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Brandstetter LS, Jírů-Hillmann S, Störk S, Heuschmann PU, Wöckel A, Reese JP. Differences in Preferences for Drug Therapy Between Patients with Metastatic Versus Early-Stage Breast Cancer: A Systematic Literature Review. THE PATIENT 2024; 17:349-362. [PMID: 38451419 PMCID: PMC11190003 DOI: 10.1007/s40271-024-00679-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Compared with early stages (eBC) metastatic BC (mBC) is incurable. In mBC, aggressive treatment may increase the duration of survival but may also cause severe treatment side effects. A better understanding how patients with BC value different aspects of drug therapy might improve treatment effectiveness, satisfaction and adherence. This systematic review aims to identify and summarise studies evaluating patient preferences for drug therapy of BC and to compare preferences of patients with eBC and mBC. METHODS The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The electronic databases PubMed and Web of Science were searched on 22 June 2023. All studies published to this point were considered. Original studies reporting patient preferences on BC drug therapy determined by any type of choice experiment were eligible. A narrative synthesis of the effect measures presented as relative importance ratings, trade-offs (required benefit to make a therapy worthwhile) or monetary values of the treatment attributes was reported for each study. Risk of bias assessment for individual studies was performed using the checklist for observational studies from the STROBE Statement and the checklist from 'Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User's Guide'. The study protocol was registered at the PROSPERO database (CRD42022377031). RESULTS A total of 34 studies met the inclusion criteria were included in the analysis evaluating the preferences of patients with eBC (n = 18), mBC (n = 10) or any stage BC (n = 6) on, for example, chemotherapy, endocrine therapy, hormonal therapy or CKD4/6-inhibitors using different types of choice experiments. Regardless of the stage, most patients valued treatment effectiveness in terms of survival gains higher than potential adverse drug reactions (ADRs). Treatment cost, mode of administration, treatment regimen and monitoring aspects were considered as least important treatment attributes. In addition, preferences concerning 16 different types of ADRs were described, showing high heterogeneity within BC stages. Yet, comparable results across BC stages were observed. CONCLUSIONS Regardless of the stage, patients with BC consistently valued survival gains as the most important attribute and were willing to accept the risk of potential ADRs. Incorporating patient preferences in shared decision making may improve the effectiveness of interventions by enhancing adherence to drug therapy in patients suffering from BC.
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Affiliation(s)
- Lilly Sophia Brandstetter
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Würzburg, Germany.
| | - Steffi Jírů-Hillmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter Ulrich Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Würzburg, Germany
- Clinical Trial Centre Würzburg, University Hospital Würzburg, Würzburg, Germany
- Institute of medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Achim Wöckel
- Department of Gynaecology and Obstetrics, University Hospital of Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Würzburg, Germany
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Bosveld MH, Smits AGM, Mertens HJMM, Zandvoort MJJMV, Mook WNKAV, Bokhoven MAV. Patients and informal caregivers in the lead: a qualitative study on the experiences of patients, informal caregivers, and healthcare professionals with involvement in treatment, e-health and self-management programs. BMC Health Serv Res 2024; 24:713. [PMID: 38858686 PMCID: PMC11165740 DOI: 10.1186/s12913-024-11156-z] [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: 01/03/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND A significant proportion of patients and informal caregivers favor an active role in decisions concerning their health. Simultaneously, governments aim to shift treatment from a professional care setting to a community setting, in light of an ageing population, a decreasing number of health workers and allocation of scarce resources. This transition of care solicits patients' and informal caregivers' ability to self-manage. Therefore, the Maastricht University Medical Centre + has established the Academy for Patients and Informal caregivers. The aim is to proactively and professionally support patients and their informal caregivers to enhance their self-management. For that, the Academy offers activities in three categories: (1) instruction of nursing techniques, (2) training of e-health competencies and (3) the provision of self-management programs. Both patients with an episodic care need, as well as patients and informal caregivers with chronic illness, are eligible to participate in the Academy's activities. However, little is known about the experience of these interventions from the perspective of patients, informal caregivers and healthcare professionals. METHODS We conducted semi-structured interviews with 15 patients, 8 informal caregivers and 19 health care professionals who either participated in, referred to or received patients from the Academy. Topics revolved around self-management and the Quadruple aim, covering topics such as patient experiences, healthcare costs, health and well-being of the population and improving work life for health professionals. Data were analyzed using thematic analysis. RESULTS Patients and caregivers experienced an increase in the ability to manage health needs independently, leading to increased mental well-being and self-efficacy. They felt recognized as partners in care, although managing illness needs came with its own burdens. Health care professionals indicated that they felt assured of the quality, uniformity and availability of activities due to its central organization, with instruction nurses finding greater meaning in their work. On the level of health care systems, participants in this study mentioned a decrease in use of formal healthcare, whilst enabling a more equitable division of care. CONCLUSION Stakeholders' experiences with the Academy for Patients and Informal caregivers indicate that participation contributes to development of self-management, whilst also improving working conditions, reducing the appeal to formal care and advancing equity in healthcare. The burden for patients and informal caregivers is to be considered in future developments.
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Affiliation(s)
- Matthijs H Bosveld
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Anne G M Smits
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands
| | - Helena J M M Mertens
- Maastricht University Medical Centre+ (board of directors), Maastricht, The Netherlands
| | | | - Walther N K A van Mook
- Maastricht University Medical Centre+ (department of Intensive Care), School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Marloes A van Bokhoven
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands
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Spinnewijn L, Scheele F, Braat D, Aarts J. Assessing the educational quality of shared decision-making interventions for residents: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 123:108187. [PMID: 38355382 DOI: 10.1016/j.pec.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions. METHODS This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible. RESULTS Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality. CONCLUSIONS This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes. PRACTICE IMPLICATIONS Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands.
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands; OLVG hospital, Department of Healthcare Education, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
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Coylewright M, Otero D, Lindman BR, Levack MM, Horne A, Ngo LH, Beaudry M, Col HV, Col NF. An interactive, online decision aid assessing patient goals and preferences for treatment of aortic stenosis to support physician-led shared decision-making: Early feasibility pilot study. PLoS One 2024; 19:e0302378. [PMID: 38771808 PMCID: PMC11108138 DOI: 10.1371/journal.pone.0302378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Guidelines recommend shared decision making when choosing treatment for severe aortic stenosis but implementation has lagged. We assessed the feasibility and impact of a novel decision aid for severe aortic stenosis at point-of-care. METHODS This prospective multi-site pilot cohort study included adults with severe aortic stenosis and their clinicians. Patients were referred by their heart team when scheduled to discuss treatment options. Outcomes included shared decision-making processes, communication quality, decision-making confidence, decisional conflict, knowledge, stage of decision making, decision quality, and perceptions of the tool. Patients were assessed at baseline (T0), after using the intervention (T1), and after the clinical encounter (T2); clinicians were assessed at T2. Before the encounter, patients reviewed the intervention, Aortic Valve Improved Treatment Approaches (AVITA), an interactive, online decision aid. AVITA presents options, frames decisions, clarifies patient goals and values, and generates a summary to use with clinicians during the encounter. RESULTS 30 patients (9 women [30.0%]; mean [SD] age 70.4 years [11.0]) and 14 clinicians (4 women [28.6%], 7 cardiothoracic surgeons [50%]) comprised 28 clinical encounters Most patients [85.7%] and clinicians [84.6%] endorsed AVITA. Patients reported AVITA easy to use [89.3%] and helped them choose treatment [95.5%]. Clinicians reported the AVITA summary helped them understand their patients' values [80.8%] and make values-aligned recommendations [61.5%]. Patient knowledge significantly improved at T1 and T2 (p = 0.004). Decisional conflict, decision-making stage, and decision quality improved at T2 (p = 0.0001, 0.0005, and 0.083, respectively). Most patients [60%] changed treatment preference between T0 and T2. Initial treatment preferences were associated with low knowledge, high decisional conflict, and poor decision quality; final preferences were associated with high knowledge, low conflict, and high quality. CONCLUSIONS AVITA was endorsed by patients and clinicians, easy to use, improved shared decision-making quality and helped patients and clinicians arrive at a treatment that reflected patients' values. TRIAL REGISTRATION Trial ID: NCT04755426, Clinicaltrials.gov/ct2/show/NCT04755426.
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Affiliation(s)
- Megan Coylewright
- Department of Cardiovascular Medicine, University of Tennessee Health Science Center College of Medicine-Chattanooga, Chattanooga, Tennessee, United States of America
| | - Diana Otero
- Department of Cardiovascular Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Brian R. Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melissa M. Levack
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Aaron Horne
- Department of Medicine, Summit Health, Berkeley Heights, NJ, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa Beaudry
- Central Vermont Medical Center, Berlin, Vermont, United States of America
| | - Hannah V. Col
- Shared Decision Making Resources, Georgetown, ME and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Nananda F. Col
- Shared Decision Making Resources, Georgetown, ME and University of New England, Biddeford, Maine, United States of America
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van der Klei VMGTH, Drewes YM, van Raaij BFM, van Dalsen MDW, Julien AG, Festen J, Polinder-Bos H, Mooijaart SP, Gussekloo J, van den Bos F. Older people's goals of care in relation to frailty status-the COOP-study. Age Ageing 2024; 53:afae097. [PMID: 38796317 PMCID: PMC11127771 DOI: 10.1093/ageing/afae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Literature relating older people's goals of care to their varying frailty status is scarce. OBJECTIVE To investigate goals of care in case of acute and/or severe disease in relationship to frailty status among the general older population. METHOD Older people aged ≥70 in the Netherlands completed a questionnaire. They were divided into three subgroups based on a self-reported Clinical Frailty Scale: fit (CFS 1-3), mildly frail (CFS 4-5) and severely frail (CFS 6-8). Seven goals were graded as unimportant (1-5), somewhat important (6-7) or very important (8-10): extending life, preserving quality of life (QoL), staying independent, relieving symptoms, supporting others, preventing hospital admission and preventing nursing home admission. RESULTS Of the 1,278 participants (median age 76 years, 63% female), 57% was fit, 32% mildly frail and 12% severely frail. Overall, participants most frequently considered preventing nursing home admission as very important (87%), followed by staying independent (84%) and preserving QoL (83%), and least frequently considered extending life as very important (31%). All frailty subgroups reported similar preferences out of the surveyed goals as the overall study population. However, participants with a higher frailty status attached slightly less importance to each individual goal compared with fit participants (Ptrend-values ≤ 0.037). CONCLUSION Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients.
