It is a widespread problem and has proved resistant to change. Overuse of diagnostic testing is a particular problem in emergency medicine. Emergency physicians cite fear of missing a diagnosis, fear of law suits, and perceived patient expectations as key contributors. However, physicians' assumptions about what patients expect are often wrong, and overlook two of patients' most consistently voiced priorities: communication and empathy. Evidence indicates that patients who are more fully informed and engaged in their care often opt for less aggressive approaches. Shared decision making refers to (1) providing balanced information so that patients understand their options and the trade-offs involved, (2) encouraging them to voice their preferences and values, and (3) engaging them-to the extent appropriate or desired-in decision making. By adopting this approach to discretionary decision making, physicians are better positioned to address patients' concerns without the use of tests and treatments patients neither need nor value.
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Affiliation(s)
- Erika H. Newton
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA
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15
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Pain evaluation in the ED: A review. Nurse Pract 2017; 42:7-9. [PMID: 28832418 DOI: 10.1097/01.npr.0000515931.76929.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Crispin V, Bugge C, Stoddart K. Sufficiency and relevance of information for inpatients in general ward settings: A qualitative exploration of information exchange between patients and nurses. Int J Nurs Stud 2017; 75:112-122. [PMID: 28783488 DOI: 10.1016/j.ijnurstu.2017.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 05/24/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Information exchange as part of shared decision-making is widely discussed in research and policy literature as a means of improving patient involvement in treatment and care. To date information exchange between patients and nurses has not been explored in ward contexts. OBJECTIVE To explore the sufficiency of, and intentions behind, information exchanged by patients and nurses in surgical and medical ward settings using a recognised model of shared decision-making. DESIGN A multiple-case study design was used. Data were collected from 19 cases. Each case comprised one patient, the nurses interacting with that patient, the interactions between them, and their perceptions about the interactions. SETTINGS The study was undertaken across six surgical, six medical and one rehabilitation ward in a large teaching hospital in the United Kingdom. PARTICIPANTS Purposive sampling was used to first recruit nurses and then patients. Inclusion criteria included nurses registered with the Nursing and Midwifery Council, and patients who had been in hospital for more than 24h and who could consent to participating. Twenty-two nurses and 19 patients participated. METHODS Interactions from 19 cases were observed and audio-recorded. Individual interviews with patients and nurses followed, and were related to, the observed interactions. RESULTS Patients and nurses perceived they had exchanged sufficient information for their own needs including patient involvement, due to: information being shared previously and on an ongoing basis; having asked all their questions; therapeutic patient/nurse relationships; and, nurses speaking in lay terms. In contrast, the observational data suggested that insufficient information was exchanged between patients and nurses due to: lost opportunities for sharing information; paternalistic practice; and withholding information. CONCLUSION The elements of information exchange within a recognised model of shared decision-making do not adequately fit with patient/nurse interactions in ward settings. Participants generally perceived they had given and received enough information for their own needs. Therefore, the ways in which patients and nurses currently interact, could remain as they are. Policymakers should be aware of the varying contexts where healthcare staff work, and should promote information exchange and shared decision-making more strategically. Due to the complexities of patient/nurse interactions, consideration should be given to situation and context when applying these findings to practice.
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Affiliation(s)
- Vivianne Crispin
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK.
