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Hughes MC, Vernon E, Egwuonwu C, Afolabi O. Measuring decision aid effectiveness for end-of-life care: A systematic review. PEC INNOVATION 2024; 4:100273. [PMID: 38525314 PMCID: PMC10957449 DOI: 10.1016/j.pecinn.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Objective To systematically review research analyzing the effectiveness of decision aids for end-of-life care, including how researchers specifically measure decision aid success. Methods We conducted a systematic review synthesizing quantitative, qualitative, and mixed-methods study results using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched through February 18, 2023. Inclusion criteria required articles to evaluate end-of-life care decision aids. The review is registered under PROSPERO (#CRD42023408449). Results A total of 715 articles were initially identified, with 43 meeting the inclusion criteria. Outcome measures identified included decisional conflict, less aggressive care desired, knowledge improvements, communication improvements, tool satisfaction, patient anxiety and well-being, and less aggressive care action completed. The majority of studies reported positive outcomes especially when the decision aid development included International Patient Decision Aid Standards. Conclusion Research examining end of life care decision aid use consistently reports positive outcomes. Innovation This review presents data that can guide the next generation of decision aids for end-of-life care, namely using the International Patient Decision Aid Standards in developing tools and showing which tools are effective for helping to prevent the unnecessary suffering that can result when patients' dying preferences are unknown.
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Affiliation(s)
- M. Courtney Hughes
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Pigott 522, Seattle, WA 98122, USA
| | - Chinenye Egwuonwu
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Oluwatoyosi Afolabi
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
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Harris E, Benham A, Stephenson J, Conway D, Chong AY, Curtis H, Astin F. Patient decision aids for aortic stenosis and chronic coronary artery disease: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:561-581. [PMID: 38147507 DOI: 10.1093/eurjcn/zvad138] [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] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
AIMS Shared decision-making is recommended for patients considering treatment options for severe aortic stenosis (AS) and chronic coronary artery disease (CAD). This review aims to systematically identify and assess patient decision aids (PtDAs) for chronic CAD and AS and evaluate the international evidence on their effectiveness for improving the quality of decision-making. METHODS AND RESULTS Five databases (Cochrane, CINAHL, Embase, MEDLINE, and PsycInfo), clinical trial registers, and 30 PtDA repositories/websites were searched from 2006 to March 2023. Screening, data extraction, and quality assessments were completed independently by multiple reviewers. Meta-analyses were conducted using Stata statistical software. Eleven AS and 10 CAD PtDAs were identified; seven were less than 5 years old. Over half of the PtDAs were web based and the remainder paper based. One AS and two CAD PtDAs fully/partially achieved international PtDA quality criteria. Ten studies were included in the review; four reported on the development/evaluation of AS PtDAs and six on CAD PtDAs. Most studies were conducted in the USA with White, well-educated, English-speaking participants. No studies fulfilled all quality criteria for reporting PtDA development and evaluation. Meta-analyses found that PtDAs significantly increased patient knowledge compared with 'usual care' (mean difference: 0.620; 95% confidence interval 0.396-0.845, P < 0.001) but did not change decisional conflict. CONCLUSION Patients who use PtDAs when considering treatments for AS or chronic CAD are likely to be better informed than those who do not. Existing PtDAs may not meet the needs of people with low health literacy levels as they are rarely involved in their development. REGISTRATION PROSPERO: CRD42021264700.
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Affiliation(s)
- Emma Harris
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, UK
| | - Alex Benham
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - Dwayne Conway
- Department of Cardiology, Chesterman Wing, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Aun-Yeong Chong
- Department of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Helen Curtis
- The Library and Knowledge Service, Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax HX3 0PW, UK
| | - Felicity Astin
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, UK
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Barradell AC, Bekker HL, Houchen-Wolloff L, Marshall-Nichols K, Robertson N, Singh SJ. A shared decision-making intervention between health care professionals and individuals undergoing Pulmonary Rehabilitation: An iterative development process with qualitative methods. PLoS One 2024; 19:e0307689. [PMID: 39159209 PMCID: PMC11332919 DOI: 10.1371/journal.pone.0307689] [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: 10/19/2023] [Accepted: 07/09/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Pulmonary Rehabilitation (PR) services typically offer programmes to support individuals living with COPD make rehabilitation choices that best meet their needs, however, uptake remains low. Shared Decision-Making (SDM; e.g., Patient Decision Aids (PtDA)) interventions increase informed and values-based decision-making between individuals and healthcare professionals (HCPs). We aimed to develop an intervention to facilitate PR SDM which was acceptable to individuals living with COPD and PR HCPs. METHODS An iterative development process involving qualitative methods was adopted. Broad overarching frameworks included: complex intervention development framework, the multiple stakeholder decision making support model, and the Ottawa Decision Support Framework. Development included: assembling a steering group, outlining the scope for the PtDA, collating data to inform the PtDA design, prototype development, alpha testing with individuals with COPD (n = 4) and PR HCPs (n = 8), PtDA finalisation, and design and development of supporting components. This took nine months. RESULTS The PtDA was revised six times before providing an acceptable, comprehensible, and usable format for all stakeholders. Supporting components (decision coaching training and a consultation prompt) were necessary to upskill PR HCPs in SDM and implement the intervention into the PR pathway. CONCLUSIONS We have developed a three-component SDM intervention (a PtDA, decision coaching training for PR healthcare professionals, and a consultation prompt) to support individuals living with COPD make informed and values-based decision about PR together with their PR healthcare professional. Clear implementation strategies are outlined which should support its integration into the PR pathway.
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Affiliation(s)
- Amy C. Barradell
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), College of Medicine, Biological Sciences & Psychology, Leicester General Hospital, Leicester, United Kingdom
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development (LUICD), Leeds Institute of Health Sciences—School of Medicine, University of Leeds, Leeds, United Kingdom
- Research Centre for Patient Involvement, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linzy Houchen-Wolloff
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom
| | - Kim Marshall-Nichols
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, United Kingdom
| | - Noelle Robertson
- School of Psychology and Vision Sciences, University of Leicester, Leicester, United Kingdom
| | - Sally J. Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
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Connor MJ, Genie M, Dudderidge T, Wu H, Sukumar J, Beresford M, Bianchini D, Goh C, Horan G, Innominato P, Khoo V, Klimowska-Nassar N, Madaan S, Mangar S, McCracken S, Ostler P, Paisey S, Robinson A, Rai B, Sarwar N, Srihari N, Jayaprakash KT, Varughese M, Winkler M, Ahmed HU, Watson V. Patients' Preferences for Cytoreductive Treatments in Newly Diagnosed Metastatic Prostate Cancer: The IP5-MATTER Study. Eur Urol Oncol 2024:S2588-9311(24)00158-5. [PMID: 38972831 DOI: 10.1016/j.euo.2024.06.010] [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: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Cytoreductive treatments for patients diagnosed with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC) confer incremental survival benefits over systemic therapy, but these may lead to added toxicity and morbidity. Our objective was to determine patients' preferences for, and trade-offs between, additional cytoreductive prostate and metastasis-directed interventions. METHODS A prospective multicentre discrete choice experiment trial was conducted at 30 hospitals in the UK between December 3, 2020 and January 25, 2023 (NCT04590976). The individuals were eligible for inclusion if they were diagnosed with de novo synchronous mHSPC within 4 mo of commencing androgen deprivation therapy and had performance status 0-2. A discrete choice experiment instrument was developed to elicit patients' preferences for cytoreductive prostate radiotherapy, prostatectomy, prostate ablation, and stereotactic ablative body radiotherapy to metastasis. Patients chose their preferred treatment based on seven attributes. An error-component conditional logit model was used to estimate the preferences for and trade-offs between treatment attributes. KEY FINDINGS AND LIMITATIONS A total of 352 patients were enrolled, of whom 303 completed the study. The median age was 70 yr (interquartile range [IQR] 64-76) and prostate-specific antigen was 94 ng/ml (IQR 28-370). Metastatic stages were M1a 10.9% (33/303), M1b 79.9% (242/303), and M1c 7.6% (23/303). Patients preferred treatments with longer survival and progression-free periods. Patients were less likely to favour cytoreductive prostatectomy with systemic therapy (Coef. -0.448; [95% confidence interval {CI} -0.60 to -0.29]; p < 0.001), unless combined with metastasis-directed therapy. Cytoreductive prostate radiotherapy or ablation with systemic therapy, number of hospital visits, use of a "day-case" procedure, or addition of stereotactic ablative body radiotherapy did not impact treatment choice. Patients were willing to accept an additional cytoreductive treatment with 10 percentage point increases in the risk of urinary incontinence and fatigue to gain 3.4 mo (95% CI 2.8-4.3) and 2.7 mo (95% CI 2.3-3.1) of overall survival, respectively. CONCLUSIONS AND CLINICAL IMPLICATIONS Patients are accepting of additional cytoreductive treatments for survival benefit in mHSPC, prioritising preservation of urinary function and avoidance of fatigue. PATIENT SUMMARY We performed a large study to ascertain how patients diagnosed with advanced (metastatic) prostate cancer at their first diagnosis made decisions regarding additional available treatments for their prostate and cancer deposits (metastases). Treatments would not provide cure but may reduce cancer burden (cytoreduction), prolong life, and extend time without cancer progression. We reported that most patients were willing to accept additional treatments for survival benefits, in particular treatments that preserved urinary function and reduced fatigue.