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Affiliation(s)
- Veerle M G T H van der Klei
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne M Drewes
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas F M van Raaij
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike D W van Dalsen
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Anneke G Julien
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Harmke Polinder-Bos
- Department of Geriatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center, Leiden, the Netherlands
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Nelis S, Dijkstra HP, Damman OC, Farooq A, Verhagen E. Shared decision-making with athletes: a survey study of healthcare professionals' perspectives. BMJ Open Sport Exerc Med 2024; 10:e001913. [PMID: 38736642 PMCID: PMC11086382 DOI: 10.1136/bmjsem-2024-001913] [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] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Objectives Shared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived practice of SDM among healthcare professionals working with athletes. This study evaluates SDM attitudes and preferences and explores how healthcare professionals perceive the factors influencing SDM. Methods A web-based cross-sectional survey with open-ended and closed-ended questions. Results Our survey was completed by 131 healthcare professionals. The majority (63.6%) reported to prefer SDM and to be confident in their SDM skills (81.1%). Despite this inclination and confidence, only one in four clinicians reported consistent practice of SDM when feasible. Additionally, most clinicians lacked SDM knowledge. The barriers perceived by healthcare professionals included time constraints (17.6%), limited patient knowledge (17.6%), limited patient motivation (13.5%) and language barriers (16.2%). Importantly, two-thirds of the participants believed that SDM in athlete health care differs from SDM in non-athletes due to the high-pressure environment, the tension between performance and health, and the involvement of multiple stakeholders with potentially conflicting interests. Conclusions Although healthcare professionals preferred SDM, they did not fully understand nor routinely practice it. Most healthcare professionals perceive SDM in athlete health care to differ from SDM in the general population. Therefore, to inform the implementation of SDM in athlete health care, future research is crucial to understand better what makes practising SDM unique in this setting.
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Affiliation(s)
- Sofie Nelis
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Hendrik Paul Dijkstra
- Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olga Catherina Damman
- Department of Public and Occupational Health, Amsterdam UMC, Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Abdulaziz Farooq
- FIFA Medical Center for Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Locatie Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lindig A, Mannagottera L, Hahlweg P, Sigl H, Klimesch A, Zeh S, Kriston L, Scholl I. Effects of a shared decision-making implementation programme on patient-centred communication in oncology-Secondary analysis of a randomised controlled trial. Health Expect 2024; 27:e14030. [PMID: 38549215 PMCID: PMC10979048 DOI: 10.1111/hex.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND There is a need for better implementation of patient-centred (PC) communication and shared decision-making (SDM) in routine cancer care. OBJECTIVE The aim of this study was to assess whether a programme to implement SDM in oncology had effects on PC communication in clinical encounters. DESIGN This study constitutes a secondary analysis of data derived from an implementation trial applying a stepped wedge design that, among other strategies, incorporated training and coaching to enhance the PC communication skills of physicians. SETTING AND PARTICIPANTS We analysed audio recordings of clinical encounters collected in three departments of a comprehensive cancer centre in Germany before and after rolling out the implementation programme. MAIN VARIABLES STUDIED We assessed the PC communication skills of physicians. MAIN OUTCOME MEASURES Each recording was rated by two researchers using the German version of the Four Habits Coding Scheme (4HCS), an observer-based measure of PC communication. Interrater reliability of the outcome measure was acceptable but moderate. Demographic data of patients participating in audio recordings were analysed. METHODS Data were analysed using descriptive statistics and linear mixed-effects models. RESULTS In total, 146 encounters, 74 before and 72 after implementation, were evaluated. The mean age of patients was 57.1 years (SD = 13.8), 70.3% were female, the largest portion of patients had medium formal education (32.4%) and were (self-) employed (37.8%). No statistically significant effect of the implementation programme on the physicians' PC communication skills was found. DISCUSSION The results indicate that the investigated programme to implement SDM in oncology, including training and coaching, had no effects on PC communication in clinical encounters. These results are in contrast to other studies that report the effects of specific training or coaching on PC communication. Reasons for the lack of effect include the short duration of our training compared to other studies, limited reliability and moderate interrater reliability of the 4HCS scale, limited reach of the intervention programme as well as the inclusion of physicians regardless of their exposure to the interventions. CONCLUSION Further research is needed to develop implementation strategies that improve physicians' PC communication skills. PATIENT CONTRIBUTION Data on patients and clinical encounters with patients and physicians were analysed. There was no other patient or public involvement.
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Affiliation(s)
- Anja Lindig
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Lotta Mannagottera
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Pola Hahlweg
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Hannah Sigl
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Anne Klimesch
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Stefan Zeh
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Levente Kriston
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Isabelle Scholl
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Ten Haaft BHEA, Furumaya A, Nooijen LE, Kazemier G, Ubbink DT, Erdmann JI. Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA). HPB (Oxford) 2024; 26:451-460. [PMID: 38161079 DOI: 10.1016/j.hpb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Shared decision-making (SDM) may improve patient autonomy and health outcomes. This study assessed the level of SDM at both ends of the spectrum of hepatobiliary surgery to identify needs and opportunities for improvement. METHODS A mixed-methods study was performed. Consultations regarding surgery for perihilar cholangiocarcinoma (pCCA) or hepatocellular adenoma (HCA) were prospectively included between September 2020 and December 2022. The level of patient involvement in treatment decision-making was assessed objectively by analysis of audio-recorded consultations using the OPTION-5 instrument. The perceived level of SDM was appreciated by patients (SDM-Q-9) and surgeons (SDM-Q-doc) through questionnaires. Higher scores indicated higher levels of SDM. Outcomes were compared between patient groups and two focus groups were held. RESULTS Ten pCCA- and nine HCA-patients were included in the quantitative part of the study. Median OPTION-5, SDM-Q-9 and SDM-Q-doc scores were 35% (IQR: 25-45%), 86% (IQR: 76-96%), and 73% (IQR: 71-78%), respectively. SDM-Q-9 scores among HCA-patients (79% [IQR: 71-82%]) were significantly lower than in pCCA-patients (96% [IQR: 93-100%], p < 0.001). In focus groups, patients reported a lack of information, support, and expressed positive attitudes towards decision support tools (DSTs). CONCLUSION Patient involvement and information provision among HPB-surgical patients show room for improvement, particularly for HCA-patients. DSTs may be helpful for this purpose.
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Affiliation(s)
- Britte H E A Ten Haaft
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lynn E Nooijen
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Waddell A, Goodwin D, Spassova G, Sampson L, Candy A, Bragge P. "We will be the ones bearing the consequences": A qualitative study of barriers and facilitators to shared decision-making in hospital-based maternity care. Birth 2024. [PMID: 38270268 DOI: 10.1111/birt.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision-making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital-based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. METHODS Qualitative semi-structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision-makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. RESULTS Women expect to be included in decisions about their care. Health service administrators and decision-makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision-making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. CONCLUSION This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient-clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational- and system-wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations.
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Affiliation(s)
- Alex Waddell
- Safer Care Victoria, Victorian Department of Health, Melbourne, Victoria, Australia
- Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Denise Goodwin
- BehaviourWorks Australia, Monash University, Clayton, Victoria, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, Victoria, Australia
| | | | - Alix Candy
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
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Warmerdam B, Oomen F, Hilt A, Melles M, Eefting D, Hamming J, van der Vorst J, van Schaik J. Perspectives of Patients and Professionals on Patient Education in Complex Endovascular Aortic Repair. Ann Vasc Surg 2024; 98:87-101. [PMID: 37355016 DOI: 10.1016/j.avsg.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Misinterpretation of patient preferences in perioperative education can lead to an undesired treatment decision. This explorative interview study presents differences in perspectives of patients and professionals on patient education in complex endovascular aortic aneurysm management. METHODS Using convenience sampling, a cross-sectional interview study was performed among patients who were in various stages of the decision-making process for complex endovascular aortic repair. Five physicians were interviewed, representing the main providers of clinical information. Interviews were transcribed verbatim and analyzed inductively. RESULTS Twelve patients (mean age 76.6 [standard deviation: 6.4], 83% male) were interviewed. Ten (83%) felt like they had no other realistic option besides undergoing surgery, whereas all professionals (5/5) stressed the importance of delicate patient selection. Five patients out of 10 (50%) who commented on their preferred decisional role considered the professional's advice as decisive. All but 1 patient (11/12) reported that the information was easy to understand, whereas 4 out of 5 professionals (80%) doubted whether patients could fully comprehend everything. Patients experienced a lack of information on the recovery process, although professionals stated that this was addressed during consultation. CONCLUSIONS Several differences were found in the perspectives of patients and professionals on education in complex aortic aneurysm management. In order to optimize patient involvement in decision-making, professionals should be aware of these possible discrepancies and address them during consultation. Future research could focus on these differences in more detail by including more patients depending on their treatment and decision stages.
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Affiliation(s)
- Britt Warmerdam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Floor Oomen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alexander Hilt
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Daniël Eefting
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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11
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Bossen JKJ, Wesselink JA, Heyligers IC, Jansen J. Implementation of a Decision Aid for Hip and Knee Osteoarthritis in Orthopedics: A Mixed-Methods Process Evaluation. Med Decis Making 2024; 44:112-122. [PMID: 37902570 PMCID: PMC10714711 DOI: 10.1177/0272989x231205858] [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: 09/20/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND In orthopedics, the use of patient decision aids (ptDAs) is limited. With a mixed-method process evaluation, we investigated patient factors associated with accepting versus declining the use of the ptDA, patients' reasons for declining the ptDA, and clinicians' perceived barriers and facilitators for its use. METHODS Patients with an indication for joint replacement surgery (N = 153) completed questionnaires measuring demographics, physical functioning, quality of life (EQ-5D-3L), and a visual analog scale (VAS) pain score at 1 time point. Subsequently, their clinician offered them the relevant ptDA. Using a retrospective design, we compared patients who used the ptDA (59%) with patients who declined (41%) on all these measures as well as the chosen treatment. If the use of the ptDA was declined, patients' reasons were recorded by their clinician and analysed (n = 46). To evaluate the experiences of clinicians (n = 5), semistructured interviews were conducted and thematically analyzed. Clinicians who did not use the ptDA substantially (<10 times) were also interviewed (n = 3). RESULTS Compared with patients who used the ptDA, patients who declined use had higher VAS pain scores (7.2 v. 6.2, P < .001), reported significantly worse quality of life (on 4 of 6 EQ-5D-3L subscales), and were less likely to receive nonsurgical treatment (4% v. 28%, P < .001). Of the patients who declined to use the ptDA, 46% said they had enough information and felt ready to make a decision without the ptDA. The interviews revealed that clinicians considered the ptDAs most useful for newly diagnosed patients who had not received previous treatment. CONCLUSION These results suggest that the uptake of a ptDA may be improved if it is introduced in the early disease stages of hip and knee osteoarthritis. HIGHLIGHTS Patients who declined the use of a patient decision aid (ptDA) for hip and knee osteoarthritis reported more pain and worse quality of life.Most patients who declined to use a ptDA felt sufficiently well informed to make a treatment decision.Patients who declined the ptDA were more likely to have received prior treatment in primary care.Clinicians found the ptDA to be a helpful addition to the consultation, particularly for newly diagnosed patients.