| | - Carol Bugge
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK
| | - Kathleen Stoddart
- University of Stirling, Bridge of Allan, Stirling, Scotland, FK9 4LA, UK
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Analgesic use by ageing and elderly patients with chronic non-malignant pain: a qualitative study. Int J Clin Pharm 2017; 39:798-807. [PMID: 28474305 PMCID: PMC5541120 DOI: 10.1007/s11096-017-0466-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 04/13/2017] [Indexed: 01/05/2023]
Abstract
Background Analgesics are used in the management of chronic non-malignant pain (CNMP), a condition which is highly prevalent among older adults. CNMP may not only be physically distressing but also complicated by psychosocial and economic factors. An individual’s perception and use of analgesics may be influenced by a range of factors such as perceptions of risk or benefits, ability to purchase medication or access to non-pharmacological therapies or specialist care. Objective The aim of this study was to describe the perceptions and experiences of analgesics by ageing and elderly individuals with CNMP and identify factors that influence their use. Setting Telephone interviews with 28 members of Chronic Pain Ireland aged ≥50. Method In-depth semi-structured interviews; audio-recorded, transcribed verbatim, and thematically analysed. Main outcome measure Experiences and perceptions of ageing and elderly individuals with CNMP taking analgesics. Results A combination of factors specific to the patient and arising from outside influences informed perceptions and experiences of analgesics. Pain severity, perceived efficacy of analgesics, occurrence of adverse-effects and concerns about addiction/dependence were identified as internal factors influencing medication use. External factors included views of family members, access to specialised care and the individual’s interaction with healthcare professionals (HCPs). Conclusion Individuals with CNMP regard analgesics as an important method for managing pain and are relied upon when other interventions are difficult to access. HCPs in primary care, who are the main point of contact for patients, need to take into account the various factors that may influence analgesic use when consulting with this patient group.
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18
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Hogan TM, Richmond NL, Carpenter CR, Biese K, Hwang U, Shah MN, Escobedo M, Berman A, Broder JS, Platts-Mills TF. Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda. Acad Emerg Med 2016; 23:1386-1393. [PMID: 27561819 DOI: 10.1111/acem.13074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/01/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022]
Abstract
Older emergency department patients have high rates of serious illness and injury, are at high risk for side effects and adverse events from treatments and diagnostic tests, and in many cases, have nuanced goals of care in which pursuing the most aggressive approach is not desired. Although some forms of shared decision making (SDM) are commonly practiced by emergency physicians caring for older adults, broader use of SDM in this setting is limited by a lack of knowledge of the types of patients and conditions for which SDM is most helpful and the approaches and tools that can best facilitate this process. We describe a research agenda to generate new knowledge to optimize the use of SDM during the emergency care of older adults.
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Affiliation(s)
| | - Natalie L. Richmond
- School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | | | - Kevin Biese
- Department of Emergency Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC
| | - Ula Hwang
- Icahn School of Medicine at Mount Sinai; New York NY
| | - Manish N. Shah
- Department of Emergency Medicine; University of Wisconsin; Madison WI
| | | | - Amy Berman
- John A. Hartford Foundation; New York NY
| | | | - Timothy F. Platts-Mills
- Department of Emergency Medicine and the Department of Anesthesiology; University of North Carolina at Chapel Hill; Chapel Hill NC
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19
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George NR, Kryworuchko J, Hunold KM, Ouchi K, Berman A, Wright R, Grudzen CR, Kovalerchik O, LeFebvre EM, Lindor RA, Quest TE, Schmidt TA, Sussman T, Vandenbroucke A, Volandes AE, Platts-Mills TF. Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda. Acad Emerg Med 2016; 23:1394-1402. [PMID: 27611892 DOI: 10.1111/acem.13083] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED). OBJECTIVE The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED. METHODS Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement. CONCLUSION Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.