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Affiliation(s)
- Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Mesfin Genie
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK; Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia; Department of Population Health Sciences, Duke University, Durham, USA
| | - Tim Dudderidge
- Urology, University Hospital Southampton, Southampton, UK
| | - Hangjian Wu
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Johanna Sukumar
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath, Bath, UK
| | - Diletta Bianchini
- Department of Oncology and Urology, Medway Maritime Hospital, Kent, UK
| | - Chee Goh
- Department of Oncology, East Surrey Hospital, Redhill, UK
| | - Gail Horan
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - Vincent Khoo
- Department of Oncology, The Royal Marsden Hospital, London, UK
| | | | - Sanjeev Madaan
- Department of Urology, Dartford and Gravesham NHS Trust, Kent, UK
| | - Stephen Mangar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Stuart McCracken
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Peter Ostler
- Department of Oncology, Luton and Dunstable University Hospital, Luton, UK
| | - Sangeeta Paisey
- Department of Oncology, Hampshire Hospitals NHS Foundation Trust, Basingstoke and Winchester, UK
| | - Angus Robinson
- Department of Oncology, Royal Sussex County Hospital, Brighton, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Freeman Hospital, Newcastle, UK
| | - Naveed Sarwar
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Kamal Thippu Jayaprakash
- Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust & The Cancer Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Mohini Varughese
- Department of Oncology, Royal Devon and Exeter NHS Foundation Trust, Oncology, Exeter, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Urology, West Middlesex University Hospital, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer Imperial College London, London, UK; Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Institute of Applied Health Science, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Almouzain L, Hamilton FL, Chard D, Stevenson F. Qualitative user experience evaluation of the MS trust's online treatment decision aid tool's accommodation of planning pregnancy. Mult Scler J Exp Transl Clin 2024; 10:20552173241262181. [PMID: 38873031 PMCID: PMC11171435 DOI: 10.1177/20552173241262181] [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: 02/28/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
Background Decision-making about treatment when planning a pregnancy (family planning) is complex for women living with multiple sclerosis (MS). Decision tools can help this process, in 2016 MS Trust launched their online digital treatment decision tool to support people with MS. Objectives To evaluate user-experience of this tool by exploring women's opinions about its content, interface, and usefulness in the context of family planning; and to synthesize recommendations to improve the tool. Methods Thirty participants qualitatively evaluated the tool using Think Aloud methodology. Sessions were conducted online using Microsoft Teams and were video recorded. Transcription was automated and data were thematically analyzed. Results Women's first impression was that the tool presented a lot of information at once, which was difficult to take in, and they found it difficult to navigate. Although the tool was helpful in allowing them to compare treatment options, the filters were confusing, and the information related to pregnancy sometimes contradicted advice from their healthcare practitioners. They suggested rewording the pregnancy recommendations and filters, updating some content, and making some changes to the interface to meet users' cognitive needs. Conclusion The MS Trust treatment decision tool is excellent in helping women with treatment choices at initial diagnosis. However, it is not currently as useful when considering family plans. Recommendations were conveyed to MS Trust where some are now applied to the new live version and the rest are to be considered for future updating projects.
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Affiliation(s)
- Lubna Almouzain
- Research Department at Primary Care and Population Health, Institution of Epidemiology, University College of London, London, UK
- Assistant Professor at Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia
| | - Fiona L. Hamilton
- Associate Professor in Primary Care & Population Health Department, University College of London, London, UK
| | - Declan Chard
- Principal Clinical Research Associate, Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, London, UK
| | - Fiona Stevenson
- Professor of Medical Sociology Primary Care & Population Health, University College of London, London, UK
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Würtz HJ, Rahr HB, Lindebjerg J, Edwards A, Steffensen KD. Impact of an in-consult patient decision aid on treatment choices and outcomes of management for patients with an endoscopically resected malignant colorectal polyp: a study protocol for a non-randomised clinical phase II study. BMJ Open 2023; 13:e073900. [PMID: 37963688 PMCID: PMC10649383 DOI: 10.1136/bmjopen-2023-073900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Management of an endoscopically resected malignant colorectal polyps can be challenging due to the risk of residual tumour and lymphatic spread. International studies have shown, that of those choosing surgical management instead of surveillance strategy, there are between 54% and 82% of bowel resections without evidence of residual tumour or lymphatic spread. As surgical management entails risks of complications and surveillance strategy entails risks of residual tumour or recurrence, a clinical dilemma arises when choosing a management strategy. Shared decision-making is a concept that can be used in preference-sensitive decision-making to facilitate patient involvement and empowerment to facilitate active patient participation in the decision-making process. METHODS AND ANALYSIS This study protocol describes our clinical multi-institutional, non-randomised, interventional phase II study at Danish surgical departments planned to commence in the second quarter of 2024. The aim of this study is to examine whether shared decision-making and using a patient decision aid in consultations affect patients' choice of management, comparing with retrospective data. The secondary aim is to investigate patients' experiences, perceived involvement, satisfaction, decision conflict and other outcomes using questionnaire feedback directly from the patients. ETHICS AND DISSEMINATION There are no conflicts of interest for principal or local investigators in any of the study sites. All results will be published at Danish and international meetings, and in English language scientific peer-reviewed journals. Our study underwent evaluation by the Regional Committees on Health Research Ethics for Southern Denmark (file number 20232000-47), concluding that formal approval was not required for this kind of research. TRIAL REGISTRATION NUMBER NCT05776381.
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Affiliation(s)
- Helene Juul Würtz
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Hans Bjarke Rahr
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jan Lindebjerg
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Pathology at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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Chu CD, Smith CE, Gorski J, Smolkin M, Zhao H, Jones RA, Hollen P, Dengel LT. Implementation of a Novel Patient Decision Aid for Women with Elevated Breast Cancer Risk Who Are Considering MRI Screening: A Pilot Study. Ann Surg Oncol 2023; 30:6152-6158. [PMID: 37505352 DOI: 10.1245/s10434-023-13901-w] [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: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE To determine the feasibility and acceptability of using a patient decision aid (DA) for women with elevated breast cancer risk who are considering MRI screening. METHODS This pilot study employed a mixed methods design to develop, modify, and test an interactive DA. The DA was administered among a consecutive patient sample with an estimated Tyrer-Cuzick v.8 lifetime breast cancer risk of 20% or greater and without a pathologic genetic mutation. The decisional conflict scale was used to measure decisional conflict. Post-intervention provider and patient feedback evaluated shared decision-making, feasibility, and acceptability. RESULTS Twenty-four patients participated, with a median age of 44 years. Prior to DA use, sixteen patients (67%) were unsure whether to add MRI to their screening, six patients elected MRI (25%), and two patients declined MRI (8%). Following DA use, thirteen of sixteen of the initially undecided participants (81%) established a preference, with eleven electing to add MRI screening. Of participants with an initial preference, all maintained the same decision following use of the DA. Prior to the DA, the median decisional conflict score among participants was 25% (range 0-60%) compared with 0% (range 0-25%) after the DA. Healthcare providers reported that the DA was useful and easily incorporated into clinical workflow. CONCLUSIONS This pilot study shows that there may be a benefit to DA utilization in the high-risk breast cancer clinic to guide shared decision-making in establishing a screening preference. The findings warrant further research to test the use of the DA in a larger, multi-site trial.