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Affiliation(s)
- Jeroen Klaas Jacobus Bossen
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Geleen, the Netherlands
- Orthopedic Department of University Hospitals Leuven, Leuven, Belgium
| | - Julia Aline Wesselink
- School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ide Christiaan Heyligers
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen/Geleen, the Netherlands
| | - Jesse Jansen
- School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, the Netherlands
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12
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Hagopian COP. From informed to empowered consent. Nurs Philos 2024; 25:e12475. [PMID: 38284806 DOI: 10.1111/nup.12475] [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: 01/18/2023] [Revised: 08/15/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024]
Abstract
Informed consent is ethically incomplete and should be redefined as empowered consent. This essay challenges theoretical assumptions of the value of informed consent in light of substantial evidence of its failure in clinical practice and questions the continued emphasis on autonomy as the primary ethical justification for the practice of consent in health care. Human dignity-rather than autonomy-is advanced from a nursing ethics perspective as a preferred justification for consent practices in health care. The adequacy of an ethic of obligation (namely, principlism) as the dominant theoretical lens for recognising and responding to persistent problems in consent practices is also reconsidered. A feminist empowerment framework is adopted as an alternative ethical theory to principlism and is advanced as a more practical and complete lens for examining the concept and context of consent in health care. To accomplish this, the three leading conceptions of informed consent are overviewed, followed by a feminist critique to reveal practical problems with each of them. The need for a language change from informed to empowered consent is strongly considered. Implications for consent activities in clinical practice are reviewed with focused discussion on the need for greater role clarity for all involved in consent-beyond and inclusive of the patient-physician dyad, as the practice and improvement of consent is necessarily a transdisciplinary endeavour. Specific concrete and practical recommendations for leveraging nursing expertise in this space are presented. Perhaps what is most needed in the discourse and practice of consent in health care is nursing.
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Affiliation(s)
- Chelsea O P Hagopian
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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13
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van Erp RAL, de Rooij SE, Wymenga ANM, Zeegers AVCME, van der Palen J. Feasibility study of the Digital Patient Benefit Assessment Scale (P-BAS): A Digital Tool to Assess Individual Patient Goals. Gerontol Geriatr Med 2024; 10:23337214241230159. [PMID: 38328389 PMCID: PMC10848793 DOI: 10.1177/23337214241230159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
The study objective was to assess the feasibility of the Patient Benefit Assessment Scale (P-BAS), a digital tool designed to enable older outpatients (≥70 years) to elucidate at home their individual goals regarding their current medical issue. Several digital tools are developed to assist older people in identifying their goals, thereby facilitating the process of shared decision making. However, studies on the feasibility of these digital tools, especially in older patients, are limited. Data were collected from 36 older patients. The study comprised three stages. In stage I and II, cognitive interviews were conducted to strengthen the feasibility of the P-BAS. In stage III, 80% of the patients completed the P-BAS independently at home. The cognitive interviews provided insight into patients' interpretation and individual understanding of the digital visual P-BAS and associated opportunities for improvement, which were subsequently implemented. One conclusion is that the digital visual P-BAS might be of added value for patients and contributes to the process of shared decision making, assuring that the goals of the patient will be into account in treatment options. Findings are useful for researchers interested in technological tools that contribute to shared decision making.
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Affiliation(s)
- Rozemarijn A L van Erp
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Job van der Palen
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
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14
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Schneider AR, Ravani P, King-Shier KM, Quinn RR, MacRae JM, Love S, Oliver MJ, Hiremath S, James MT, Ortiz M, Manns BR, Elliott MJ. Alignment Among Patient, Caregiver, and Health Care Provider Perspectives on Hemodialysis Vascular Access Decision-Making: A Qualitative Study. Can J Kidney Health Dis 2023; 10:20543581231215858. [PMID: 38033483 PMCID: PMC10685780 DOI: 10.1177/20543581231215858] [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: 06/05/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Updates to the Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Vascular Access emphasize the "right access, in the right patient, at the right time, for the right reasons." Although this implies a collaborative approach, little is known about how patients, their caregivers, and health care providers engage in vascular access (VA) decision-making. Objective To explore how the perspectives of patients receiving hemodialysis, their caregivers, and hemodialysis care team align and diverge in relation to VA selection. Design Qualitative descriptive study. Setting Five outpatient hemodialysis centers in Calgary, Alberta. Participants Our purposive sample included 19 patients receiving maintenance hemodialysis, 2 caregivers, and 21 health care providers (7 hemodialysis nurses, 6 VA nurses, and 8 nephrologists). Methods We conducted semi-structured interviews with consenting participants. Using an inductive thematic analysis approach, we coded transcripts in duplicate and characterized themes addressing our research objective. Results While participants across roles shared some perspectives related to VA decision-making, we identified areas where views diverged. Areas of alignment included (1) optimizing patient preparedness-acknowledging decisional readiness and timing, and (2) value placed on trusting relationships with the kidney care team-respecting decisional autonomy with guidance. Perspectives diverged in the following aspects: (1) differing VA priorities and preferences-patients' emphasis on minimizing disruptions to normalcy contrasted with providers' preferences for fistulas and optimizing biomedical parameters of dialysis; (2) influence of personal and peer experience-patients preferred pragmatic, experiential knowledge, whereas providers emphasized informational credibility; and (3) endpoints for VA review-reassessment of VA decisions was prompted by access dissatisfaction for patients and a medical imperative to achieve a functioning access for health care providers. Limitations Participation was limited to individuals comfortable communicating in English and from urban, in-center hemodialysis units. Few informal caregivers of people receiving hemodialysis and younger patients participated in this study. Conclusions Although patients, caregivers, and healthcare providers share perspectives on important aspects of VA decisions, conflicting priorities and preferences may impact the decisional outcome. Findings highlight opportunities to bridge knowledge and readiness gaps and integrate shared decision-making in the VA selection process.
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Affiliation(s)
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kathryn M. King-Shier
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Robert R. Quinn
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jennifer M. MacRae
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannan Love
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew T. James
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Mia Ortiz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden R. Manns
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Meghan J. Elliott
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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15
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Clerke T, Margetts J, Donovan H, Shepherd HL, Makris A, Canty A, Ruhotas A, Catling C, Henry A. Piloting a shared decision-making clinician training intervention in maternity care in Australia: A mixed methods study. Midwifery 2023; 126:103828. [PMID: 37717344 DOI: 10.1016/j.midw.2023.103828] [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: 05/17/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
PROBLEM Implementation of woman-centred care in evidence-based maternity practice requires clinicians to be skilled in shared decision-making, yet there is limited training or research into such interventions. BACKGROUND Shared decision-making enables women to make informed decisions in partnership with clinicians where there are varied clinical options in relation to indications for and timing of planned birth. AIM We aimed to develop a shared decision-making training intervention and evaluate its feasibility and acceptability to midwives and obstetricians. METHODS The intervention was co-designed by midwifery and medical clinician-researchers, and a consumer representative. Online training and demonstration videos were distributed to midwives and obstetricians in three Sydney hospitals, followed by two online workshops in 2021 and 2022 where participants practised shared decision-making in roleplaying scenarios tailored to timing of birth. Training was evaluated using post-workshop and post-training surveys and semi-structured qualitative interviews. FINDINGS The training workshop format, duration and content were well received. Barriers to the uptake of shared decision-making were time, paternalistic practices and fear of repercussions of centring women in the decision-making process. DISCUSSION The intervention enabled midwifery and medical colleagues to learn communication repertoires from each other in woman-centred discussions around timing of birth. Roleplay scenarios enabled participants to observe and provide feedback on their colleagues' shared decision-making practices, while providing a space for collective reflection on ways to promote, and mitigate barriers to, its implementation in practice. CONCLUSION Shared decision-making training supports maternity clinicians in developing skills that implement woman-centred care in the timing of planned birth.
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Affiliation(s)
- Teena Clerke
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia.
| | - Jayne Margetts
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Helen Donovan
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Heather L Shepherd
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Australia
| | - Angela Makris
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia
| | - Alison Canty
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; Liverpool Hospital, South West Sydney Local Health District, Australia; Western Sydney University, Women's Health Initiative Translation Unit (WHITU), Australia
| | - Annette Ruhotas
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia
| | - Christine Catling
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of Technology Sydney, Faculty of Health, Australia
| | - Amanda Henry
- Maridulu Budyari Gumal, Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; University of New South Wales, Australia; St George Hospital, South East Sydney Local Health District, Australia
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16
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Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [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: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
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Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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17
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Gong X, Pei Y, Zhang M, Wu B. Quality of death among older adults in China: The role of medical expenditure and timely medical treatment. J Aging Soc Policy 2023; 35:667-682. [PMID: 35608353 DOI: 10.1080/08959420.2022.2079907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/30/2021] [Indexed: 10/18/2022]
Abstract
Medical expenses in the last year of life consume a large portion of healthcare expenditures, yet little is known about the relationship between medical expenditures in the last year of life and quality of death. Few empirical studies have investigated the association between timely medical treatment before dying and quality of death. This study aimed to examine the associations between medical expenditures in the last year of life, timely medical treatment before dying, and quality of death. Data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the largest national representative study of the oldest-old in China. Results from multinomial logistic regression suggested that higher medical expenses in the last year of life and lack of timely medical treatment before dying are associated with lower quality of death. These findings highlight an urgent need for strengthening education on death and dying, developing hospice and palliative care services, and improving pain management at the end of life in China.
