User-testing an interactive option grid decision aid for prostate cancer screening: lessons to improve usability

Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France

BACKGROUND

With the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists.

METHODS

Firstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3).

DISCUSSION

We expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability.

TRIAL REGISTRATION

Registry: ClinicalTrials.gov.

TRIAL REGISTRATION NUMBER

NCT05989776. Date of registration: 7th September 2023. URL: https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05989776 .

PROTOCOL VERSION

Manuscript based on study protocol version 2.0, 21st may 2023.

Influencing factors of lung cancer patients' participation in shared decision-making: a cross-sectional study

PURPOSE

The purpose of this study was to investigate and analyze the level of actual participation and perceived importance of shared decision-making on treatment and care of lung cancer patients, to compare their differences and to explore their influencing factors.

METHODS

A total of 290 lung cancer patients were collected from oncology and thoracic surgery departments of a comprehensive medical center in Qingdao from October 2018 to December 2019. Participants completed a cross-sectional questionnaire to assess their actual participation and perceived importance in shared decision-making on treatment and care. Descriptive analysis and non-parametric tests were carried out to assess the status quo of patients' shared decision-making on treatment and care. Binary logistic regression analysis with a stepwise back-wards was applied to predict factors that affected patients' participation in shared decision-making.

RESULTS

The results showed that patients with lung cancer had a low degree of participation in shared decision-making. There were significant differences between actual participation and perceived importance of shared decision-making on treatment and care. Education level, age, gender, income, marital status, personality, the course of the disease (> 6 months), and the pathological TNM staging (III) affected patient's level of participation in shared decision-making.

CONCLUSION

Actual participation in shared decision-making on the treatment and care of lung cancer patients was low and considered unimportant. We could train oncology nurses to use patient decision aids to help patients and families participate in shared decision-making on patients' value, preferences and needs.

Fact Boxes: What gets through? A focus group study

BACKGROUND

The "fact box" format was developed to present the benefits and side effects of medical treatments without distortion and in a comprehensible manner. Few studies were able to show that fact boxes, when compared with other formats, significantly improve risk perception, comprehensibility and readability. The fact boxes available in Germany, however, vary with regard to how tables and accompanying texts are presented. It is unclear to what extent the existing evidence can be applied to these formats. Hardly any fact boxes have been piloted systematically. The aim was to pilot the fact box "Antibiotics for acute bronchitis" as a model for the format in terms of feasibility.

METHOD

We used print and online media to recruit adults (> 18 years). The characteristics gender, age and level of education were considered for sampling. The feasibility was explored by means of a semi-structured interview guideline. The focus group interviews were audio-taped and then transcribed. Data analysis was conducted as content analysis according to Mayring.

RESULTS

Five focus groups with a total of 28 participants took place between April 2018 and May 2019 (Halle/Saale, Saxony-Anhalt: n=3; St. Ingbert, Saarland: n=1; Trier, Rhineland-Palatinate: n=1). The fact box was piloted in an iterative process; the results were revised accordingly and checked again in focus groups until information saturation was achieved. The analysis identified the following main categories: interpretation of contents, readability, low reliability; credibility, relevance of the information, relevance of the presentation; superfluous information; completeness and layout. Overall, the fact box was hardly understood, especially regarding the numerical presentation given and the technical terms used. Both the objective and the intended addressees of the fact box were not clear. After revision, feasibility was established.

DISCUSSION

The iterative revision process resulted in a final version that was well understood and perceived as a decision aid.

CONCLUSION

The results support the demand of the guideline "Evidence-based Health Information" for piloting evidence-based health information prior to their dissemination and further evaluation. The next step will be to evaluate the fact box format in a randomised controlled trial.

User testing of a Scottish Intercollegiate Guideline Network public guideline for the parents of children with autism

Background

The Scottish Intercollegiate Guidelines Network (SIGN) is the leading national clinical guideline producer in Scotland. Improved design and dissemination of guidelines produced for the public can empower people to take an active role in self-management and shared decision-making. The public version of the guideline examined covered getting assessed and diagnosed with autism, and approaches that can help. The aim of this study was to test a public version of a guideline for the parents of children and young people with autism, implement improvements, and identify what works in making it usable and accessible.

Methods

We recruited mothers from across Scotland. User testing involved formal ‘think aloud’ semi-structured interviews that guided users through the booklet. Interviews took place individually and were recorded and transcribed. Key findings were identified and themed using the honeycomb user experience model.

Results

Fourteen user-testing interviews were conducted. Facilitators for usability and desirability of the guideline included the chunking of text, consistent use of colour and boxes to highlight important information. Simple language, written in a tone of partnership, helped to engage mothers. Value arose from the guidelines ability to explain the process of diagnosis and make mothers feel empowered in their relationships with healthcare professionals. There was a lack of consensus on the usefulness of rating the strength of evidence and recommendations.