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Affiliation(s)
- Crystal D Chu
- University of Virginia School of Nursing, Charlottesville, VA, USA.
| | - Caleigh E Smith
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Mark Smolkin
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Hui Zhao
- James Madison University School of Nursing, Harrisonburg, VA, USA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Patricia Hollen
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Lynn T Dengel
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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van Delft LCJ, Essers BAB, Nelemans PJ, Mosterd K, van Winden MEC, Romaen IFL, Retra SJJ, Arits AHMM, Steijlen PM, Lubeek SFK, Kelleners-Smeets NWJ. Effectiveness of a patient decision aid for patients with superficial basal cell carcinoma: A pre- and post-implementation study. PATIENT EDUCATION AND COUNSELING 2023; 115:107907. [PMID: 37487347 DOI: 10.1016/j.pec.2023.107907] [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: 01/31/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE This study evaluates whether using a patient decision aid (PDA) for patients with superficial basal-cell carcinoma (sBCC) results in a decreased decisional conflict level and increased knowledge. METHODS In a prospective multicentre study, patient groups were included before and after implementation of a PDA. Decisional conflict levels were compared directly after making the treatment decision, measured once as the mean score on the decisional conflict scale (DCS). Higher scores correspond with higher conflict levels (0-100). Secondary outcomes were knowledge on treatment options, recognizing a BCC, and risk factors for developing a BCC measured on an adapted version of a validated knowledge questionnaire for melanoma patients, and patient satisfaction with the PDA. RESULTS Data was available for 103 patients in the control-group and 109 in the PDA-group. The mean DCS score in the control-group was 22.78 (SD 14.76) compared to 22.34 (SD 14.54) in the PDA-group; the decrease was non-significant (p = 0.828). The average percentage correct answers on the knowledge questionnaire increased from 76.5% in the control-group to 80.5% in the PDA-group (p = 0.044). According to the majority of patients in the PDA-group (73.7%) the PDA had added value. CONCLUSION Using the PDA had no significant effect on decisional conflict levels, but increased overall knowledge on relevant issues concerning sBCC. PRACTICE IMPLICATIONS The PDA can be used as an informational tool by patients with sBCC.
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Affiliation(s)
- Lieke C J van Delft
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands.
| | - Brigitte A B Essers
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
| | | | - Ine F L Romaen
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
| | - Sean J J Retra
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Aimee H M M Arits
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Dermatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Peter M Steijlen
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
| | - Satish F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, the Netherlands
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Pacyna JE, Dueck AC, Chang GJ, Chow S, Paskett ED, Kim S, Tilburt JC. Lessons learned from conducting the first cancer care delivery trial in the Alliance for Clinical Trials in Oncology (Alliance A191402CD). Clin Trials 2023; 20:559-563. [PMID: 37050880 PMCID: PMC10523847 DOI: 10.1177/17407745231167123] [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] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Testing healthcare delivery interventions in rigorous clinical trials is a critical step in improving patient care, but conducting multisite randomized clinical trials to test the effect of care delivery interventions has unique challenges and requires foresight and planning. METHODS We conducted the first care delivery trial (A191402CD) in the Alliance for Clinical Trials in Oncology, a National Cancer Institute Community Oncology Research Program research base, which tested the effectiveness of two different decision aids for supporting shared decision-making about prostate cancer treatment. Our experience illustrates the kind of challenges that confront care delivery researchers as they seek to test interventions to improve the experiences of patients. RESULTS Lessons learned include the following: cluster-randomized designs introduce complexity; workflow disruption can discourage site participation; evidence-based methods may not always be sufficient. CONCLUSION We conclude with the following recommendations: assessing feasibility requires special rigor; relationships and interpersonal dynamics must be leveraged. Our experiences may inform future care delivery research.
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Affiliation(s)
- Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Selina Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL, USA
| | | | - Simon Kim
- Division of Urology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Dennison Himmelfarb CR, Beckie TM, Allen LA, Commodore-Mensah Y, Davidson PM, Lin G, Lutz B, Spatz ES. Shared Decision-Making and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 2023; 148:912-931. [PMID: 37577791 DOI: 10.1161/cir.0000000000001162] [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: 08/15/2023]
Abstract
Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues. Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions. This scientific statement shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities. Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.
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Kiss A, Lewis KB, Légaré F, Pacheco-Brousseau L, Zhang Q, Wilding L, Sikora L, Stacey D. Appraising publicly available online resources to support patients considering decisions about medical assistance in dying in Canada: an environmental scan. CMAJ Open 2023; 11:E869-E883. [PMID: 37788864 PMCID: PMC10558241 DOI: 10.9778/cmajo.20220224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized in Canada in 2016, with legislation updated in 2021. It is unclear whether resources are available to help patients make this difficult decision; therefore, we sought to identify and quality appraise Canadian MAiD resources for supporting patients making this decision. METHODS We conducted an environmental scan by searching Canadian websites for online MAiD resources that were published after the 2016 MAiD legislation, patient targeted, publicly accessible and able to inform decisions about MAiD in Canada. We excluded resources that targeted health care professionals or policy-makers, service protocols and personal narratives. Two authors appraised resources using the International Patient Decision Aids Standards (IPDAS) criteria and the Patient Education Materials Assessment Tool (PEMAT) for health literacy. Descriptive analysis was conducted. We defined resources as patient decision aids if 7 IPDAS defining criteria were met, and we rated resources as adequate for understandability or actionability if the PEMAT score was 70% or greater. RESULTS We identified 80 MAiD resources. As of March 2023, 62 resources (90%) provided eligibility according to the 2021 legislation and 11 did not discuss any eligibility criteria. The median IPDAS score was 3 out of 7; 52% discussed alternative options and none provided benefits or harms. Of 80 resources, 59% were adequate for understandability and 29% were adequate for actionability. INTERPRETATION Although many resources on MAiD were updated with 2021 legislation, few were adequate to support patients with lower health literacy. There is a need to determine whether a patient decision aid would be appropriate for people in Canada considering MAiD.
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Affiliation(s)
- Alda Kiss
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont.
| | - Krystina B Lewis
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - France Légaré
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Lissa Pacheco-Brousseau
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Qian Zhang
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Laura Wilding
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Lindsey Sikora
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
| | - Dawn Stacey
- School of Nursing (Kiss, Lewis, Zhang, Stacey), Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Faculty of Medicine (Légaré), Université Laval, Laval, Que.; School of Rehabilitation Sciences (Pacheco-Brousseau), Faculty of Health Sciences, University of Ottawa; The Ottawa Hospital (Wilding); Faculty of Health Sciences (Sikora), University of Ottawa; Centre for Implementation Research (Stacey), Ottawa Hospital Research Institute, Ottawa, Ont
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Barradell AC, Gerlis C, Houchen-Wolloff L, Bekker HL, Robertson N, Singh SJ. Systematic review of shared decision-making interventions for people living with chronic respiratory diseases. BMJ Open 2023; 13:e069461. [PMID: 37130669 PMCID: PMC10163462 DOI: 10.1136/bmjopen-2022-069461] [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] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Shared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients' pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome). DESIGN We conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools. DATA SOURCES MEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023. ELIGIBILITY CRITERIA Trials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken. RESULTS Eight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies. CONCLUSIONS These findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice. PROSPERO REGISTRATION NUMBER CRD42020169897.
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Affiliation(s)
- Amy C Barradell
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- College of Medicine, Biological Sciences & Psychology, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Charlotte Gerlis
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUICD), University of Leeds, Leeds, UK
- Research Centre for Patient Involvement, Central Denmark Region and Aarhus University, Aarhus, Denmark
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
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Fisher A, Eugene Dit Rochesson S, Harvey LR, Marel C, Mills KL. Development and pilot of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Purpose
Evidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).
Design/methodology/approach
ADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.
Findings
Of the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).
Originality/value
ADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.
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Leung T, Portz J, Fischer SM, Greenway E, Johnson RL, Knoepke CE, Matlock DD, Omeragic F, Peterson RA, Ranney ML, Betz ME. A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e43702. [PMID: 36719721 PMCID: PMC9929727 DOI: 10.2196/43702] [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: 10/22/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Firearm safety among individuals with Alzheimer disease and related dementias (ADRD) is an underdiscussed and underresearched concern in the United States, especially given the growing population of community-dwelling adults with ADRD. The "Safety in Dementia" (SiD) web-based decision aid was developed to support caregivers in addressing firearm access; the efficacy of SiD is unknown. OBJECTIVE Through the SiD decision aid, the Safe at Home (S@H) study aims to support caregivers in making decisions about home safety that align with their goals and values, and behaviors regarding firearm access for persons with ADRD and firearm access. METHODS The S@H study is a 2-armed randomized controlled trial to test the effect of the SiD decision aid on caregivers of community-dwelling adults with ADRD who have firearm access. S@H aims to recruit 500 ADRD caregivers (age ≥18 years, fluent in English or Spanish, and in the United States) through online or social media advertisements and through relevant organizations. Participants are randomized to view SiD or a control website at their own pace; all participants complete web-based questionnaires at baseline, 2 weeks, 2 months, and 6 months. The primary outcome is immediate preparation for decision-making; secondary outcomes include longitudinal decision outcomes and self-reported modifications to firearm access. The relative reach and effectiveness of each recruitment method (online/social media and through relevant organizations) will be assessed by examining differences in caregiver participation, retention rates, and relative cost. RESULTS The study enrollment began in May 2022. As of December 2022, a total of 117 participants had enrolled. CONCLUSIONS The S@H study is the first randomized trial of a firearm safety decision aid for ADRD caregivers. The results from this study will inform how best to support caregivers in decision-making regarding firearm safety. Further, results may guide approaches for recruiting caregivers and for dissemination of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05173922; https://clinicaltrials.gov/ct2/show/NCT05173922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43702.
