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Ikeda AK, Suarez-Goris D, Reich AJ, Pattisapu P, Raol NP, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 16: Qualitative and Quantitative Methods-Contrasting and Complementary Approaches. Otolaryngol Head Neck Surg 2023. [PMID: 37668182 DOI: 10.1002/ohn.469] [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: 04/14/2023] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 09/06/2023]
Abstract
Qualitative methods have been increasingly applied in our literature, providing richness to data and incorporating the nuances of patient and family perspectives. These qualitative research techniques provide breadth and depth beyond what can be gleaned through quantitative methods alone. When both quantitative and qualitative approaches are coupled, their findings provide complementary information which can further substantiate study conclusions. We thus aim to provide insight into qualitative and quantitative methods in comparison and contrast to each other, as well as guidance on when each approach is most apt. In relation, we also describe mixed methods and the theory supporting their framework. In doing so, we provide the foundation for an ensuing, more detailed exposition of qualitative methods.
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Affiliation(s)
- Allison K Ikeda
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Dany Suarez-Goris
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Amanda J Reich
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Prasanth Pattisapu
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, USA
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nikhila P Raol
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. FRONTIERS IN ALLERGY 2023; 4:1137907. [PMID: 36970067 PMCID: PMC10036764 DOI: 10.3389/falgy.2023.1137907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Shared decision-making is an approach where physicians and patients work together to determine a personalized treatment course. Such an approach is integral to patient-centered care in chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a chronic inflammatory condition of the sinonasal cavity that can severely impact physical health, smell, and quality of life (QOL). Traditional standard-of-care treatment options include topical (i.e. sprays) and oral corticosteroids and endoscopic sinus surgery, but more recently, novel corticosteroid delivery methods (i.e. high volume irrigations, recently-approved exhalation breath-powered delivering devices, and drug-eluting steroid implants) and 3 new FDA approved biologics directed against type II immunomodulators have become available. The availability of these therapeutics offers exciting new opportunities in CRSwNP management but requires personalized and shared-decision making as each modality has variable impacts on CRSwNP and related comorbid conditions. Studies have published treatment algorithms, but the practical use of these lean guidelines is heavily influenced by the lens of the treating physician, the most common being otolaryngologists and allergy immunologists. Clinical equipoise occurs when there is no basis for one intervention to be regarded as “better” than another. While most guidelines, in general, support the use of topical corticosteroids with or without oral corticosteroids followed by ESS for the majority of unoperated CRSwNP patients, there are situations of clinical equipoise that arise particularly in CRSwNP who have failed surgery or those with severe comorbid conditions. In the shared decision-making process, clinicians and patients must consider symptomatology, goals, comfort, compliance, treatment efficacy, and treatment cost when determining the initial choice of therapy and escalation of therapy with the potential use of multiple modalities for recalcitrant CRSwNP. A summary of salient considerations that might constitute shared decision-making is presented in this summary.
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Affiliation(s)
- Shreya P. Ramkumar
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Devyani Lal
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Correspondence: Amar Miglani
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Wamkpah NS, Gerndt SP, Kallogjeri D, Piccirillo JF, Chi JJ. Patients' Views of Shared Decision-making and Decisional Conflict in Otolaryngologic Surgery During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg 2021; 147:879-886. [PMID: 34499093 DOI: 10.1001/jamaoto.2021.2230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A patient's decision to undergo surgery may be fraught with uncertainty and decisional conflict. The unpredictable nature of the COVID-19 pandemic warrants further study into factors associated with patient decision-making. Objective To assess decisional conflict and patient-specific concerns for people undergoing otolaryngologic surgery during the pandemic. Design, Setting, Participants This prospective cross-sectional survey study was conducted via telephone from April 22 to August 31, 2020. English-speaking adults scheduled for surgery from a single academic surgical center were invited to participate. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, scheduled for emergent surgery, or had a communication disability were excluded. For race and ethnicity reporting, participants were classified dichotomously as White according to the Behavioral Risk Factor Surveillance System from the Centers for Disease Control and Prevention or non-White as a collective term including Black or African American, American Indian or Alaska Native, Asian, or Pacific Islander race and ethnicity. Exposures The SURE Questionnaire (sure of myself, understand information, risks/benefits ratio, and encouragement) was used to screen for decisional conflict, with a total score greater than or equal to 3 indicating clinically significant decisional conflict. Participants were asked to share their specific concerns about having surgery. Main Outcome and Measures Decisional conflict and patient demographic data were assessed via bivariate analyses, multivariable logistic regression and conjunctive consolidation. Patient-specific concerns were qualitatively analyzed for summative themes. Results Of 444 patients screened for eligibility, 182 (40.9%) respondents participated. The median age was 60.5 years (interquartile range, 48-70 years). The racial and ethnic identity of the participants was classified as binary White (84% [153 of 182]) and non-White (16% [29 of 182]). The overall prevalence of decisional conflict was 19% (34 of 182). Decisional conflict was more prevalent among non-White than White participants (proportion difference 18.8%, 95% CI, 0.6%-37.0% and adjusted odds ratio 3.0; 95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non-White patients with no college education receiving urgent surgery (odds ratio, 10.8; 95% CI, 2.6-45.0). Intraoperative and postoperative concerns were the most common themes expressed by participants. There was a clinically significant difference in the proportion of participants who screened positive for decisional conflict (30%) and expressed postoperative concerns than those who screened negative for decisional conflict (17%) (proportion difference, 13%; 95% CI, 1%-25%). Among patients reporting concerns about COVID-19, most screened positive for decisional conflict. Conclusions and Relevance Results of this cross-sectional survey study suggest that the COVID-19 pandemic was associated with decisional conflict in patients undergoing otolaryngologic surgery. Consistent discussion of risks and benefits is essential. The role of race and ethnicity in decisional conflict warrants further study.