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Affiliation(s)
- Naomi R. George
- Department of Emergency Medicine; Brown University; Providence RI
| | | | | | - Kei Ouchi
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Amy Berman
- Hartford Program Officer/Patient Representative; New York NY
| | - Rebecca Wright
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | - Corita R. Grudzen
- Department of Emergency Medicine; NYU School of Medicine; New York NY
| | | | - Eric M. LeFebvre
- Department of Emergency Medicine, Geriatric Fellow; University of North Carolina-Chapel Hill; Chapel Hill NC
| | | | - Tammie E. Quest
- Department of Emergency Medicine; Emory University; Atlanta GA
| | - Terri A. Schmidt
- Departments of Emergency Medicine and Hematology/Oncology; Oregon Health and Science University; Portland OR
| | - Tamara Sussman
- School of Social Work; McGill University; Montreal Quebec Canada
| | | | | | - Timothy F. Platts-Mills
- Department of Emergency Medicine and Department of Anesthesiology; University of North Carolina-Chapel Hill; Chapel Hill NC
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20
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Kraus CK, Marco CA. Shared decision making in the ED: ethical considerations. Am J Emerg Med 2016; 34:1668-72. [DOI: 10.1016/j.ajem.2016.05.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022] Open
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21
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Heid C, Knobloch MJ, Schulz LT, Safdar N. Use of the Health Belief Model to Study Patient Perceptions of Antimicrobial Stewardship in the Acute Care Setting. Infect Control Hosp Epidemiol 2016; 37:576-82. [PMID: 26809477 PMCID: PMC5262496 DOI: 10.1017/ice.2015.342] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. DESIGN We conducted semi-structured interviews with 30 hospitalized patients using the Health Belief Model as the framework for questions and analysis. SETTING An academic tertiary care hospital in Madison, Wisconsin. PARTICIPANTS A total of 30 general medicine inpatients receiving at least 1 anti-infective medication were interviewed. RESULTS Participants recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Views of susceptibility were influenced by a high degree of trust in physicians and misperceptions regarding the mechanisms underlying resistance. Participants expressed high self-efficacy and a desire to be involved in their health care. Perceived roles for patients in preventing the inappropriate use of antibiotics ranged from asking questions and speaking up about concerns to active involvement in decision making regarding antibiotic treatments. Few participants reported being offered the opportunity to engage in such shared decision making while hospitalized. CONCLUSIONS Our findings suggest an important role for patients in improving antibiotic use in hospitals. However, patient engagement has not been recognized as a critical component of antimicrobial stewardship programs. Our study suggests that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act. Further investigation into how patients may be engaged as good stewards of antibiotics may reveal new ways to improve antibiotic prescribing practices in the inpatient setting.
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Affiliation(s)
- Cydney Heid
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Mary Jo Knobloch
- William S. Middleton Memorial Veterans Hospital Madison, Wisconsin
| | - Lucas T. Schulz
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital Madison, Wisconsin
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Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD. Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study. Acad Emerg Med 2016; 23:375-81. [PMID: 26806170 PMCID: PMC5308213 DOI: 10.1111/acem.12904] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective was to describe perceptions of practicing emergency physicians (EPs) regarding the appropriateness and medicolegal implications of using shared decision-making (SDM) in the emergency department (ED). METHODS We conducted a cross-sectional survey of EPs at a large, national professional meeting to assess perceived appropriateness of SDM for different categories of ED management (e.g., diagnostic testing, treatment, disposition) and in common clinical scenarios (e.g., low-risk chest pain, syncope, minor head injury). A 21-item survey instrument was iteratively developed through review by content experts, cognitive testing, and pilot testing. Descriptive and multivariate analyses were conducted. RESULTS We approached 737 EPs; 709 (96%) completed the survey. Two-thirds (67.8%) of respondents were male; 51% practiced in an academic setting and 44% in the community. Of the seven management decision categories presented, SDM was reported to be most frequently appropriate for deciding on invasive procedures (71.5%), computed tomography (CT) scanning (56.7%), and post-ED disposition (56.3%). Among the specific clinical scenarios, use of thrombolytics for acute ischemic stroke was felt to be most frequently appropriate for SDM (83.4%), followed by lumbar puncture to rule out subarachnoid hemorrhage (73.8%) and CT head for pediatric minor head injury (69.9%). Most EPs (66.8%) felt that using and documenting SDM would decrease their medicolegal risk while a minority (14.2%) felt that it would increase their risk. CONCLUSIONS Acceptance of SDM among EPs appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.