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Affiliation(s)
| | - Jennifer Portz
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stacy M Fischer
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily Greenway
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher E Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel D Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Brown University, Providence, RI, United States.,School of Public Health, Brown University, Providence, RI, United States.,Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States
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Xu RH, Wang LL, Zhou LM, Wong ELY, Wang D. Assessment of eHealth literacy to reduce financial toxicity and improve shared decision-making in cancer patients: A cross-sectional study. Digit Health 2023; 9:20552076231181475. [PMID: 37334320 PMCID: PMC10272650 DOI: 10.1177/20552076231181475] [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: 10/27/2022] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives This study aimed to investigate the associations between eHealth literacy, preferences for financial decision-making, and financial toxicity (FT) in a sample of Chinese cancer patients. Methods Eligible cancer patients were invited to participate in a cross-sectional survey from January to April 2021. Three measures (eHealth literacy scale, control preference scale, and COST) were used to analyze patients' eHealth literacy, decisional preferences, and FT, respectively. Wilcoxon signed-rank test and Kruskal-Wallis H test assessed the differences between population subgroups. Binary logistic and multivariate linear regression models were used to assess the relationships between eHealth literacy, decisional preferences, and FT. Results A total of 590 cancer patients completed the questionnaire. We found that high FT was associated with poor ECOG performance, severe cancer stage, and longer cancer duration. Patients who preferred to adopt collaborative attitude toward decision-making showed a significantly higher eHealth literacy. However, there was an inverse relationship between eHealth literacy and a patient-driven attitude toward decision-making in female cancer patients. Regression analysis indicated that patients who were highly educated and actively employed might report a higher eHealth literacy. A significant relationship was found between high eHealth literacy and low FT. However, this relationship became insignificant when the background characteristics of cancer patients were taken into account. Conclusions A relationship between enhanced eHealth literacy, preference for collaborative decision-making, and low risk of FT is identified. Practical implication Interventions to improve patients' ability to use quality and reliable web-based information on cancer care should be encouraged.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ling-ling Wang
- Department of Blood Transfusion Medicine, School of Medicine, Nanjing University, Nanjing, China
| | - Ling-ming Zhou
- Department of Human Resource, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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Knoepke CE, Wallace BC, Allen LA, Lewis CL, Gupta SK, Peterson PN, Kramer DB, Brancato SC, Varosy PD, Mandrola JM, Tzou WS, Matlock DD. Experiences Implementing a Suite of Decision Aids for Implantable Cardioverter Defibrillators: Qualitative Insights From the DECIDE-ICD Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e009352. [PMID: 36378770 PMCID: PMC9680003 DOI: 10.1161/circoutcomes.122.009352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Shared decision making (SDM) is gaining importance in cardiology, including Centers for Medicare & Medicaid Services (CMS) reimbursement policies requiring documented SDM for patients considering primary prevention implantable cardioverter defibrillators. The DECIDE-ICD Trial (Decision Support Intervention for Patients offered implantable Cardioverter-Defibrillators) assessed the implementation and effectiveness of patient decision aids (DAs) using a stepped-wedge design at 7 sites. The purpose of this subanalysis was to qualitatively describe electrophysiology clinicians' experience implementing and using the DAs. METHODS This included semi-structured individual interviews with electrophysiology clinicians at participating sites across the US, at least 6 months following conversion into the implementation phase of the trial (from June 2020 through February 2022). The interview guide was structured according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance [implementation evaluation model]) framework, assessing clinician experiences, which can impact implementation domains, and was qualitatively assessed using a mixed inductive/deductive method. RESULTS We completed 22 interviews post-implementation across all 7 sites. Participants included both physicians (n=16) and other clinicians who counsel patients regarding treatment options (n=6). While perception of SDM and the DA were positive, participants highlighted reasons for uneven delivery of DAs to appropriate patients. The CMS mandate for SDM was not universally viewed as associating with patients receiving DA's, but rather (1) logistics of DA delivery, (2) perceived effectiveness in improving patient decision-making, and (3) match of DA content to current patient populations. Remaining tensions include the specific trial data used in DAs and reconciling timing of delivery with when patients are actively making decisions. CONCLUSIONS Clinicians charged with delivering DAs to patients considering primary prevention implantable cardioverter defibrillators were generally supportive of the tenets of SDM, and of the DA tools themselves, but noted several opportunities to improve the reach and continued use of them in routine care. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique Identifier: NCT03374891.
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Affiliation(s)
- Christopher E. Knoepke
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan C. Wallace
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry A. Allen
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carmen L. Lewis
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Pamela N. Peterson
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- Denver Health Medical Center, Denver, CO, USA
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Paul D. Varosy
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | | | - Wendy S. Tzou
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel D. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Development of a measure to assess the quality of proxy decisions about research participation on behalf of adults lacking capacity to consent: the Combined Scale for Proxy Informed Consent Decisions (CONCORD scale). Trials 2022; 23:843. [PMID: 36195929 PMCID: PMC9531498 DOI: 10.1186/s13063-022-06787-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recruitment of adults lacking the capacity to consent to trials requires the involvement of an alternative 'proxy' decision-maker, usually a family member. This can be challenging for family members, with some experiencing emotional and decisional burdens. Interventions to support proxy consent decisions in non-emergency settings are being developed. However, the ability to evaluate interventions is limited due to a lack of measures that capture outcomes of known importance, as identified through a core outcome set (COS). METHODS Using established measure development principles, a four-stage process was used to develop and refine items for a new measure of proxy decision quality: (1) findings from a recent scoping review and consensus study were reviewed to identify items for inclusion in the scale and any existing outcome measures, (2) assessment of content coverage by existing measures and identification of insufficiency, (3) construction of a novel scale, and (4) cognitive testing to explore comprehension of the scale and test its content adequacy through interviews with family members of people with impaired capacity. RESULTS A range of outcome measures associated with healthcare decision-making and informed consent decisions, such as the Decisional Conflict Scale, were identified in the scoping review. These measures were mapped against the key constructs identified in the COS to assess content coverage. Insufficient coverage of areas such as proxy-specific satisfaction and knowledge sufficiency by existing instruments indicated that a novel measure was needed. An initial version of a combined measure (the CONCORD scale) was drafted and tested during cognitive interviews with eleven family members. The interviews established comprehension, acceptability, feasibility, and content adequacy of the scale. Participants suggested re-phrasing and re-ordering some questions, leading to the creation of a revised version. CONCLUSIONS The CONCORD scale provides a brief measure to evaluate the quality of decisions made on behalf of an adult who lacks the capacity to consent in non-emergency settings, enabling the evaluation of interventions to improve proxy decision quality. Initial evaluation indicates it has content adequacy and is feasible to use. Further statistical validation work is being undertaken.
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Green AR, Aschmann H, Boyd CM, Schoenborn N. Association between willingness to deprescribe and health outcome priorities among U.S. older adults: Results of a national survey. J Am Geriatr Soc 2022; 70:2895-2904. [PMID: 35661991 PMCID: PMC9588518 DOI: 10.1111/jgs.17917] [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: 11/09/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is not known whether older adults' willingness to deprescribe is associated with their health outcome priorities related to medications. METHODS A cross-sectional survey was conducted from March-April 2020 using a nationally representative online panel. The survey presented two vignettes: (1) a preventive medicine; and (2) a symptom-relief medicine. Participants were asked whether they would be willing to stop each medicine if their doctor recommended it, and to rate their level of agreement with two health outcome priorities statements: "I am willing to accept the risk of future side effects … to feel better now," and "I would prefer to take fewer medicines, even if … I may not live as long or may have bothersome symptoms sometimes." Ordinal logistic regression was used to examine associations between willingness to stop each medicine, baseline characteristics and health outcome priorities. RESULTS Of 1193 panel members ≥65 years invited to participate, 835 (70%) completed the survey. Mean (SD) age was 73 years; 496 (59%) had taken a statin and 124 (15%) a prescription sedative-hypnotic. 507 (61%) were willing to stop preventive medicines; 276 (33%) were maybe willing. 419 (50%) were willing to stop symptom-relief medicines; 380 (46%) were maybe willing. Prioritizing fewer medicines was associated with higher odds of being willing to stop symptom-relief medicines (aOR 1.43 [95% CI 1.02-2.00]) and preventive medicines (aOR 1.52 [95% CI 1.05-2.18]). Prioritizing now over future was associated with lower odds of being willing to stop symptom-relief medicines (aOR 0.62 [95% CI 0.39-1.00]). Current/prior use of statins was associated with lower willingness to stop preventive medicines (aOR 0.66 [95% CI 0.48-0.91]). CONCLUSIONS Older adults' health outcome priorities related to medication use are associated with their willingness to consider deprescribing. Future research should determine how best to elicit patients' health outcome priorities to facilitate goal-concordant decisions about medication use.