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Affiliation(s)
- Xiuquan Gong
- Professor, Social Science and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Yaolin Pei
- Research Scientist. Rory Meyers College of Nursing, New York University, NY, USA
| | - Min Zhang
- Master student, Social Science and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Bei Wu
- Dean's Professor in Global Health, Rory Meyers College of Nursing, New York University, NY, USA
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18
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Zeng L, Li SA, Yang M, Yan L, Helsingen LM, Bretthauer M, Agoritsas T, Vandvik PO, Mustafa RA, Busse J, Siemieniuk RAC, Lytvyn L, Zhang L, Brignardello-Petersen R, Guyatt GH. Qualitative study of guideline panelists: innovative surveys provided valuable insights regarding patient values and preferences. J Clin Epidemiol 2023; 161:173-180. [PMID: 37517505 DOI: 10.1016/j.jclinepi.2023.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To explore guideline panelists' understanding of panel surveys for eliciting panels' inferences regarding patient values and preferences, and the influence of the surveys on making recommendations. STUDY DESIGN AND SETTING We performed sampling and data collection from all four guideline panels that had conducted the surveys through October 2020. We collected the records of all panel meetings and interviewed some panelists in different roles. We applied inductive thematic analysis for analyzing and interpreting data. RESULTS We enrolled four guideline panels with 99 panelists in total and interviewed 25 of them. Most panelists found the survey was easy to follow and facilitated the incorporation of patient values and preferences in the tradeoffs between benefits and harms or burdens. The variation of patient preferences and uncertainty regarding patient values and preferences reflected in the surveys helped the panels ponder the strength of recommendations. In doing so, the survey results enhanced a rationale for panels' decision on the recommendations. CONCLUSION The panel surveys have proved to help guideline panels explicitly consider and incorporate patient values and preferences in making recommendations. Guideline panels would benefit from widespread use of the panel surveys, particularly when primary evidence regarding patient values and preferences is scarce.
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Affiliation(s)
- Linan Zeng
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mengting Yang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Lijiao Yan
- Centre for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Lise M Helsingen
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division General Internal Medicine & Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland
| | - Per O Vandvik
- Department of Medicine, Lovisenberg Hospital Trust, Oslo, Norway
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jason Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lingli Zhang
- Evidence-based Pharmacy Centre/Pharmacy Department, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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19
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Hole B, Scanlon M, Tomson C. Shared decision making: a personal view from two kidney doctors and a patient. Clin Kidney J 2023; 16:i12-i19. [PMID: 37711639 PMCID: PMC10497374 DOI: 10.1093/ckj/sfad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 09/16/2023] Open
Abstract
Shared decision making (SDM) combines the clinician's expertise in the treatment of disease with the patient's expertise in their lived experience and what is important to them. All decisions made in the care of patients with kidney disease can potentially be explored through SDM. Adoption of SDM in routine kidney care faces numerous institutional and practical barriers. Patients with chronic disease who have become accustomed to paternalistic care may need support to engage in SDM-even though most patients actively want more involvement in decisions about their care. Nephrologists often underestimate the risks and overestimate the benefits of investigations and treatments and often default to recommending burdensome treatments rather than discussing prognosis openly. Guideline bodies continue to issue recommendations written for healthcare professionals without providing patient decision aids. To mitigate health inequalities, care needs to be taken to provide SDM to all patients, not just the highly health-literate patients least likely to need additional support in decision making. Kidney doctors spend much of their time in the consulting room, and it is unjustifiable that so little attention is paid to the teaching, audit and maintenance of consultation skills. Writing letters to the patient to summarise the consultation rather than sending them a copy of a letter between health professionals sets the tone for a consultation in which the patient is an active partner. Adoption of SDM will require nephrologists to relinquish long-established paternalistic models of care and restructure care around the values and preferences of patients.
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Affiliation(s)
- Barnaby Hole
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- University of Bristol, Bristol Medical School, Bristol, UK
| | - Miranda Scanlon
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Lay Advisory Group, Peterborough, UK
| | - Charlie Tomson
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Board of Trustees, Peterborough, UK
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Hahlweg P, Lindig A, Frerichs W, Zill J, Hanken H, Müller V, Peters MC, Scholl I. Major influencing factors on routine implementation of shared decision-making in cancer care: qualitative process evaluation of a stepped-wedge cluster randomized trial. BMC Health Serv Res 2023; 23:840. [PMID: 37553560 PMCID: PMC10408234 DOI: 10.1186/s12913-023-09778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is highly relevant in oncology but rarely implemented in routine care. In a stepped-wedge cluster randomized implementation trial, the outcome evaluation of a theoretically and empirically based multi-component SDM implementation program did not show a statistically significant effect on patient-reported SDM uptake. Within this SDM implementation trial, a thorough a priori planned process evaluation was conducted. Thus, the aim of this study was to investigate factors influencing SDM implementation in the context of a multi-component SDM implementation program. METHODS We conducted qualitative process evaluation of a stepped-wedge SDM implementation trial. Qualitative data included interviews with nurses and physicians of participating departments, field notes by the study team, and meeting minutes. Data were analyzed via deductive and inductive qualitative content analysis on basis of the Consolidated Framework for Implementation Research (CFIR). RESULTS Transcripts of 107 interviews with 126 nurses and physicians, 304 pages of field note documentation, and 125 pages of meeting minutes were analyzed. Major factors influencing SDM implementation were found for all domains of the CFIR: a) four regarding characteristics of the individuals involved (e.g., perceived personal relevance, individual motivation to change), b) eleven regarding the inner setting (e.g., leadership engagement, networks and communication, available resources, compatibility with clinical practice), c) two regarding the outer setting (e.g., culture of health care delivery), d) eight regarding characteristics of the intervention (e.g., relative advantage, adaptability), and e) three regarding the implementation process (e.g., integration into existing structures). Furthermore, we found strong interrelations between several of the influencing factors within and between domains. CONCLUSIONS This comprehensive process evaluation complements the outcome evaluation of the SDM implementation trial and adds to its interpretation. The identified influencing factors can be used for planning, conducting, and evaluating SDM implementation in the future. TRIAL REGISTRATION clinicaltrials.gov, NCT03393351, registered 8 January 2018, https://clinicaltrials.gov/ct2/show/NCT03393351.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anja Lindig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jördis Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral, Maxillofacial and Plastic Surgery, Asklepios Klinik Nord - Heidberg, Tangstedter Landstr. 400, 22417, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Mia-Carlotta Peters
- II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Leonard C, Sayre G, Williams S, Henderson A, Norvell D, Turner AP, Czerniecki J. Perceived shared decision-making among patients undergoing lower-limb amputation and their care teams: A qualitative study. Prosthet Orthot Int 2023; 47:379-386. [PMID: 37079358 DOI: 10.1097/pxr.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/18/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is increasingly advocated in the care of vascular surgery patients. The goal of this investigation was to gain a greater understanding of the patient and provider experience of SDM during clinical decision-making around the need for lower-extremity amputation and amputation level related to chronic limb-threatening ischemia (CLTI) in the Veterans Health Administration. METHODS Semistructured interviews in male Veterans with CLTI, vascular surgeons, physical medicine and rehabilitation physicians, and podiatric surgeons. Interviews were analyzed using team-based content analysis to identify themes related to amputation-level decisions. RESULTS We interviewed 22 patients and 21 surgeons and physicians and identified 4 themes related to SDM: (1) providers recognize the importance of incorporating patient preferences into amputation-level decisions and strive to do so; (2) patients do not perceive that they are included as equal partners in decisions around amputation or amputation level; (3) providers perceive several obstacles to including patients in amputation level decisions; and (4) patients describe facilitators to their involvement in SDM. CONCLUSIONS Despite the recognized importance SDM in amputation decision-making, patients often perceived that their opinion was not solicited. This may result from provider perception of significant challenges to SDM posed by the clinical context of amputation. Patients identified key features that might enhance SDM including presentation of clear, concise information, and the importance of communicating concern during the discussion. These findings point to gaps in the provision of patient-centric care through SDM discussions at the time of amputation.
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Affiliation(s)
- Chelsea Leonard
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, and Denver Seattle Center of Innovation, VA Eastern Healthcare System, Aurora, CO, USA
- VA Collaborative Evaluation Center (VACE), Seattle, WA, USA
| | - George Sayre
- VA Puget Sound Health Care System, Seattle, WA, USA
- Qualitative Research Core, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- VA Collaborative Evaluation Center (VACE), Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sienna Williams
- VA Puget Sound Health Care System, Seattle, WA, USA
- VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
| | - Alison Henderson
- VA Puget Sound Health Care System, Seattle, WA, USA
- VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
| | - Dan Norvell
- VA Puget Sound Health Care System, Seattle, WA, USA
- VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Joseph Czerniecki
- VA Puget Sound Health Care System, Seattle, WA, USA
- VA Center for Limb Loss and Mobility (CLiMB), Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Patil A, Chawathey S, Malim A. Adequacy of Informed Consent in Elective Surgical Procedures: A Study in a Navi Mumbai Tertiary Care Centre. Cureus 2023; 15:e41777. [PMID: 37449289 PMCID: PMC10337701 DOI: 10.7759/cureus.41777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
Background Informed consent (IC) is a voluntary authorisation given by a patient or research subject after fully comprehending the risks involved in various procedures and treatments. Though a patient may fulfill all the aspects of consent by completing an informed consent form (ICF), research indicates poor execution of the IC process by ill-informed patients with little comprehension. The present study was done on patients to assess their understanding and involvement in the consenting process, thereby providing insight into the adequacy and sufficiency of the IC process. Materials and methodology Patients undergoing elective surgical procedures were surveyed using a questionnaire to study whether the written informed consent (IC) process was adequately used in elective surgeries and to assess the patient's understanding of the IC and whether the informed consent forms (ICF) used met the ethical and legal standards for this purpose. The questionnaire was administered to the patients by two surveyors. As per the inclusion/exclusion criteria, data was collected from 221 admitted patients who were planned to undergo or recently underwent various elective surgical/operative procedures. Descriptive analysis using frequency and percentages of the positive and negative responses was used to analyse the data. Results In 219 (99%) of the cases, informed consent was taken. Two hundred-eight patients (94.1%) understood the knowledgeable consent information, while 13 (5.9%) did not. Of the total 221 patients, more than 90% of patients were informed about the nature and indication of the surgery. The expected benefits were told to 83.25% of patients, while possible complications of the procedure were reported to 91 patients (41.2%). Of the total, 58.37 % of patients knew the type of anaesthesia used for elective surgery. Two hundred and sixteen (97.73%) patients favoured the informed consent process, and 213 (96.38%) were satisfied with the information provided in the consent form. The education status of the patient varied, with nearly 15.5% being illiterate while 35.3% being educated till high school. Patients undergoing surgical procedures must be explained the nature and indication of the proposed surgical treatment, including its benefits and risks. About 208 (94.1%) of the patients stated that they understood all the information provided in the ICF, and 213 patients (96.3%) were satisfied with it. Most patients (88.7%) exercised autonomy in deciding to undergo surgery. Ninety-seven percent of patients favoured the IC process, of which 38.46% believed informed consent has a medicolegal significance. Conclusion The present study revealed that a better understanding of the informed consent by the patients is a vital component of the process as it helps exercise autonomy in the decision-making process. However, the lack of information in the informed consent forms critically affects the quality and adequacy of the IC, thus posing ethical and legal challenges to genuinely informed consent.