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Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Sophie P Gerndt
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.,Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - John J Chi
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Washington University in St Louis, St Louis, Missouri
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DeVore EK, Gray ST, Huston MN, Song PC, Alkire BC, Naunheim MR. Decision aid and preference assessment of topical anesthesia for otolaryngology procedures. Laryngoscope Investig Otolaryngol 2021; 6:794-799. [PMID: 34401504 PMCID: PMC8356857 DOI: 10.1002/lio2.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To determine preference patterns for topical anesthesia in patients undergoing endoscopy pre-coronavirus (2019 coronavirus disease [COVID-19]) pandemic and analyze outcomes based on preference, using a decision aid format. METHODS A decision aid was developed with expert and patient input. New patients presenting to subspecialty clinics over a 2-month pre-COVID-19 period completed a pre-procedure survey about their priorities, then were asked to choose between topical oxymetazoline/lidocaine spray or none. A post-procedure outcome survey followed. RESULTS Of 151 patients, 90.1% patients elected to have topical anesthesia. Top patient priorities were "I want the scope to be easy for the doctor" and "I want to be as comfortable as possible." Patients who strongly wanted to avoid medication (P = .002) and bad taste (P = .003) were more likely to select no spray, whereas those who wanted to avoid pain received anesthetic (P = .011). According to the post-procedure assessment, 95.4% of patients were satisfied or strongly satisfied their choice, and this did not correlate with anesthetic vs none. CONCLUSIONS Patient preferences are easily elicited and correlate with treatment choices. Most patients chose to have topical anesthetic and were willing to tolerate side effects; however, both patients with and without topical anesthetic were satisfied with their choices. This decision aid can be used to optimize shared decision making in the otolaryngology clinic. Given the aerosolizing potential of both spray and no spray conditions, this insight may be consequential when devising office protocols for post-COVID-19 practice. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Elliana K. DeVore
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Stacey T. Gray
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Molly N. Huston
- Department of Otolaryngology, Washington University in St. LouisSt. LouisMissouriUSA
| | - Phillip C. Song
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Blake C. Alkire
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Matthew R. Naunheim
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
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Evaluation of the literature surrounding shared decision-making in elective rhinological surgery: A scoping review. Auris Nasus Larynx 2021; 48:922-927. [PMID: 33773853 DOI: 10.1016/j.anl.2021.03.008] [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: 10/22/2020] [Revised: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE [1] review all studies utilizing SDM in the treatment of chronic rhinosinusitis (CRS) [2], increase awareness of otolaryngologists to shared decision-making, and [3] provide a framework for its incorporation into research and clinical practice. METHODS systematic search was performed in November 2019 using PubMed/MEDLINE 1947-, CINAHL Complete 1937-, the Cochrane Library, ClinicalTrials.gov, and Web of Science Core Collection (SCI-EXPANDED, SSCI, A&HCI, ESCI) 1900-. All databases were searched from their inception through the date of search. Studies were eligible if they involved a discussion of SDM in the management of CRS. Studies were excluded if they lacked original patient data or outcomes of interest. Identified studies were screened by title/abstract, followed by full-text review. PRISMA guidelines were strictly followed. RESULTS in total, 416 articles met screening criteria. Six were eligible for full text review. Only one study - an expert panel of the framework for the presurgical treatment of CRS - pertained to SDM. While this study mentions that SDM is a critically important piece to optimize care quality, it does not directly investigate the effects of SDM in CRS. CONCLUSION this review represents a significant negative study that identifies a clear gap in the rhinology literature. Despite the recognized importance of SDM, there have been no interventional studies in the literature to investigate SDM in CRS. This review highlights the need for exploring the role of SDM in rhinological surgery, outlines an overview of SDM and its impact on patient outcomes, and provides a proposed framework for incorporating SDM in research and clinical practice.