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Affiliation(s)
- Ariel R. Green
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Hélène Aschmann
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Epidemiology, Biostatistics and Prevention InstituteUniversity of ZurichZurichSwitzerland
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA,Department of Health Policy and ManagementJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Nancy Schoenborn
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Loría-Rebolledo LE, Ryan M, Bond C, Porteous T, Murchie P, Adam R. Using a discrete choice experiment to develop a decision aid tool to inform the management of persistent pain in pharmacy: a protocol for a randomised feasibility study. BMJ Open 2022; 12:e066379. [PMID: 36137622 PMCID: PMC9511577 DOI: 10.1136/bmjopen-2022-066379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In an era of personalised healthcare, it has become increasingly important to elicit individual-level preferences. While discrete choice experiments (DCEs) are widely used to measure patient preferences in the delivery of healthcare, the focus has been sample-level analysis. Using the DCE methodology, this project has designed a digital decision aid tool (DAT) with the potential to estimate individual preferences in real time to inform clinical consultation decisions in persistent pain management. METHODS Using a feasibility randomised control trial, this study aims to assess the feasibility of using this Understanding Persistent Pain (UPP) DAT in a pharmacy-based clinical setting and to test processes for a future definite randomised trial. Community and practice-based pharmacists (up to 10) will be recruited in The National Health Service (NHS) Grampian and trained in the use of the digital UPP DAT. Pharmacists will recruit up to 60 patients who are living with persistent pain. Patients will be randomised to one of two groups: using the UPP DAT or usual care. Pharmacists will follow-up patients as needed according to clinical need and following standard practice. DCE response data collected by the UPP DAT will be analysed using the penalised logit model, allowing estimation of individual preferences in real time. We will follow-up pharmacists and patients who use the UPP DAT to gather feedback on their experiences. ETHICS AND DISSEMINATION This study received ethical approval from the North of Scotland Research Ethics Committee (21/NS/0059) and received Research & Development Management Permission to proceed from NHS Grampian (2021UA003E). The study has been registered in the ClinicalTrials.gov database. Findings will be disseminated in peer-reviewed publications, presentations and newsletters and made available in the University of Aberdeen and Pharmacy Research UK websites. Participants gave informed consent to participate in the study before taking part. TRIAL REGISTRATION NUMBER NCT05102578; clinicaltrials.gov.
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Affiliation(s)
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Terry Porteous
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter Murchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Rosalind Adam
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
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20
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Shepherd V. (Re)Conceptualising 'good' proxy decision-making for research: the implications for proxy consent decision quality. BMC Med Ethics 2022; 23:75. [PMID: 35850682 PMCID: PMC9294776 DOI: 10.1186/s12910-022-00809-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
People who are unable to make decisions about participating in research rely on proxies to make a decision based on their wishes and preferences. However, patients rarely discuss their preferences about research and proxies find it challenging to determine what their wishes would be. While the process of informed consent has traditionally been the focus of research to improve consent decisions, the more conceptually complex area of what constitutes 'good' proxy decision-making for research has remained unexplored. Interventions are needed to improve and support proxy decision-making for research but are hampered by a lack of understanding about what constitutes decision quality in this context. A global increase in conditions associated with cognitive impairment such as dementia has led to an urgent need for more research into these conditions. The COVID-19 pandemic and subsequent necessity to conduct research with large numbers of critically ill patients has made this need even more pressing. Much of the empirical research centres on the desire to improve decision accuracy, despite growing evidence that authenticity is more reflective of the aim of proxy decisions and concerns about the methodological flaws in authenticity-focused studies. Such studies also fail to take account of the impact of decision-making on proxies, or the considerable body of research on improving the quality of healthcare decisions. This paper reports a concept synthesis of the literature that was conducted to develop the first conceptualisation of 'good' proxy decisions about research participation. Elements of decision quality were identified across three stages of decision-making: proxy preparedness for decision-making which includes knowledge and understanding, and values clarification and preference elicitation; the role of uncertainty, decisional conflict, satisfaction and regret in the decision-making process; and preference linked outcomes and their effect. This conceptualisation provides an essential first step towards the future development of interventions to enhance the quality of proxy decision-making and ensure proxy decisions represent patients' values and preferences.
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Affiliation(s)
- Victoria Shepherd
- Centre for Trials Research, Cardiff University, 4th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 0GB, UK.
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21
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Barradell AC, Bourne C, Alkhathlan B, Larkin M, Singh SJ. A qualitative assessment of the pulmonary rehabilitation decision-making needs of patients living with COPD. NPJ Prim Care Respir Med 2022; 32:23. [PMID: 35768417 PMCID: PMC9243001 DOI: 10.1038/s41533-022-00285-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary rehabilitation (PR) is highly evidenced but underutilised in patients living with chronic obstructive pulmonary disease (COPD). A menu of centre and home-based programmes is available to facilitate uptake but is not routinely offered. An appraisal of the current PR referral approach compared to a menu-based approach was warranted to explore the decision-making needs of patients living with COPD when considering a referral to PR. Face-to-face or telephone, semi-structured interviews were conducted with patients diagnosed with COPD and referred to PR and referring HCPs. Interviews were audio-recorded, transcribed verbatim and analysed using the enhanced critical incident technique. 14 HCPs and 11 patients were interviewed (n = 25). Interview data generated 276 critical incidents which informed 28 categories (30 sub-categories). Five high-level themes captured patients' decision-making needs for PR: Understanding COPD, understanding PR, perceived ability to access PR, a desire to accept PR, and supporting the offer. A menu-based approach would further support patients' PR decision-making, however, insufficient knowledge of the programmes would limit its perceived feasibility and acceptability. The development of shared decision making interventions (e.g., a patient decision aid) to elicit patient-centred, meaningful discussions about the menu is suggested.
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Affiliation(s)
- A C Barradell
- Centre for Exercise & Rehabilitation Science (CERS), NIHR Leicester BRC (Respiratory), Glenfield Hospital, Leicester, UK.
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK.
- Applied Research Collaboration: East Midlands, College of Medicine, Biological Sciences and Psychology, Leicester General Hospital, Gwendoline Road, Leicester, UK.
| | - C Bourne
- Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, UK
| | - B Alkhathlan
- Centre for Exercise & Rehabilitation Science (CERS), NIHR Leicester BRC (Respiratory), Glenfield Hospital, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK
| | - M Larkin
- School of Life and Health Sciences, Aston University, Aston Street, Birmingham, UK
| | - S J Singh
- Centre for Exercise & Rehabilitation Science (CERS), NIHR Leicester BRC (Respiratory), Glenfield Hospital, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, University Road, Leicester, UK
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22
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Yung KK, Ardern CL, Serpiello FR, Robertson S. A Framework for Clinicians to Improve the Decision-Making Process in Return to Sport. SPORTS MEDICINE - OPEN 2022; 8:52. [PMID: 35416633 PMCID: PMC9008084 DOI: 10.1186/s40798-022-00440-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/23/2022] [Indexed: 12/14/2022]
Abstract
Return-to-sport (RTS) decisions are critical to clinical sports medicine and are often characterised by uncertainties, such as re-injury risk, time pressure induced by competition schedule and social stress from coaches, families and supporters. RTS decisions have implications not only for the health and performance of an athlete, but also the sports organisation. RTS decision-making is a complex process, which relies on evaluating multiple biopsychosocial factors, and is influenced by contextual factors. In this narrative review, we outline how RTS decision-making of clinicians could be evaluated from a decision analysis perspective. To begin with, the RTS decision could be explained as a sequence of steps, with a decision basis as the core component. We first elucidate the methodological considerations in gathering information from RTS tests. Second, we identify how decision-making frameworks have evolved and adapt decision-making theories to the RTS context. Third, we discuss the preferences and perspectives of the athlete, performance coach and manager. We conclude by proposing a framework for clinicians to improve the quality of RTS decisions and make recommendations for daily practice and research.