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Affiliation(s)
- Amit Patil
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Shreyas Chawathey
- Anaesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, IND
| | - Adel Malim
- College of Medicine, Dr D Y Patil Medical College, Hospital, and Research Centre, Navi Mumbai, IND
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23
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Vingerhoets C, Hay-Smith J, Graham F. Getting to know our patients and what matters: exploring the elicitation of patient values, preferences, and circumstances in neurological rehabilitation. Disabil Rehabil 2023; 45:1444-1452. [PMID: 35476588 DOI: 10.1080/09638288.2022.2063416] [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: 08/13/2021] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Patient values, preferences, and circumstances are critical to decision-making in both patient-centred and evidence-based practice models of healthcare. Despite the established importance of integrating these patient attributes, the ways they are elicited in rehabilitation remain unclear. This study aimed to explore how health professionals elicit and share patients' 'values', 'preferences', and 'circumstances', and what they understand by the terms. METHODS This exploratory qualitative descriptive study used interviews with 13 clinicians from interprofessional teams in inpatient neurological rehabilitation. Data were analysed using a general inductive approach. RESULTS Participants understood 'values' to mean what is important and meaningful; 'preferences' as likes/dislikes and choices; and 'circumstances' as the social, physical, and environmental context surrounding the person. Formal and informal strategies were used to gather information directly from patients or indirectly from other sources. The processes of eliciting and communicating this information were influenced by relationships and relied on contributions from many people. Elicitation involved a flexible approach tailored to the individual and considering each unique context. CONCLUSION The strategies used and the approach used to implement these strategies were both essential to eliciting patient values, preferences, and circumstances in neurological rehabilitation. These findings offer insights into the practices of interprofessional rehabilitation clinicians. Implications for rehabilitationEliciting patient values, preferences, and circumstances involves a combination of strategies and approaches that are applied gradually throughout the continuum of rehabilitation.These processes are flexible, and strategies should be tailored to individual patients/families and phases of rehabilitation.Clinicians should be attentive to informal opportunities to gather valuable information throughout rehabilitation.Establishing positive relationships and using effective communication is foundational to these processes.
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Affiliation(s)
| | - Jean Hay-Smith
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Fiona Graham
- Department of Medicine, University of Otago, Wellington, New Zealand
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24
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N'cho-Mottoh MPB, Erpelding ML, Roubaud C, Delahaye F, Fraisse T, Dijos M, Ennezat PV, Fluttaz A, Richard B, Beaufort C, Nazeyrollas P, Brasselet C, Pineau O, Tattevin P, Curlier E, Iung B, Forestier E, Selton-Suty C. The impact of transoesophageal echocardiography in elderly patients with infective endocarditis. Arch Cardiovasc Dis 2023; 116:258-264. [PMID: 37147149 DOI: 10.1016/j.acvd.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.
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Affiliation(s)
| | - Marie-Line Erpelding
- CHRU of Nancy, Inserm, université de Lorraine, CIC, épidémiologie clinique, 54000 Nancy, France
| | | | | | | | - Marina Dijos
- University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | | | | | | | | | | | | | | | - Elodie Curlier
- University Hospital of Guadeloupe, Les Abymes 97142, France
| | - Bernard Iung
- Bichat-Claude Bernard Hospital, 75018 Paris, France
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25
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Aoki Y, Takeshima M, Tsuboi T, Katsumoto E, Udagawa K, Inada K, Watanabe K, Mishima K, Takaesu Y. A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5373. [PMID: 37047987 PMCID: PMC10094391 DOI: 10.3390/ijerph20075373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders' perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists. METHODS A cross-sectional survey was conducted. RESULTS Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that "patient and psychiatrist make the decision together on an equal basis" compared to patients (p < 0.001), while more patients felt that "the decision is (was) made considering the psychiatrists' opinion" compared to psychiatrists (p < 0.001). Of 543 psychiatrists, 79% reported "patients were not willing to discontinue hypnotic/anxiolytic" whereas a certain number of patients conveyed "psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)". CONCLUSION The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.
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Affiliation(s)
- Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke’s International University, Tokyo 104-0044, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | | | - Ken Udagawa
- Community Mental Health & Welfare Bonding Organization, Chiba 272-003, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Kanagawa 252–0374, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
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Schneider-Kamp A, Nielsen HL, Sodemann M. Patientology revisited: Toward tailored care pathways. J Eval Clin Pract 2023; 29:472-484. [PMID: 36464961 DOI: 10.1111/jep.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concepts such as patient-centred care, patient empowerment and patient participation have challenged our understanding of what it means to be a patient and what role patients play in care pathways. Consequently, patientology as the medical sociological and anthropological study of patients is currently being reconceptualized through perspectives of health as individualized and privatized capital. AIMS This article explores the potential of such a patientological perspective to enhance our understanding of and tailor care pathways. Particularly, we aim to investigate how such a perspective can contribute to tailoring care pathways to the capacities of individual patients and their relatives. MATERIALS & METHODS We elaborate on an emerging health capital-theoretic model for patientology and study its potential for optimizing care pathways through two distinct cases of care contexts: communicative challenges in the context of integrative primary care for vulnerable chronically ill multi-morbid patients and the potential of parent involvement in the acute hospitalization of children suspected to be affected by multisystem inflammatory syndrome in children. RESULTS Our results shed light on the importance of cultural and social capital of patients and their relatives in the design of effective tailored care pathways. We find that a lack of cultural and social capital presents a significant barrier to effective communication between patients and the healthcare professionals involved in their care pathways. We also find that understanding the cultural and social capital of relatives provides an entry point to their effective involvement in the care pathways of their children. DISCUSSION & CONCLUSION The implications of these findings extend beyond the concrete care contexts studied. This article contributes to our understanding of care pathways through a perspective of health inequalities being based on differences in health capital and demonstrates how the health capital-theoretic patientology model facilitates the systematic development of guidelines for healthcare professionals to assess patients' resources and tailor their care pathways accordingly.
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Affiliation(s)
- Anna Schneider-Kamp
- Department of Business and Management, University of Southern Denmark, Odense, Denmark
| | | | - Morten Sodemann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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27
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Zhu M, Dong D, Lo HHM, Wong SYS, Mo PKH, Sit RWS. Patient preferences in the treatment of chronic musculoskeletal pain: a systematic review of discrete choice experiments. Pain 2023; 164:675-689. [PMID: 36149784 PMCID: PMC10026832 DOI: 10.1097/j.pain.0000000000002775] [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: 05/19/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic musculoskeletal pain (CMP) is a preference-sensitive condition for which numerous treatment options are available, each with benefits and risks. Thus, patient preferences play a critical role in decision making. This study summarized evidence from discrete choice experiments (DCEs) to quantify patient preferences for CMP treatment and identified important treatment attributes. A systematic review of DCEs on patient preferences for CMP treatment was conducted. Studies were included if they used DCE to determine patient preferences for CMP. A previously described methodological assessment tool was used to assess the risk of bias. The treatment attributes were summarized and sorted according to the frequency of citation and relative weight. Subgroup analyses were conducted to explore the intervention-specific attributes. A total of 15 eligible studies with 4065 participants were included. We identified "capacity to realize daily life activities," "risk of adverse events," "effectiveness in pain reduction," and "out-of-pocket cost" as important attributes. Although "treatment frequency" and "onset of treatment efficacy" were less frequently mentioned, they were also important attributes. The attribute of "risk of adverse events" was especially important for drug treatment. The "out-of-pocket cost" and "treatment location and mode" were important attributes of exercise therapy. The attributes identified in this review will inform the design of future DCE studies, facilitate the translation of measurement-based care to value-based care, and provide the rationale to promote shared decision making and patient-centered care.
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Affiliation(s)
- Mengting Zhu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Hermione Hin-Man Lo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix Kit-Han Mo
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Regina Wing-Shan Sit
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Davis C, Wagner AK, Salcher-Konrad M, Scowcroft H, Mintzes B, Pokorny AMJ, Lew J, Naci H. Communication of anticancer drug benefits and related uncertainties to patients and clinicians: document analysis of regulated information on prescription drugs in Europe. BMJ 2023; 380:e073711. [PMID: 36990506 PMCID: PMC10053600 DOI: 10.1136/bmj-2022-073711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To evaluate the frequency with which relevant and accurate information about the benefits and related uncertainties of anticancer drugs are communicated to patients and clinicians in regulated information sources in Europe. DESIGN Document content analysis. SETTING European Medicines Agency. PARTICIPANTS Anticancer drugs granted a first marketing authorisation by the European Medicines Agency, 2017-19. MAIN OUTCOME MEASURES Whether written information on a product addressed patients' commonly asked questions about: who and what the drug is used for; how the drug was studied; types of drug benefit expected; and the extent of weak, uncertain, or missing evidence for drug benefits. Information on drug benefits in written sources for clinicians (summaries of product characteristics), patients (patient information leaflets), and the public (public summaries) was compared with information reported in regulatory assessment documents (European public assessment reports). RESULTS 29 anticancer drugs that received a first marketing authorisation for 32 separate cancer indications in 2017-19 were included. General information about the drug (including information on approved indications and how the drug works) was frequently reported across regulated information sources aimed at both clinicians and patients. Nearly all summaries of product characteristics communicated full information to clinicians about the number and design of the main studies, the control arm (if any), study sample size, and primary measures of drug benefit. None of the patient information leaflets communicated information to patients about how drugs were studied. 31 (97%) summaries of product characteristics and 25 (78%) public summaries contained information about drug benefits that was accurate and consistent with information in regulatory assessment documents. The presence or absence of evidence that a drug extended survival was reported in 23 (72%) summaries of product characteristics and four (13%) public summaries. None of the patient information leaflets communicated information about the drug benefits that patients might expect based on study findings. Scientific concerns about the reliability of evidence on drug benefits, which were raised by European regulatory assessors for almost all drugs in the study sample, were rarely communicated to clinicians, patients, or the public. CONCLUSIONS The findings of this study highlight the need to improve the communication of the benefits and related uncertainties of anticancer drugs in regulated information sources in Europe to support evidence informed decision making by patients and their clinicians.