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Affiliation(s)
- Marc A Probst
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hemal K Kanzaria
- The Department of Emergency Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Dominick L Frosch
- The Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA
- The Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Erik P Hess
- The Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Gary Winkel
- The Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ka Ming Ngai
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lynne D Richardson
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Marcum ZA, Kisak A, Visoiu A, Resnick N. Medication Discrepancies and Shared Decision-Making. J Am Geriatr Soc 2016; 64:653-4. [DOI: 10.1111/jgs.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Zachary A. Marcum
- Department of Pharmacy; School of Pharmacy; University of Washington; Seattle Washington
| | - Anne Kisak
- Magee-Womens Hospital; UPMC; Pittsburgh Pennsylvania
| | - Adrian Visoiu
- Magee-Womens Hospital; UPMC; Pittsburgh Pennsylvania
- Division of Geriatrics Medicine; School of Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Neil Resnick
- Magee-Womens Hospital; UPMC; Pittsburgh Pennsylvania
- Division of Geriatrics Medicine; School of Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
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Holland WC, Hunold KM, Mangipudi SA, Rittenberg AM, Yosipovitch N, Platts-Mills TF. A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain. Acad Emerg Med 2016; 23:306-14. [PMID: 26728174 DOI: 10.1111/acem.12888] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. METHODS This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants' desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. RESULTS Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35%), received care from a nurse practitioner versus a resident or an attending physician (32% vs. 9%; difference 23%, 95% CI = 4% to 42%), or received care from a female versus a male provider (24% vs. 5%; difference 19%, 95% = CI 5% to 32%). After potential confounders were adjusted for, the mean decrease in pain severity from the ED visit to 1-week follow-up was not significantly different across tertiles of SDM (p = 0.06). Higher SDM scores were associated with greater satisfaction with the discharge pain medications (p = 0.006). SDM was not associated with the class of analgesic received. CONCLUSIONS In this sample of older adults with acute musculoskeletal pain, the reported desire of patients to contribute to decisions regarding analgesics varied based on both patient and provider characteristics. SDM was not significantly related to pain reduction in the first week or type of pain medication received, but was associated with greater patient satisfaction.
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Affiliation(s)
- Wesley C. Holland
- Department of Emergency Medicine; University of North Carolina; Chapel Hill NC
| | | | - Sowmya A. Mangipudi
- Department of Health Policy and Management; University of North Carolina; Chapel Hill NC
| | | | - Natalie Yosipovitch
- Department of Emergency Medicine; University of North Carolina; Chapel Hill NC
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25
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Clayman ML, Bylund CL, Chewning B, Makoul G. The Impact of Patient Participation in Health Decisions Within Medical Encounters. Med Decis Making 2015; 36:427-52. [DOI: 10.1177/0272989x15613530] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/18/2015] [Indexed: 02/01/2023]
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.
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Affiliation(s)
- Marla L. Clayman
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Carma L. Bylund
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Betty Chewning
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Gregory Makoul
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
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26
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Rising KL, Printz AD, Hess EP. Patient-Centered Care in Acute Cardiovascular Disease. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40138-014-0061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Collins SP, Storrow AB. Moving toward comprehensive acute heart failure risk assessment in the emergency department: the importance of self-care and shared decision making. JACC-HEART FAILURE 2014; 1:273-280. [PMID: 24159563 DOI: 10.1016/j.jchf.2013.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation.
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Affiliation(s)
- Sean P Collins
- Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee
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28
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Storrow AB, Jenkins CA, Self WH, Alexander PT, Barrett TW, Han JH, McNaughton CD, Heavrin BS, Gheorghiade M, Collins SP. The burden of acute heart failure on U.S. emergency departments. JACC. HEART FAILURE 2014; 2:269-77. [PMID: 24952694 PMCID: PMC4429129 DOI: 10.1016/j.jchf.2014.01.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/14/2014] [Accepted: 01/27/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The goal of this study was to examine 2006 to 2010 emergency department (ED) admission rates, hospital procedures, lengths of stay, and costs for acute heart failure (AHF). BACKGROUND Patients with AHF are often admitted and are associated with high readmissions and cost. METHODS We utilized Nationwide Emergency Department Sample AHF data from 2006 to 2010 to describe admission proportion, hospital length of stay (LOS), and ED charges as a surrogate for resource utilization. Results were compared across U.S. regions, patient insurance status, and hospital characteristics. RESULTS There were 958,167 mean yearly ED visits for AHF in the United States. Fifty-one percent of the patients were female, and the median age was 75.1 years (interquartile range [IQR]: 62.5 to 83.7 years). Overall, 83.7% (95% confidence interval: 83.1% to 84.2%) were admitted; the median LOS was 3.4 days (IQR: 1.9 to 5.8 days). Comparing 2006 with 2010, there was a small decrease in median LOS (0.09 days), but the proportion admitted did not change. Odds of admission, adjusting for age, sex, hospital characteristic (academic and safety net status), and insurance (Medicare, Medicaid, private, self-pay/no charge) were highest in the Northeast. Median ED charges were $1,075 (IQR: $679 to $1,665) in 2006 and $1,558 (IQR: $1,018 to $2,335) in 2010. Patients without insurance were more likely to be discharged from the ED, but when admitted, were more likely to receive a major diagnostic or therapeutic procedure. CONCLUSIONS A very high proportion of ED patients with AHF are admitted nationally, with significant variation in disposition and procedural decisions based on region of the country and type of insurance, even after adjusting for potential confounding.