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Affiliation(s)
- Kate K Yung
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Clare L Ardern
- Musculoskeletal and Sports Injury Epidemiology Centre, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Fabio R Serpiello
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sam Robertson
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Hamid M, Rogers E, Chawla G, Gill J, Macanovic S, Mucsi I. Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review. Transplantation 2022; 106:722-733. [PMID: 34260472 DOI: 10.1097/tp.0000000000003893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient-Doctor Communication. Jt Comm J Qual Patient Saf 2022; 48:233-240. [PMID: 35177360 PMCID: PMC9941976 DOI: 10.1016/j.jcjq.2022.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low-value medical testing is a major component of health care overuse, both directly and through the potential for borderline and/or incidental results to trigger cascades (downstream services of uncertain value). The costs and harms from marginal test results and their cascades can add up. It is thus important to both prevent low-value tests at the outset and mitigate cascades when they arise. METHODS Informed by a framework for understanding and reducing overuse of care, this study employed user-centered design methods (focus groups and 1:1 design meetings) with patients and primary care physicians (PCPs) to understand the problem and iteratively develop an intervention. RESULTS Design meetings with 15 PCPs, 12 patients, and 3 patient focus groups revealed myriad drivers for medical test overuse and cascades. Patients commonly believed that all medical tests yield definitive results and lack downsides. PCPs cited expert recommendations, limited time during visits, fear of lawsuits, and desire to be responsive to patients as reasons for ordering potentially low-value medical tests. To address these issues, an intervention was designed using patient pre-visit educational materials, clinician reference materials on test interpretation and incidental findings, and clinician peer comparison on test overuse. CONCLUSION Overuse of medical testing is driven by a range of factors related to PCPs, patients, and their interactions. Multipronged interventions may have the potential to address these drivers after they are rigorously tested.
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25
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Barradell AC, Singh SJ, Houchen-Wolloff L, Robertson N, Bekker HL. A pulmonary rehabilitation shared decision-making intervention for patients living with COPD: PReSent: protocol for a feasibility study. ERJ Open Res 2022; 8:00645-2021. [PMID: 35677396 PMCID: PMC9168082 DOI: 10.1183/23120541.00645-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background Despite the variety of pulmonary rehabilitation programmes for patients living with COPD, uptake remains low. To improve this, it is recommended that health professionals engage patients in informed decisions about pulmonary rehabilitation. Shared decision-making (SDM) facilitates informed and value-based decision-making between patients and health professionals. This protocol describes the development and evaluation of a complex SDM intervention for patients living with COPD, who are referred for pulmonary rehabilitation, and their pulmonary rehabilitation health professional. Methods and analysis We are developing a complex SDM intervention involving a patient decision aid (PtDA) and a decision coaching workshop. Prior to patient recruitment, pulmonary rehabilitation health professionals will attend the workshop. Upon referral to pulmonary rehabilitation, patients will receive the PtDA to support their decision-making prior to and during their pulmonary rehabilitation assessment with a health professional. The intervention will be evaluated in a one-arm exploratory study to investigate its feasibility and acceptability for patients and health professionals, with an integrated fidelity assessment. The primary outcome is recruitment feasibility, data collection feasibility and intervention fidelity. Secondary outcomes include routine pulmonary rehabilitation data, decisional conflict, patient activation, intervention attendance/attrition and patient and pulmonary rehabilitation health professional experience of the intervention. Quantitative outcomes will be evaluated using the most appropriate statistical test, dependent on the sample distribution. Qualitative outcomes will be evaluated using reflexive thematic analysis. Fidelity will be assessed using the Observer OPTION 5 scale. Conclusion This intervention will provide structure for an informed and values-based decision-making consultation between a patient with COPD and a pulmonary rehabilitation health professional with the potential for optimising pulmonary rehabilitation decision-making.
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Affiliation(s)
- Amy C. Barradell
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
- National Institute for Health Research Applied Research Collaboration (East Midlands), College of Medicine, Biological Sciences and Psychology, Leicester General Hospital, Leicester, UK
| | - Sally J. Singh
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
| | - Linzy Houchen-Wolloff
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, UK
| | - Noelle Robertson
- Dept of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development, School of Medicine, University of Leeds, Leeds, UK
- Research Centre for Patient Involvement, Central Denmark Region and Aarhus University, Aarhus, Denmark
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26
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Decisional Conflict after Deciding on Potential Participation in Early Phase Clinical Cancer Trials: Dependent on Global Health Status, Satisfaction with Communication, and Timing. Cancers (Basel) 2022; 14:cancers14061500. [PMID: 35326653 PMCID: PMC8946532 DOI: 10.3390/cancers14061500] [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: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023] Open
Abstract
When standard treatment options are not available anymore, patients with advanced cancer may participate in early phase clinical trials. Improving this complex decision-making process may improve their quality of life. Therefore, this prospective multicenter study with questionnaires untangles several contributing factors to decisional conflict (which reflects the quality of decision-making) in patients with advanced cancer who recently decided upon early phase clinical trial participation (phase I or I/II). We hypothesized that health-related quality of life, health literacy, sense of hope, satisfaction with the consultation, timing of the decision, and the decision explain decisional conflict. Mean decisional conflict in 116 patients was 30.0 (SD = 16.9). Multivariate regression analysis showed that less decisional conflict was reported by patients with better global health status (β = −0.185, p = 0.018), higher satisfaction (β = −0.246, p = 0.002), and who made the decision before (β = −0.543, p < 0.001) or within a week after the consultation (β = −0.427, p < 0.001). These variables explained 37% of the variance in decisional conflict. Healthcare professionals should realize that patients with lower global health status and who need more time to decide may require additional support. Although altering such patient intrinsic characteristics is difficult, oncologists can impact the satisfaction with the consultation. Future research should verify whether effective patient-centered communication could prevent decisional conflict.
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27
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Parry M, Ceroni T, Wells D, Richards DP, Toupin-April K, Ansari H, Bjørnnes AK, Burnside H, Cavallo S, Day A, Ellis A, Feldman D, Gilron I, Najam A, Zulfiqar Z, Marlin S. Patient engagement partnerships in clinical trials (PEP-CT): protocol for the systematic development and testing of patient partner and investigator decision aids. BMJ Open 2022; 12:e060267. [PMID: 35190448 PMCID: PMC8862478 DOI: 10.1136/bmjopen-2021-060267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Building capacity to improve sex/gender knowledge and strengthen patient engagement in clinical trials requires training and support. The overall goal of this 2-year project is to refine, translate and evaluate two web-based open-access patient and investigator decision aids aimed to improve patient engagement partnerships in clinical trials. METHODS AND ANALYSIS Two decision aids were designed in Phase 1 of this programme of research and this protocol describes a subsequent sequential phased approach to refine/translate (Phase 2A) and conduct alpha/usability (Phase 2B) and beta/field (Phase 3) testing. Decision aid development is guided by the International Patient Decision Aid Standards, User-Centred Design, Ottawa Decision-Support Framework and the Ottawa Model of Research Use. We have integrated patient-oriented research methods by engaging patient partners across all phases of our programme of research. Decision aids will first be refined and then translated to French (Phase 2A). Eight iterative cycles of semistructured interviews with 40 participants (20 patient partners and 20 investigators) will be conducted to determine usability (Phase 2B). A pragmatic pre/post pilot study design will then be implemented for field/beta testing using another purposive sample of 80 English-speaking and French-speaking participants (40 patients and 40 investigators). The samples are purposive to ensure an equal representation of English-speaking and French-speaking participants and an equal representation of men and women. Since sex and/or gender differences in utilisation and effectiveness of decision aids have not been previously reported, Phase 3 outcomes will be reported for the total sample and separately for men and women. ETHICS AND DISSEMINATION Ethics approval has been granted from the University of Toronto (41109, 28 September 2021). Informed consent will be obtained from participants. Dissemination will include co-authored publications, conference presentations, educational national public forums, fact sheets/newsletters, social media sharing and videos/webinars.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tina Ceroni
- Clinical Trials Ontario, Toronto, Ontario, Canada
| | - David Wells
- Diabetes Action Canada, Toronto, Ontario, Canada
| | | | - Karine Toupin-April
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Hafsa Ansari
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Heather Burnside
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Andrew Day
- Department of Community Health and Epidemiology and CERU, Queen's Unversity, Kingston, Ontario, Canada
| | - Anne Ellis
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Debbie Feldman
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Ian Gilron
- Departments of Anesthesiology and Perioperative Medicine, Biomedical and Molecular Sciences and School of Policy Studies, Queen's University, Kingston, Ontario, Canada
| | | | - Zoya Zulfiqar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marlin
- Clinical Trials Ontario, Toronto, Ontario, Canada