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Affiliation(s)
- Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Henry Scowcroft
- Alzheimer's Research UK, Cambridge, UK
- National Cancer Research Institute Bladder and Renal Research Group, London, UK
| | - Barbara Mintzes
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian M J Pokorny
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Alice Springs Hospital, Northern Territory, Australia
| | - Jianhui Lew
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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29
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Pelzang R. Why Bhutan needs a policy push on person-centred care. J Eval Clin Pract 2023. [PMID: 36871216 DOI: 10.1111/jep.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
Delivering quality healthcare services to people has become a core issue for the Bhutanese healthcare system. There are considerable challenges for healthcare policymakers to recognise and implement an appropriate healthcare model to enhance quality healthcare services in the Bhutanese healthcare system. Actions to improve quality healthcare services in Bhutan requires careful analysis of the healthcare model in the context of the Bhutanese socio-political and healthcare environment. This article provides a brief concept analysis of person-centred care in the context of the Bhutanese socio-political and healthcare environment and describes why it is important to integrate person-centred care into the healthcare system. The article argues that person-centred care is important and relevant to the Bhutanese healthcare system to achieve quality healthcare services and Gross National Happiness.
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Affiliation(s)
- Rinchen Pelzang
- Allity Princeton View Aged Care, Brighton East, Victoria, Australia
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Kriston L, Schumacher L, Hahlweg P, Härter M, Scholl I. Application of the skills network approach to measure physician competence in shared decision making based on self-assessment. PLoS One 2023; 18:e0282283. [PMID: 36848388 PMCID: PMC9970074 DOI: 10.1371/journal.pone.0282283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Several approaches to and definitions of 'shared decision making' (SDM) exist, which makes measurement challenging. Recently, a skills network approach was proposed, which conceptualizes SDM competence as an organized network of interacting SDM skills. With this approach, it was possible to accurately predict observer-rated SDM competence of physicians from the patients' assessments of the physician's SDM skills. The aim of this study was to assess whether using the skills network approach allows to predict observer-rated SDM competence of physicians from their self-reported SDM skills. We conducted a secondary data analysis of an observational study, in which outpatient care physicians rated their use of SDM skills with the physician version of the 9-item Shared Decision Making Questionnaire (SDM-Q-Doc) during consultations with chronically ill adult patients. Based on the estimated association of each skill with all other skills, an SDM skills network for each physician was constructed. Network parameters were used to predict observer-rated SDM competence, which was determined from audio-recorded consultations using three widely used measures (OPTION-12, OPTION-5, Four Habits Coding Scheme). In our study, 28 physicians rated consultations with 308 patients. The skill 'deliberating the decision' was central in the population skills network averaged across physicians. The correlation between parameters of the skills networks and observer-rated competence ranged from 0.65 to 0.82 across analyses. The use and connectedness of the skill 'eliciting treatment preference of the patient' showed the strongest unique association with observer-rated competence. Thus, we found evidence that processing SDM skill ratings from the physicians' perspective according to the skills network approach offers new theoretically and empirically grounded opportunities for the assessment of SDM competence. A feasible and robust measurement of SDM competence is essential for research on SDM and can be applied for evaluating SDM competence during medical education, for training evaluation, and for quality management purposes. [A plain language summary of the study is available at https://osf.io/3wy4v.].
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Waddell A, Spassova G, Sampson L, Jungbluth L, Dam J, Bragge P. Co-designing a theory-informed intervention to increase shared decision-making in maternity care. Health Res Policy Syst 2023; 21:15. [PMID: 36721156 PMCID: PMC9888748 DOI: 10.1186/s12961-023-00959-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) has been shown to improve healthcare outcomes and is a recognized right of patients. Policy requires health services to implement SDM. However, there is limited research into what interventions work and for what reasons. The aim of the study was to develop a series of interventions to increase the use of SDM in maternity care with stakeholders. METHODS Interventions to increase the use of SDM in the setting of pregnancy care were developed using Behaviour Change Wheel and Theoretical Domains Framework and building on findings of an in-depth qualitative study which were inductively analysed. Intervention development workshops involved co-design, with patients, clinicians, health service administrators and decision-makers, and government policy makers. Workshops focused on identifying viable SDM opportunities and tailoring interventions to the local context (the Royal Women's Hospital) and salient qualitative themes. RESULTS Pain management options during labour were identified by participants as a high priority for application of SDM, and three interventions were developed including patient and clinician access to the Victorian Government's maternity record via the patient portal and electronic medical records (EMR); a multi-layered persuasive communications campaign designed; and clinical champions and SDM simulation training. Factors identified by participants for successful implementation included having alignment with strategic direction of the service, support of leaders, using pre-standing resources and workflows, using clinical champions, and ensuring equity. CONCLUSION Three interventions co-designed to increase the use of SDM for pain management during labour address key barriers and facilitators to SDM in maternity care. This study exemplifies how health services can use behavioural science and co-design principles to increase the use of SDM. Insights into the co-design of interventions to implement SDM in routine practice provide a framework for other health services, policy makers and researchers.
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Affiliation(s)
- Alex Waddell
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, VIC, 3800, Clayton, Australia.
- Victorian Department of Health, Safer Care Victoria, 50 Lonsdale St, Melbourne, VIC, 3000, Australia.
| | - Gerri Spassova
- Department of Marketing, Monash Business School, 900 Dandenong Rd, Caulfield East, Victoria, 3145, Australia
| | - Louise Sampson
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Melbourne, VIC, 3052, Australia
| | - Lena Jungbluth
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, VIC, 3800, Clayton, Australia
| | - Jennifer Dam
- Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton Campus, VIC, 3800, Clayton, Australia
| | - Peter Bragge
- Evidence Review Service, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, VIC, 3800, Australia
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Elkefi S, Asan O. The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey. J Patient Exp 2023; 10:23743735231151533. [PMID: 36698621 PMCID: PMC9869234 DOI: 10.1177/23743735231151533] [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] [Indexed: 01/19/2023] Open
Abstract
Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
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Van der Voorden M, Ahaus K, Franx A. Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands. BMJ Open 2023; 13:e063175. [PMID: 36604123 PMCID: PMC9827266 DOI: 10.1136/bmjopen-2022-063175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Although previous studies largely emphasize the positive effects of patient participation in patient safety, negative effects have also been observed. This study focuses on bringing together the separate negative effects that have been previously reported in the literature. This study set out to uncover how these negative effects manifest themselves in practice within an obstetrics department. DESIGN An exploratory qualitative interview study with 16 in-depth semistructured interviews. The information contained in the interviews was deductively analysed. SETTING The study was conducted in one tertiary academic healthcare centre in the Netherlands. PARTICIPANTS Patients (N=8) and professionals (N=8) from an obstetrics department. RESULTS The results of this study indicate that patient participation in patient safety comes in five different forms. Linked to these different forms, four negative effects of patient participation in patient safety were identified. These can be summarised as follows: patients' confidence decreases, the patient-professional relationship can be negatively affected, more responsibility can be demanded of the patient than they wish to accept and the professional has to spend additional time on a patient. CONCLUSION This study identifies and brings together four negative effects of patient participation in patient safety that have previously been individually identified elsewhere. In our interviews, there was a consensus among patients and professionals on five different forms of participation that would allow patients to positively participate in patient safety. Further studies should investigate ways to prevent and to mitigate the potential negative effects of patient participation.
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Affiliation(s)
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Department of Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Arie Franx
- Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
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Hardy V, Usher-Smith J, Archer S, Barnes R, Lancaster J, Johnson M, Thompson M, Emery J, Singh H, Walter FM. Agreement between patient's description of abdominal symptoms of possible upper gastrointestinal cancer and general practitioner consultation notes: a qualitative analysis of video-recorded UK primary care consultation data. BMJ Open 2023; 13:e058766. [PMID: 36604136 PMCID: PMC9827246 DOI: 10.1136/bmjopen-2021-058766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Abdominal symptoms are common in primary care but infrequently might be due to an upper gastrointestinal (UGI) cancer. Patients' descriptions may differ from medical terminology used by general practitioners (GPs). This may affect how information about abdominal symptoms possibly due to an UGI cancer are documented, creating potential missed opportunities for timely investigation. OBJECTIVES To explore how abdominal symptoms are communicated during primary care consultations, and identify characteristics of patients' descriptions that underpin variation in the accuracy and completeness with which they are documented in medical records. METHODS AND ANALYSIS Primary care consultation video recordings, transcripts and medical records from an existing dataset were screened for adults reporting abdominal symptoms. We conducted a qualitative content analysis to capture alignments (medical record entries matching patient verbal and non-verbal descriptions) and misalignments (symptom information omitted or differing from patient descriptions). Categories were informed by the Calgary-Cambridge guide's 'gathering information' domains and patterns in descriptions explored. RESULTS Our sample included 28 consultations (28 patients with 18 GPs): 10 categories of different clinical features of abdominal symptoms were discussed. The information GPs documented about these features commonly did not match what patients described, with misalignments more common than alignments (67 vs 43 instances, respectively). Misalignments often featured patients using vague descriptors, figurative speech, lengthy explanations and broad hand gestures. Alignments were characterised by patients using well-defined terms, succinct descriptions and precise gestures for symptoms with an exact location. Abdominal sensations reported as 'pain' were almost always documented compared with expressions of 'discomfort'. CONCLUSIONS Abdominal symptoms that are well defined or communicated as 'pain' may be more salient to GPs than those expressed vaguely or as 'discomfort'. Variable documentation of abdominal symptoms in medical records may have implications for the development of clinical decision support systems and decisions to investigate possible UGI cancer.
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Affiliation(s)
- Victoria Hardy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rebecca Barnes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Lancaster
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Margaret Johnson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jon Emery
- Centre for Cancer Research and General Practice and Primary Care Academic Centre, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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López Cano M, García-Alamino JM. Shared decision making. Patient-centered evidence. Cir Esp 2023; 101:60-62. [PMID: 35809786 DOI: 10.1016/j.cireng.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Manuel López Cano
- Unidad de Cirugía de Pared Abdominal, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Josep M García-Alamino
- Grupo de Investigación Salud Global, Género y Sociedad (GHenderS), Blanquerna-Universitat Ramon Llull, Barcelona, Spain; Programme in Evidence Based Health Care, University of Oxford, Oxford, UK
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Leu S, Cahill J, Grundy PL. A prospective study of shared decision-making in brain tumor surgery. Acta Neurochir (Wien) 2023; 165:15-25. [PMID: 36576561 PMCID: PMC9795149 DOI: 10.1007/s00701-022-05451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/25/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Shared decision-making (SDM) is a key tenet of personalized care and is becoming an essential component of informed consent in an increasing number of countries. The aim of this study is to analyze patient and healthcare staff satisfaction with the SDM process before and after SDM was officially introduced as the standard of care. Decision grids are important tools in the SDM process, and we developed them for three different types of intracranial tumors. METHODS This prospective study was conducted in a high-volume neuro-oncological center on all consecutive eligible patients undergoing consideration of treatment for intracranial glioma and metastases. Twenty-two patients participated before and 74 after the introduction of SDM. Six and 5 staff members respectively participated in the analysis before and after team training and the introduction of SDM. The main outcome was patient and healthcare staff satisfaction with the SDM process. RESULTS Patients reported high satisfaction with the SDM process before (mean CollaboRATE score 26 of 27 points) and after (mean CollaboRATE score 26.3 of 27 points, p = 0.23) the introduction of SDM. Interestingly, staff attitude toward SDM improved significantly from 61.68 before to 90.95% after the introduction of SDM (p-value < 0.001). Decision grids that were developed for three different types of intracranial tumors are presented. CONCLUSIONS Team training in SDM and the introduction of techniques into daily practice can increase staff satisfaction with the SDM process. High levels of patient satisfaction were observed before, with a non-significant increase after the introduction of SDM. Decision grids are an important tool to facilitate the conveyance and understanding of complex information and to achieve SDM in daily clinical practice.