Conclusion

There was a marked similarity between what was important to the mothers and what has been found to be important to other groups. The involvement of service users and carers in the guidelines development was key to its credibility. One size does not fit all in presenting evidence-based recommendations to the public and it is a challenge to provide sufficient information while avoiding information overload. Recommendations and evidence levels are suitable for use in public versions, but these should be kept as simple as possible.

Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older

BACKGROUND

To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75 years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment.

METHODS

A secondary analysis was conducted of 283 women who received the DA before a personal care provider (PCP) visit during the trial to examine the acceptability of the DA and its effects on knowledge of the benefits and harms of mammography, screening intentions, and receipt of screening by educational attainment. Adjusted analyses accounted for clustering by PCP.

RESULTS

Of the 283 participants, 43% had a college education or less. Regardless of educational attainment, 87.2% found the DA helpful. Women with lower educational attainment were less likely to understand all of the DA's content (46.3% vs 67.5%; P < .001), had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; P < .001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P = .01). Receipt of screening did not differ by educational attainment.

CONCLUSIONS

A mammography DA for women aged 75 years and older was helpful to women regardless of their educational attainment; however, those with a college degree or greater understood the DA and, possibly as a result, lowered their screening intentions. Future studies need to examine how to better support informed decision making around mammography screening in older women with lower educational attainment.

LAY SUMMARY

The authors examined data from a previous study to learn the effects of a mammography decision aid (DA) for women aged 75 years and older according to their level of education. Overall, women found the DA helpful, but women with lower educational attainment found it harder to understand the benefits and harms of mammography screening and were less likely to lower their screening intentions than women with a college degree. The findings suggest that women aged 75 years and older who have lower educational attainment may need an even lower literacy DA and/or more support from health care professionals.

Processes for evidence summarization for patient decision aids: A Delphi consensus study

BACKGROUND

Patient decision aids (PDAs) should provide evidence-based information so patients can make informed decisions. Yet, PDA developers do not have an agreed-upon process to select, synthesize and present evidence in PDAs.

OBJECTIVE

To reach the consensus on an evidence summarization process for PDAs.

DESIGN

A two-round modified Delphi survey.

SETTING AND PARTICIPANTS

A group of international experts in PDA development invited developers, scientific networks, patient groups and listservs to complete Delphi surveys.

DATA COLLECTION

We emailed participants the study description and a link to the online survey. Participants were asked to rate each potential criterion (omit, possible, desirable, essential) and provide qualitative feedback.

ANALYSIS

Criteria in each round were retained if rated by >80% of participants as desirable or essential. If two or more participants suggested rewording, reordering or merging, the steering group considered the suggestion.

RESULTS

Following two Delphi survey rounds, the evidence summarization process included defining the decision, reporting the processes and policies of the evidence summarization process, assembling the editorial team and managing (collect, manage, report) their conflicts of interest, conducting a systematic search, selecting and appraising the evidence, presenting the harms and benefits in plain language, and describing the method of seeking external review and the plan for updating the evidence (search, selection and appraisal of new evidence).

CONCLUSION

A multidisciplinary stakeholder group reached consensus on an evidence summarization process to guide the creation of high-quality PDAs.

PATIENT CONTRIBUTION

A patient partner was part of the steering group and involved in the development of the Delphi survey.

User testing a patient information resource about potential complications of vaginally inserted synthetic mesh

BACKGROUND

Vaginal mesh implants are medical devices used in a number of operations to treat stress urinary incontinence and pelvic organ prolapse. Although many of these operations have delivered good outcomes, some women have experienced serious complications that have profoundly affected their quality of life. To ensure that evolving patient information is up-to-date, accurate and appropriate, the Transvaginal Mesh Oversight Group 'user-tested' a newly developed Scottish patient resource, the first to focus exclusively on the issue of complications. The aim of this research was to gather feedback on usability, content, language and presentation to inform the development of the resource from a user perspective.

METHODS

The experience of using the patient resource was captured through semi-structured interviews that followed a 'think-aloud' protocol. The interviewer observed each participant as they went through the resource, asking questions and making field notes. Participants' comments were then categorised using a validated model of user experience and subsequently analysed thematically.

RESULTS

Thirteen people participated in the user testing interviews, including women with lived experience of mesh implants (n = 7), a convenience sample of staff working for Healthcare Improvement Scotland (n = 5) and a patient's carer (n = 1). The majority of participants considered the resource as clear and helpful. Respondents reported that some presentational aspects promoted usability and understandability, including the use of a font that is easy to read, bullet lists, coloured headings and simple language. Barriers included the reliance on some technical language and an explicit anatomical diagram. Participants endorsed the valuable role of health professionals as co-mediators of patient information.

CONCLUSIONS

The findings illustrate the value of undertaking in-depth user-testing for patient information resources before their dissemination. The study highlighted how the direct guidance or navigation of a patient information resource by a health professional could increase its salience and accuracy of interpretation by patients, their families and carers. These insights may also be useful to other developers in improving patient information.

A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations

The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.