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Farrell B, Dilliott D, Richardson L, Conklin J, McCarthy LM, Raman-Wilms L. “Talking About Your Medications”: A workshop series aimed at helping older adults participate in conversations about their medications. Can Pharm J (Ott) 2022; 155:86-92. [PMID: 35300023 PMCID: PMC8922225 DOI: 10.1177/17151635221076075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Barbara Farrell
- Bruyère Research Institute, Ottawa, Ontario
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | | | | | - James Conklin
- Bruyère Research Institute, Ottawa, Ontario
- Concordia University, Montreal, Quebec
| | - Lisa M. McCarthy
- Bruyère Research Institute, Ottawa, Ontario
- Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine
| | - Lalitha Raman-Wilms
- University of Toronto, Toronto, Ontario; and the College of Pharmacy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Broadbent R, Seale T, Armitage CJ, Linton K. The development of a decision aid to support Hodgkin lymphoma survivors considering lung cancer screening. BMC Med Inform Decis Mak 2022; 22:29. [PMID: 35105364 PMCID: PMC8805261 DOI: 10.1186/s12911-022-01768-y] [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: 10/05/2021] [Accepted: 01/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decisions aids (DA) can support patients to make informed decisions about screening tests. This study describes the development and initial evaluation of a lung cancer screening (LCS) DA targeted towards survivors of Hodgkin lymphoma (HL). METHODS A prototype decision aid booklet was developed and subsequently reviewed by a steering group who provided feedback. Revisions were made to produce the DA tested in this study. HL survivors were recruited to an online survey and/or focus groups. Lymphoma practitioners were invited to an interview study. In the online survey, decisional conflict scales and knowledge scales were completed before and after accessing the DA. The focus groups and interviews explored acceptability and comprehensibility and the decisional needs of stakeholders. Focus groups and interviews were audio recorded. The framework method was used to analyse qualitative data. RESULTS 38 HL survivors completed the online survey. Following exposure to the DA, knowledge of LCS and risk factors and decisional conflict scores (total score and subscale scores) improved significantly. 11 HL survivors took part in two focus groups (n = 5 and n = 6) and 11 practitioners were interviewed. Focus group and interview results: The language, format and length were considered acceptable. Both groups felt the DA was balanced and presented a choice. Icon arrays were felt to aid comprehension of absolute risk values and for some survivors, they reduced affective risk perceptions. Among survivors, the impact of radiation risk on decision making varied according to gender and screening interval, whilst practitioners did not anticipate it to be a major concern for patients. Both groups expressed that a screening offer could mitigate anxiety about lung cancer risk. As anticipated by practitioners, survivors expressed a desire to seek advice from their clinical team. Practitioners thought the DA would meet their informational needs regarding LCS when supporting survivors. CONCLUSIONS The DA is considered acceptable by HL survivors and practitioners. The DA reduces decisional conflict and improves knowledge in HL survivors, suggesting that it would support HL survivors to make informed decisions when considering LCS in a future clinical trial.
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Affiliation(s)
- Rachel Broadbent
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. .,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK. .,The Christie NHS Foundation Trust, Manchester, UK.
| | - Tania Seale
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Christopher J Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.,Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kim Linton
- Manchester Cancer Research Centre, Wilmslow Road, Manchester, M20 4QL, UK
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A Novel Decision Aid Improves Quality of Reproductive Decision-Making and Pregnancy Knowledge for Women with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:4303-4314. [PMID: 35499712 PMCID: PMC9352739 DOI: 10.1007/s10620-022-07494-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more childlessness and fear of IBD medications in pregnancy. The Pregnancy in IBD Decision Aid (PIDA), developed by an international multidisciplinary team, offers personalized online decision support regarding pregnancy in IBD. AIMS Assess the impact of PIDA on quality of reproductive decision-making and pregnancy-related knowledge among preconception (PC) and pregnant patients with IBD, and evaluate acceptability to patients and clinicians. METHODS PC and pregnant patients with IBD aged 18-45 completed questionnaires pre- and post-PIDA to assess quality of decision-making (Decisional Conflict Scale (DCS); Decision Self-Efficacy Scale (DSES) and IBD-in-pregnancy knowledge (Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow)). Paired t test assessed for differences pre- and post-PIDA. Patients and clinicians completed acceptability surveys. RESULTS DCS and DSES were completed by 74 patients (42 Crohn's disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post-PIDA in PC patients regarding pregnancy planning (t(40) = 4.83, p < 0.0001, Cohen's dz = 0.75) and in pregnant patients regarding medication management (t(32) = 2.37, p = 0.0242, dz = 0.41). DSES for PC patients improved significantly post-PIDA (t(40) = -3.56, p = 0.001, dz = -0.56). CCPKnow improved significantly post-PIDA in PC (t(42) = 4.93, p < 0.0001, dz = -0.75) and pregnant patients (t(32) = 5.1, p < 0.0001, dz = -0.89). PIDA was deemed optimal for length, readability, and content amount and considered highly useful by patients (n = 73) and clinicians (n = 14). CONCLUSIONS Patients using PIDA developed an improved quality of reproductive decision-making and IBD-in-pregnancy knowledge. PIDA is an accessible tool that can empower women with IBD to make values-congruent, evidence-based decisions regarding pregnancy and may reduce voluntary childlessness.
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Shepherd V, Wood F, Robling M, Randell E, Hood K. Development of a core outcome set for the evaluation of interventions to enhance trial participation decisions on behalf of adults who lack capacity to consent: a mixed methods study (COnSiDER Study). Trials 2021; 22:935. [PMID: 34924004 PMCID: PMC8684591 DOI: 10.1186/s13063-021-05883-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/26/2021] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Trials involving adults who lack capacity to provide consent rely on proxy or surrogate decision-makers, usually a family member, to make decisions about participation. Interventions to enhance proxy decisions about trial participation are now being developed. However, a lack of standardised outcome measures limits evaluation of these interventions. The aim of this study was to establish an agreed standardised core outcome set (COS) for use when evaluating interventions to improve proxy decisions about trial participation. METHODS We used established methods to develop the COS including a consensus study with key stakeholder groups comprising those who will use the COS in research (researchers and healthcare professionals) and patients or their representatives. Following a scoping review to identify candidate items, we used a modified two-round Delphi survey to achieve consensus on core outcomes, with equivocal items taken to a consensus meeting for discussion. The COS was finalised following an online consensus meeting in October 2020. RESULTS A total of 28 UK stakeholders (5 researchers, 10 trialists, 3 patient/family representatives, 7 recruiters and 3 advisors/approvers) participated in the online Delphi survey to rank candidate items from the scoping review (n = 36) and additional items proposed by participants (n = 1). Items were broadly grouped into three categories: how family members make decisions, their experiences of making decisions, and the personal aspects that influence the decision. Following the Delphi survey, 27 items were included and ten items exhibited no consensus which required discussion at the consensus meeting. Sixteen participants attended the meeting, including additional patient/family representatives invited to increase representation from this key group (n = 2). We reached consensus for the inclusion of 28 outcome items, including one selected at the consensus meeting. CONCLUSIONS The study identified outcomes that should be measured as a minimum in all evaluations of interventions to enhance proxy decisions about trials. These relate to the process of decision-making, proxies' experience of decision-making, and factors that influence decision-making such as understanding. Further work with people with impairing conditions and their families is needed to explore their views about the COS and to identify appropriate outcome measures and timing of measurement. TRIAL REGISTRATION The study is registered on the COMET database ( https://www.comet-initiative.org/Studies/Details/1409 ).
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Affiliation(s)
- V Shepherd
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - F Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Cardiff, UK
| | - M Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - K Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Cardiff, UK
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Marques F, Josloff K, Hung K, Wakamatsu M, Sepucha KR. Decision aids and shared decision making in urogynecology. Menopause 2021; 29:178-183. [PMID: 34905749 DOI: 10.1097/gme.0000000000001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the efficacy and acceptability of decision aids (DAs) in counseling urogynecology patients with prolapse, stress urinary incontinence, or refractory overactive bladder. METHODS This pilot study enrolled 33 patients into a control group that underwent usual care without a DA, followed by 33 patients into an intervention group where providers utilized a DA for counseling. Postvisit patient surveys assessed differences in treatment preference, knowledge, and in patient-physician collaboration using SURE, CollaboRATE, and Shared Decision Making (SDM) Process scales. Postvisit provider surveys assessed their perception of the usefulness and the difficulty of using a DA and visit length. Independent t tests were used for continuous variables (Knowledge and SDM Process scores) and Chi-Square for categorical variables (treatment preference, SURE, and CollaboRATE). RESULTS The majority of eligible patients 66/71 (93%) completed the survey. The intervention group trended toward higher knowledge scores (72% vs 60%, P = 0.06), clearer treatment preferences (85% vs 67%, P = 0.08), higher rates of top SURE scale scores (91% vs 73%, P = 0.11), and top CollaboRATE scores (75% vs 52%, P = 0.07). SDM process scores were similar across groups (3.2 vs 3.2, P = 0.96). Providers used the DA in 73% of intervention group visits and rated the visit length as "normal" in both groups (70% vs 76%, P = 0.78). CONCLUSIONS There were no statistically significant differences between the control group and the intervention group. The use of DAs was acceptable to providers and indicated a trend toward increased patient knowledge, treatment preference, and satisfaction. A larger study is warranted to examine the impact of DAs on decision making and patient experience.