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Affiliation(s)
- Severina Leu
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK.
- Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Julian Cahill
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
- The National Centre for Stereotactic Radiosurgery, Sheffield, South Yorkshire, UK
| | - Paul L Grundy
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK
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Gremyr A, Holmberg C, Thor J, Malm U, Gäre BA, Andersson AC. How a point-of-care dashboard facilitates co-production of health care and health for and with individuals with psychotic disorders: a mixed-methods case study. BMC Health Serv Res 2022; 22:1599. [PMID: 36585696 PMCID: PMC9803257 DOI: 10.1186/s12913-022-08992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden's largest department specializing in psychotic disorders sought to improve patients' health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics. METHODS This study evaluates the dashboard by addressing two questions: 1) Can differences in health-related outcome measures be attributed to the use of the dashboard? 2) How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients. RESULTS Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients' health. The dashboard helped users identify critical changes and enabled joint planning and evaluation. CONCLUSION Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients' health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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Affiliation(s)
- Andreas Gremyr
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Christopher Holmberg
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Göteborg, Sweden
| | - Johan Thor
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Ulf Malm
- grid.8761.80000 0000 9919 9582Sahlgrenska Academy at Gothenburg University, Institute of Neuroscience and Physiology, Box 400, 40530 Göteborg, Sweden
| | - Boel Andersson Gäre
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,Futurum Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Ann-Christine Andersson
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,grid.32995.340000 0000 9961 9487Department of Care Science, Malmö University, Nordenskiöldsgatan 1, 21119 Malmö, Sweden
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Lauck S, Lewis K. Shared decision-making in cardiac care: can we close the gap between good intentions and improved outcomes? Heart 2022; 109:4-5. [PMID: 36104221 DOI: 10.1136/heartjnl-2022-321482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Sandra Lauck
- Heart Centre, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystina Lewis
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Heesen C, Rahn AC, Köpke S. Communicating with people with MS: A key role for evidence-based patient information. PATIENT EDUCATION AND COUNSELING 2022; 105:3339-3340. [PMID: 36243599 DOI: 10.1016/j.pec.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Christoph Heesen
- Institute for Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Germany
| | - Anne Christin Rahn
- Institute or Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Medical Faculty and University Hospital Cologne, Germany.
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Vainieri M, Nuti S, Mantoan D. Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy. BMJ Open 2022; 12:e061415. [PMID: 36424104 PMCID: PMC9692139 DOI: 10.1136/bmjopen-2022-061415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES During 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and reduce the overall volumes of treatments.The aim of this paper is to analyse whether the pandemic and the prioritisation policies on elective surgery were done considering the potential inappropriateness highlighted by the measurement of geographic variation. SETTING The setting of the study is acute care with a focus on elective surgical procedures. Data were analysed at the Italian regional level. PARTICIPANTS The study is observational and relies on national hospitalisation records from 2019 to 2020. The analyses refer to the 21 Italian regional health systems, using 48 917 records for 2019 and 33 821 for 2020. The surgical procedures analysed are those considered at high risk of unwarranted variation: coronary angioplasty, cholecystectomy, colectomy, knee replacement, hysterectomy, tonsillectomy, hip replacement and vein stripping. PRIMARY AND SECONDARY OUTCOME MEASURES Primary measures were the hospitalisation rate and its reduction per procedure, to understand the level of potential inappropriateness. Secondary measures were the SD and high/low ratio, to map the level of geographic variation. RESULTS For some procedures, there is a linear negative relationship (eg, tonsillectomy: ρ = -0.92, p<0.01; vein stripping: ρ = -0.93, p<0.01) between the reduction in hospitalisation and its starting point. The only two procedures for which no significant differences were registered are cholecystectomy (ρ = -0.22, p=0.31) and hysterectomy (ρ = -0.22, p=0.33). In particular, in all cases, data show that regions with higher 2019 hospitalisation rates registered a larger reduction. CONCLUSIONS The Italian data show that the pandemic seems to have led hospital managers and health professionals to cut surgical interventions more likely to be inappropriate. Hence, these findings can inform and guide the healthcare system to manage unwarranted variation when coming back to the new normal. This new starting point (lower volumes in some selected elective surgical procedures) should be used to plan elective surgical treatments that can be cancelled because of their high risk of inappropriateness.
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Affiliation(s)
- Milena Vainieri
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sabina Nuti
- Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Domenico Mantoan
- AGENAS, Agenzia Nazionale per i Servizi Sanitari Regionali, Roma, Italy
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Blayac T, Dubois D, Duchêne S, Nguyen-Van P, Ventelou B, Willinger M. What drives the acceptability of restrictive health policies: An experimental assessment of individual preferences for anti-COVID 19 strategies. ECONOMIC MODELLING 2022; 116:106047. [PMID: 36118956 PMCID: PMC9472681 DOI: 10.1016/j.econmod.2022.106047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/04/2023]
Abstract
The public acceptability of a policy is an important issue in democracies, in particular for anti-COVID-19 policies, which require the adherence of the population to be applicable and efficient. Discrete choice experiment (DCE) can help elicit preference ranking among various policies for the whole population and subgroups. Using a representative sample of the French population, we apply DCE methods to assess the acceptability of various anti-COVID-19 measures, separately and as a package. Owing to the methods, we determine the extent to which acceptability depends on personal characteristics: political orientation, health vulnerability, or age. The young population differs in terms of policy preferences and their claim for monetary compensation, suggesting a tailored policy for them. The paper provides key methodological tools based on microeconomic evaluation of individuals' preferences for improving the design of public health policies.
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Affiliation(s)
- Thierry Blayac
- CEE-M, Université de Montpellier, CNRS, INRAE, Institut Agro, Montpellier, France
| | - Dimitri Dubois
- CEE-M, Université de Montpellier, CNRS, INRAE, Institut Agro, Montpellier, France
| | | | - Phu Nguyen-Van
- ECONOMIX, CNRS, UPL, Université Paris Nanterre, Nanterre, France
| | - Bruno Ventelou
- Aix-Marseille Université, CNRS, AMSE, Marseille, France
- Observatoire Régional de La Santé PACA, France
| | - Marc Willinger
- CEE-M, Université de Montpellier, CNRS, INRAE, Institut Agro, Montpellier, France
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Barber S, Bekker H, Marti J, Pavitt S, Khambay B, Meads D. Adolescent and Parent Preferences for Hypodontia: Discrete Choice Experiment. J Dent Res 2022; 101:1590-1596. [PMID: 36271667 DOI: 10.1177/00220345221111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Choosing hypodontia treatment requires young people and parents to consider a large amount of information, identify what is important to them, and make trade-offs between options. This study aimed to examine young people and parents' preferences for hypodontia treatment using discrete choice experiment (DCE). This was a cross-sectional survey of young people (12-16 y) with hypodontia of any severity, at any stage of treatment, and their parents. Participants were recruited from NHS Hospitals in England and Wales. A bespoke DCE questionnaire was developed to measure preferences for 6 attributes of hypodontia treatment (waiting time, treatment time, problems during treatment, discomfort during treatment, bite, appearance). The questionnaire was completed 1) online by young people and parents, individually or together, and 2) by child-parent dyads under observation. Preferences were analyzed using regression models. In total, 204 participants (122 young people, 56 parents, 26 dyads) completed the online questionnaire and 15 child-parent dyads completed the questionnaire under observation. The most important attribute in hypodontia treatment was improvement in appearance, but significant heterogeneity was found in preferences. Four distinct groups of participants were found: group 1 (39%): severe discomfort and problems were most important; group 2 (31%): most concerned about improvement in appearance of teeth and improvement in bite; group 3 (22%): appearance 3 times more important than any other attribute; and group 4 (9%): preferences difficult to interpret. There was variation in how child-parent dyads approached decision-making, with some negotiating joint preferences, while for others, one individual dominated. Making trade-offs in DCE tasks helped some people think about treatment and identify their preferences. Appearance is an important outcome from hypodontia treatment, but preferences vary and potential risks and functional outcome are also important to some people. There is a notable level of uncertainty in decision-making, which suggests further shared decision support would be valuable.