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Forner D, Noel CW, Shuman AG, Hong P, Corsten M, Rac VE, Pieterse AH, Goldstein D. Shared Decision-making in Head and Neck Surgery: A Review. JAMA Otolaryngol Head Neck Surg 2021; 146:839-844. [PMID: 32701131 DOI: 10.1001/jamaoto.2020.1601] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Shared decision-making is a partnership between physicians and patients whereby patient values and preferences are incorporated with the best medical evidence. Shared decision-making may reduce decisional conflict, improve value-choice congruence, and increase patient involvement. Despite potential benefit in many key areas of otolaryngology-head and neck surgery, both clinical and research focuses on shared decision-making are scarce. Head and neck surgical oncology is of particular interest owing to the frequency by which preference-sensitive decisions must be made. Information used in this review was obtained between January 1 and February 1, 2020. Observations Various conceptual models have been developed in an attempt to define the concept of shared decision-making. More than 40 instruments have endeavored to measure the construct of shared decision-making. However, in head and neck surgery, few studies to date have explicitly done so. Situations of clinical equipoise, such as in the management of indeterminate thyroid nodules and in the treatment of laryngeal cancer, are frequent. In contrast, value-option incongruence may occur when patient values do not align with the most oncologically sound treatment choice, such as when the resection and reconstruction of oral cancer may leave patients with significant sequelae. Several patient decision aids have been developed to improve shared decision-making in specific clinical scenarios, for example, in considering total laryngectomy or primary chemoradiotherapy. Conclusions and Relevance Despite its potential benefit, there is a dearth of research and clinical applications of shared decision-making in head and neck surgery. Shared decision-making represents an area of substantial need in this regard, and additional efforts should be put forth.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Andrew G Shuman
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valeria E Rac
- Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - David Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto and University Health Network, Toronto, Ontario, Canada
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Hockman L, Bailey J, Sanders J, Muzzey C, Wakefield M, Christensen A, Murray K. A Qualitative Assessment of Patient Satisfaction with Radical Cystectomy for Bladder Cancer at a Single Institution: How Can We Improve? Res Rep Urol 2020; 12:447-453. [PMID: 33117744 PMCID: PMC7550214 DOI: 10.2147/rru.s269405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate patient satisfaction (with emphasis on preoperative education) with radical cystectomy for bladder cancer at our institution, the University of Missouri Hospital, qualitatively in order to identify specific areas where improvements can be made. MATERIALS AND METHODS We developed a patient survey that used open-ended questions to identify positive and negative experiences that contributed to patient satisfaction. We administered the survey to radical cystectomy patients who met inclusion criteria and agreed to participate. We recorded, transcribed and qualitatively coded the responses. We identified four themes under which both positive and negative responses were placed, and constructed two diagrams to better illustrate contributors to patient experience and satisfaction. RESULTS We identified 25 patients who met inclusion criteria. Of those, 13 participated in the survey. Regarding overall experience, 92.3% of patients rated their care as excellent or good. Regarding preoperative education, 76.9% of patients reported they definitely or somewhat received enough information on what to expect after surgery, and 76.9% definitely received enough guidance on how to care for themselves after surgery. From qualitative coding of patient responses to open-ended questions, we identified preoperative preparation, delivery of care, caregiver availability, and patient-centered care as themes that contributed positively and negatively to patient experience. CONCLUSION Although the overall patient satisfaction could be perceived as high (92.3%), qualitative analysis revealed several areas where improvements can be made to improve patient experience with radical cystectomy at our institution. As previously expected, preoperative preparation was a contributor.
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Affiliation(s)
- Lukas Hockman
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Bailey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jacob Sanders
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Catherine Muzzey
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Mark Wakefield
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Amy Christensen
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Katie Murray
- Division of Urology, Department of Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Naunheim MR, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology Part XII: Assessing Patient Preferences. Otolaryngol Head Neck Surg 2020; 164:473-481. [PMID: 32895002 DOI: 10.1177/0194599820950723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a contemporary resource to update clinicians and researchers on the current state of assessment of patient preferences. DATA SOURCES Published studies and literature regarding patient preferences, evidence-based practice, and patient-centered management in otolaryngology. REVIEW METHODS Patients make choices based on both physician input and their own preferences. These preferences are informed by personal values and attitudes, and they ideally result from a deliberative evaluation of the risks, benefits, and other outcomes pertaining to medical care. To date, rigorous evaluation of patient preferences for otolaryngologic conditions has not been integrated into clinical practice or research. This installment of the "Evidence-Based Medicine in Otolaryngology" series focuses on formal assessment of patient preferences and the optimal methods to determine them. CONCLUSIONS Methods have been developed to optimize our understanding of patient preferences. IMPLICATIONS FOR PRACTICE Understanding these patient preferences may help promote an evidence-based approach to the care of individual patients.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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