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Affiliation(s)
- Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pauline T Alexander
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin S Heavrin
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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29
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Hunold KM, Esserman DA, Isaacs CG, Dickey RM, Pereira GF, Fillingim RB, Sloane PD, McLean SA, Platts-Mills TF. Side effects from oral opioids in older adults during the first week of treatment for acute musculoskeletal pain. Acad Emerg Med 2013; 20:872-9. [PMID: 24033733 DOI: 10.1111/acem.12212] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/21/2013] [Accepted: 04/02/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The authors sought to describe the frequency of short-term side effects experienced by older adults initiating treatment with opioid-containing analgesics for acute musculoskeletal pain. METHODS This was a cross-sectional study of individuals age 65 years or older initiating analgesic treatment following emergency department (ED) visits for acute musculoskeletal pain. Patients were called by phone 4 to 7 days after their ED visits to assess the intensity of six common opioid-related side effects using a 0 to 10 scale and to assess medication discontinuation due to side effects. Propensity score matching was used to compare side effects among patients initiating treatment with any opioid-containing analgesics to side effects among those initiating treatment with only nonopioids. RESULTS Of 104 older patients initiating analgesic treatment following ED visits for musculoskeletal pain, 71 patients took opioid-containing analgesics, 15 took acetaminophen, and 18 took ibuprofen. Among the patients who took opioids, at least one side effect of moderate or severe intensity (score ≥ 4) was reported by 62%. Among patients with matching propensity scores, those taking opioids were more likely to have had moderate or severe side effects than those taking only nonopioids (62%, 95% confidence interval [CI] = 48% to 74% vs. 4%, 95% CI = 1% to 20%) and were also more likely to have discontinued treatment due to side effects (16%, 95% CI = 8% to 29% vs. 0%, 95% CI = 0% to 13%). The most common side effects due to opioids were tiredness, nausea, and constipation. CONCLUSIONS Among older adults initiating treatment with opioid-containing analgesics for musculoskeletal pain, side effects were common and sometimes resulted in medication discontinuation.
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Affiliation(s)
- Katherine M. Hunold
- Department of Biostatistics; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Denise A. Esserman
- Department of Biostatistics; University of North Carolina Chapel Hill; Chapel Hill NC
- Division of General Medicine and Clinical Epidemiology; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Cameron G. Isaacs
- School of Medicine; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Ryan M. Dickey
- Department of Anesthesiology; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Greg F. Pereira
- Department of Anesthesiology; University of North Carolina Chapel Hill; Chapel Hill NC
| | | | - Philip D. Sloane
- Department of Family Medicine; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Samuel A. McLean
- Department of Emergency Medicine; University of North Carolina Chapel Hill; Chapel Hill NC
- Department of Anesthesiology; University of North Carolina Chapel Hill; Chapel Hill NC
| | - Timothy F. Platts-Mills
- Department of Emergency Medicine; University of North Carolina Chapel Hill; Chapel Hill NC
- Department of Anesthesiology; University of North Carolina Chapel Hill; Chapel Hill NC
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Offerman SR, Nishijima DK, Holmes JF. In reply. Acad Emerg Med 2013; 20:856. [PMID: 24033629 DOI: 10.1111/acem.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Steven R Offerman
- Department of Emergency Medicine, Kaiser Permanente Northern California, Oakland, CA.
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Platts-Mills TF, Keil LG. Delayed telephone consent in emergency medicine research. Acad Emerg Med 2013; 20:855. [PMID: 23879772 DOI: 10.1111/acem.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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