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Affiliation(s)
- S Barber
- Orthodontic Department, School of Dentistry, University of Leeds, Leeds, UK
| | - H Bekker
- Leeds Institute of Health Sciences, Leeds, UK
| | - J Marti
- Institute of Social and Preventive Medicine (IUMSP), Université de Lausanne-CHUV, Lausanne, Switzerland
| | | | - B Khambay
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - D Meads
- Leeds Institute of Health Sciences, Leeds, UK
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Ubbink DT. Shared decision-making should be a standard part of surgical care. Br J Surg 2022; 109:1049-1050. [PMID: 36065508 PMCID: PMC10364737 DOI: 10.1093/bjs/znac291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Dirk T Ubbink
- Department of Surgery, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
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Kang JH. Influences of decision preferences and health literacy on temporomandibular disorder treatment outcome. BMC Oral Health 2022; 22:385. [PMID: 36064350 PMCID: PMC9446804 DOI: 10.1186/s12903-022-02420-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Shared decision-making is defined as the process by which physicians and informed patients make a shared medical decision, taking into account the preferences and values of the patients. It is well known that shared decision-making practices improve both clinicians’ and patients’ satisfaction and lead to better treatment outcomes. The aim of the study was to assess associations between patients’ roles in decision-making, health literacy levels, and treatment outcomes of temporomandibular disorders (TMDs). Methods In total, 131 participants were enrolled. Participants underwent interview and physical examination at baseline and six months after TMD management. TMD was diagnosed according to Diagnostic Criteria/TMD criteria. Myofascial trigger points were bilaterally evaluated in the two masticatory muscles including the temporalis and masseter muscles. The roles that participants preferred to play or had perceived during decision-making and their health literacy levels were assessed using Control Preferences Scale and Newest Vital Sign, respectively. Results Participants who perceived themselves as occupying active roles in decision-making showed higher health literacy levels than those with passive perceived roles. Participants with appropriate health literacy showed higher perceived participation levels in decision-making than did those with limited health literacy. The extent of subjective symptomatic improvement after six months of treatment showed significant associations with perceived role in decision-making, despite lack of significant relationships between perceived role in decision-making and the extent of improvement of objective parameters. Conclusion Active participation of patients in decision-making improves the satisfaction but limited health literacy constitutes barriers to effective patient engagement during TMD management. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02420-x.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, 164, Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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Lai J, Brettle A, Zhang Y, Zhou C, Li C, Fu J, Wu Y. Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study. NURSE EDUCATION TODAY 2022; 116:105436. [PMID: 35709543 DOI: 10.1016/j.nedt.2022.105436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/17/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practice have been identified, most studies have focused on clinical nurses' perceptions of the barriers to evidence-based nursing practice, with a lack of investigation into barriers from the hospitals' viewpoint. OBJECTIVES To identify existing barriers to implementing evidence-based nursing practice from the hospitals' viewpoint. DESIGN A descriptive study employing a regional cross-sectional survey. SETTINGS AND PARTICIPANTS A convenience sample of 91 hospitals in Guangdong Province, China. METHODS The survey used an online questionnaire containing basic hospital information and an open-ended question. Descriptive statistics were used to analyse basic hospital data. Responses to the open-ended question were analysed with thematic analysis. RESULTS The sample consisted of 89 valid responses to the open-ended question. Five themes were identified: (1) knowledge (70.8 %); (2) environmental context and resources (42.7 %); (3) social influences (7.9 %); (4) intentions (7.9 %); and (5) beliefs about capabilities (1.1 %). CONCLUSION Introduced early in 2001, China has embraced evidence-based nursing for more than 20 years. However, lack of knowledge is still the top barrier to implementing evidence-based nursing practice in hospitals in China. The findings indicate a need for more evidence-based nursing practice teaching strategies towards further enhancing clinical nurses' and nursing managers' evidence-based nursing practice beliefs, knowledge, and skills.
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Affiliation(s)
- Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Alison Brettle
- School of Health & Society, University of Salford, Salford, UK
| | - Yingjie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China; School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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van der Velden NCA, van Laarhoven HWM, Burgers SA, Hendriks LEL, de Vos FYFL, Dingemans AMC, Jansen J, van Haarst JMW, Dits J, Smets EM, Henselmans I. Characteristics of patients with advanced cancer preferring not to know prognosis: a multicenter survey study. BMC Cancer 2022; 22:941. [PMID: 36050628 PMCID: PMC9434918 DOI: 10.1186/s12885-022-09911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022] Open
Abstract
Background For some patients with advanced cancer not knowing prognosis is essential. Yet, in an era of informed decision-making, the potential protective function of unawareness is easily overlooked. We aimed to investigate 1) the proportion of advanced cancer patients preferring not to know prognosis; 2) the reasons underlying patients’ prognostic information preference; 3) the characteristics associated with patients’ prognostic information preference; and 4) the concordance between physicians’ perceived and patients’ actual prognostic information preference. Methods This is a cross-sectional study with structured surveys (PROSPECT). Medical and thoracic oncologists included patients (n = 524), from seven Dutch hospitals, with metastatic/inoperable cancer and an expected median overall survival of ≤ 12 months. For analysis, descriptive statistics and logistic regression models were used. Results Twenty-five to 31% of patients preferred not to know a general life expectancy estimate or the 5/2/1-year mortality risk. Compared to patients preferring to know prognosis, patients preferring unawareness more often reported optimism, avoidance and inability to comprehend information as reasons for wanting limited information; and less often reported expectations of others, anxiety, autonomy and a sense of control as reasons for wanting complete information. Females (p < .05), patients receiving a further line of systemic treatment (p < .01) and patients with strong fighting spirit (p < .001) were more likely to prefer not to know prognosis. Concordance between physicians’ perceived and patients’ actual prognostic information preference was poor (kappa = 0.07). Conclusions We encourage physicians to explore patients’ prognostic information preferences and the underlying reasons explicitly, enabling individually tailored communication. Future studies may investigate changes in patients’ prognostic information preferences over time and examine the impact of prognostic disclosure on patients who prefer unawareness. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09911-8.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sjaak A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Jansen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan-Maarten W van Haarst
- Department of Respiratory Medicine and Department of Surgery, Tergooi Ziekenhuis, Hilversum, The Netherlands
| | - Joyce Dits
- Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Thiel C, Richie C. Carbon Emissions from Overuse of U.S. Health Care: Medical and Ethical Problems. Hastings Cent Rep 2022; 52:10-16. [PMID: 35993105 DOI: 10.1002/hast.1404] [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] [Indexed: 11/06/2022]
Abstract
The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to "green" health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health care industry, with structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions-and the paucity of attention to the carbon of hospital care and clinical services-this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data-driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States.
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Mertz K, Lindsay SE, Morris A, Kamal RN. Outcome Metrics in the Treatment of Carpal Tunnel Syndrome: A Systematic Review. Hand (N Y) 2022; 17:659-667. [PMID: 33073583 PMCID: PMC9274895 DOI: 10.1177/1558944720949951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The purpose of this systematic review was to determine the metrics used to assess outcomes after treatment for carpal tunnel syndrome. METHODS We performed a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of level I and II randomized controlled trials of treatment for carpal tunnel syndrome. We searched the PubMed/MEDLINE electronic database for studies on treatment of carpal tunnel syndrome from January 2008 to January 2018. A total of 105 studies were included in the final analysis. The metrics used to assess outcomes in each studies were collected, compared, and described. RESULTS Nearly all the studies used a patient-reported outcome measure (PROM) to assess outcomes (94%). The most common PROMs used were the Boston Carpal Tunnel Questionnaire (60%) and the Visual Analog Scale for pain (51%). Electrophysiological testing and physical examination were also commonly used to assess outcomes (50% and 46%, respectively). Cost, sleep, and return to activities of daily living were assessed in a minority of studies (1%, 1%, and 5%, respectively). CONCLUSIONS Successful treatment of carpal tunnel syndrome is commonly defined based on a PROM, highlighting recent efforts to measure outcomes from the patient's perspective. Other patient-centered metrics such as return to work and sleep quality, however, were rarely reported, whereas objective measures such as nerve conduction studies were prevalent. Further work is needed to determine patients' preferred method of measuring outcomes after treatment for carpal tunnel syndrome to inform goal-directed decision-making and treatment.
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Affiliation(s)
| | | | | | - Robin N. Kamal
- Stanford University, CA, USA,Robin N. Kamal, Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford Medicine, Stanford University, 450 Broadway Street, MC: 6342, Redwood City, CA 94063, USA.
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Lognon T, Gogovor A, Plourde KV, Holyoke P, Lai C, Aubin E, Kastner K, Canfield C, Beleno R, Stacey D, Rivest LP, Légaré F. Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey. MDM Policy Pract 2022; 7:23814683221116304. [PMID: 35983319 PMCID: PMC9380233 DOI: 10.1177/23814683221116304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background. In Canada, caregivers of older adults receiving home
care face difficult decisions that may lead to decision regret. We assessed
difficult decisions and decision regret among caregivers of older adults
receiving home care services and factors associated with decision regret.
Methods. From March 13 to 30, 2020, at the outbreak of the
COVID-19 pandemic, we conducted an online survey with caregivers of older adults
receiving home care in the 10 Canadian provinces. We distributed a
self-administered questionnaire through Canada’s largest and most representative
private online panel. We identified types of difficult health-related decisions
faced in the past year and their frequency and evaluated decision regret using
the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive
statistics as well as bivariable and multivariable linear regression to identify
factors predicting decision regret. Results. Among 932
participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The
most frequently reported difficult decisions were regarding housing and safety
(75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with
less decision regret included higher caregiver age, involvement of other family
members in the decision-making process, wanting to receive information about the
options, and considering organizations interested in the decision topic and
health care professionals as trustworthy sources of information (all
P < 0.001). Factors associated with more decision regret
included mismatch between the caregiver’s preferred option and the decision
made, the involvement of spouses in the decision-making process, higher
decisional conflict, and higher burden of care (all P <
0.001). Discussion. Decisions about housing and safety were the
difficult decisions most frequently encountered by caregivers of older adults in
this survey. Our results will inform future decision support interventions.
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Affiliation(s)
- Tania Lognon
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, QC, Canada
| | - Karine V. Plourde
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | | | | | - Carolyn Canfield
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Caregiver Partner, Canada
| | | | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Patient Decision Aids Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Louis-Paul Rivest
- Tier 1 Canada Research Chair in Statistical Sampling and Data Analysis, Université Laval, Quebec, QC, Canada
- Faculty of Sciences and Engineering, Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Kushner BS, Holden T, Han B, Sehnert M, Majumder A, Blatnik JA, Holden SE. Randomized control trial evaluating the use of a shared decision-making aid for older ventral hernia patients in the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) Program. Hernia 2022; 26:901-909. [PMID: 34686942 DOI: 10.1007/s10029-021-02524-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Shared decision making (SDM) is ideally suited to abdominal wall surgery in older adults given the breadth of decision making required by the hernia surgeon and the impact on quality of life (QOL) by various treatment options. Given the paucity of literature surrounding SDM in hernia patients, the feasibility of a novel, formalized SDM aid/tool was evaluated in a pilot randomized trial. METHODS Patients 60 years or older with a diagnosed ventral hernia were prospectively randomized at an academic hernia center. In the experimental arm, a novel SDM tool, based on the SHARE Approach, guided the consultation. Previously validated SDM assessments and patient's hernia knowledge retention was measured. RESULTS Eighteen (18) patients were randomized (9 control and 9 experimental). Cohorts were well matched in age (p = 0.51), comorbidities (Charlson Comorbidity Score: p = 0.43) and frailty (mFI-11: p = 0.19; Risk Analysis Index: p = 0.33). Consultation time was 11 min longer in the experimental cohort (p < 0.01). There was a trend towards better Decisional Conflict Scores in the experimental group (p = 0.25) and the experimental cohort had improved post-visit retained hernia knowledge (p < 0.01). All patients in the experimental arm (100%) enjoyed working through the SDM aid/tool and felt it was a worthwhile exercise. CONCLUSION Incorporating a formalized SDM tool into a busy hernia surgical practice is feasible and well received by patients. In addition, early results suggest it improves retention of basic hernia knowledge and may reduce patient's decisional conflict. Next steps include condensing the SDM tool to enhance efficiency within the clinic and beginning a large, randomized control trial.
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Affiliation(s)
- B S Kushner
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
| | - T Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - B Han
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - M Sehnert
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - A Majumder
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - J A Blatnik
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - S E Holden
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
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