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Affiliation(s)
- Felisha Marques
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kevan Josloff
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kristin Hung
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA
| | - May Wakamatsu
- Vincent Obstetrics and Gynecology Department, Division of Female Pelvic Medicine and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
- Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, Boston, MA
| | - Karen R Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Hurley VB. Are patients really getting what they want? The routine implementation of decision aids for patients with hip or knee osteoarthritis in the high value healthcare collaborative and alignment between patient treatment choice and receipt. J Eval Clin Pract 2021; 27:1207-1215. [PMID: 33829617 DOI: 10.1111/jep.13570] [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: 11/24/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Alignment between patients' treatment choices and treatments received is acknowledged as an important outcome of shared decision-making (SDM), yet recent research suggests that patients' choices do not always align with their actual treatment trajectories. This paper explores the alignment of patient-expressed treatment choices (for surgery or medical management) after exposure to decision aids and treatments received among patients with hip or knee osteoarthritis within High Value Healthcare Collaborative (HVHC) systems as the collaborative integrated decision aids intended to support SDM into routine clinical practice. METHOD This retrospective cohort study examines data from adult (≥18 years) patients with hip or knee osteoarthritis who received decision aids as part of orthopaedic consultations within HVHC systems between 2012 and 2015. Multivariable logistic regression explored the association between patient-level characteristics with the odds of treatment choice-receipt alignment. RESULTS The majority of patients with knee osteoarthritis (68.3%) and hip osteoarthritis (71.9%) received treatments aligned with their choices following exposure to decision aids, but analyses reveal important differences in the odds of such alignment across patient characteristics. In adjusted models, African American patients with knee osteoarthritis had 50% lower odds of receiving treatment aligned with their choices compared with Caucasian patients (OR = 0.52, P < .05). Medicare- or Medicaid-insured knee patients had 49% and 59% lower odds (respectively) of receiving choice-aligned treatments relative to privately insured patients. Patients with knee (OR = 0.40, P < .01) or hip (OR = 0.75, P < .05) osteoarthritis at earlier decision-making stages had lower odds of receiving treatments congruent with their choices. CONCLUSION This work elucidates the odds of treatment choice-aligned care for patients within health care systems attempting to routinely integrate decision aids to support SDM into clinical practice and underscores the gaps in achieving this alignment among African American patients, those with public insurance and those at early decision-making stages.
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Affiliation(s)
- Vanessa B Hurley
- Health Systems Administration, Georgetown University, Washington, District of Columbia, USA
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Raphael D, Russell N, Winkens B, Immink J, Westhoff P, Stenfert Kroese M, Stam M, Bijker N, van Gestel C, van der Weijden T, Boersma L. A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices. Tech Innov Patient Support Radiat Oncol 2021; 20:1-9. [PMID: 34589620 PMCID: PMC8461042 DOI: 10.1016/j.tipsro.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict. MATERIAL AND METHODS We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis. RESULTS After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time. CONCLUSIONS Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
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Affiliation(s)
- D.B. Raphael
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - N.S. Russell
- Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute,Maastricht University, Maastricht, the Netherlands
| | - J.M. Immink
- Department of Radiation Oncology, Reinier de Graaf Hospital, Delft, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - P.G. Westhoff
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - M.R. Stam
- Radiotherapy Group, Arnhem, the Netherlands
| | - N. Bijker
- Department of Radiation Oncology, Amsterdam University Medical Centers, the Netherlands
| | | | - T. van der Weijden
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - L.J. Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Eiriksdottir VK, Jonsdottir T, Valdimarsdottir HB, Taylor KL, Schwartz MD, Hilmarsson R, Gudmundsson EO, Fridriksson JO, Baldursdottir B. An Adaptation, Extension and Pre-Testing of an Interactive Decision Aid for Men Diagnosed with Localized Prostate Cancer in Iceland: A Mixed-Method Study. Behav Med 2021; 49:137-150. [PMID: 34791986 DOI: 10.1080/08964289.2021.2000926] [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] [Indexed: 12/24/2022]
Abstract
In this study an interactive decision aid (DA) for men diagnosed with localized prostate cancer was adapted, extended and pre-tested. The DA's prototype was based on a literature review and other empirically tested DAs. Semi-structured interviews with 12 men (age 65-80) diagnosed with localized prostate cancer were conducted to get feedback on content, usability, and the DA's layout. The interviews were analyzed using thematic analysis and themes were identified using deductive and inductive coding. Participants found the accessibility of the information and the explicit values clarification tool helpful. Four themes were identified: (1) usability and design, (2) content and knowledge, (3) deciding factors of decision-making, and (4) social support. Participants valued receiving extensive and realistic information on surgery/radiation therapy side effects and getting unbiased presentations of treatment options. Following the thematic analysis, the DA was revised and tested in a survey among 11 newly diagnosed prostate cancer patients (age 60-74). The participants valued the DA and found it helpful when making a treatment decision, and all reported that they would recommend it to others making a prostate cancer treatment decision. The DA is currently being tested in a randomized clinical trial (RCT). This is the first DA developed for prostate cancer patients in Iceland and if the results of the RCT show that it is more effective than standard care in assisting newly diagnosed patients with their treatment decision, the DA can be easily translated and adapted to cultures similar to Iceland such as the Nordic countries.
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Affiliation(s)
| | | | - Heiddis B Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Cancer Prevention and Control, Ruttenberg Cancer Center, Mount Sinai School of Medicine
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Thomas EC, Suarez J, Lucksted A, Siminoff LA, Hurford I, Dixon LB, O'Connell M, Penn DL, Salzer MS. Facilitating treatment engagement for early psychosis through peer-delivered decision support: intervention development and protocol for pilot evaluation. Pilot Feasibility Stud 2021; 7:189. [PMID: 34689830 PMCID: PMC8543800 DOI: 10.1186/s40814-021-00927-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Emerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact. METHODS The intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engagement in the program) will also be assessed. Additionally, through observation and feedback from the peer decision coach and study participants, we will evaluate the feasibility of research and intervention procedures, and the acceptability of information and support from the peer decision coach. DISCUSSION The peer-delivered decision coaching intervention holds promise for assisting young people with making informed and values-consistent decisions about their care, and potentially enhancing service engagement within this traditionally difficult-to-engage population. If the intervention demonstrates feasibility and acceptability, and pilot data show its potential for improving treatment decision-making, our work will also lay the foundation for a new evidence base regarding roles for peer specialists on early intervention teams. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034 ) on 28 August 2020 as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis.
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Affiliation(s)
- Elizabeth C Thomas
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA.
| | - John Suarez
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
| | - Alicia Lucksted
- University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, 21201, USA
| | - Laura A Siminoff
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
| | - Irene Hurford
- Irene Hurford MD PLLC, 261 Old York Road #925, Jenkintown, PA, 19046, USA
| | - Lisa B Dixon
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Maria O'Connell
- Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
| | - David L Penn
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, 256 Davie Hall, Chapel Hill, NC, 27514, USA
- Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia
| | - Mark S Salzer
- Temple University College of Public Health, 1700 N Broad Street, Philadelphia, PA, 19121, USA
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Molina-Mula J. Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting. World J Clin Cases 2021; 9:8312-8326. [PMID: 34754841 PMCID: PMC8554413 DOI: 10.12998/wjcc.v9.i28.8312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/30/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships, patient-professional relationships, and moral ethics critique. Foucault tried to break loose from the self, which is merely the result of a biopolitical subjectivation and constituted an interpersonal level. From this, different elements involved in the decision-making capacity of patients in a clinical setting were analysed. Firstly, the context in which decision-making occurs has been explained, distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations. Secondly, an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called "techniques of the self". Finally, the ethical framework for a subject's "self-creation", insisting more on the exercises of self-subjectivation, reinforcing the ethics of the self by itself, the "care of the self", has been explained. The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient's autonomy in the clinical environment is constituted. All these elements could generate grounded theory on the qualitative methodology of this phenomenon. The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making, relegating to the background their opinions and beliefs. Consequently, a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.
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Affiliation(s)
- Jesús Molina-Mula
- Nursing and Physiotherapy Department, University of Balearics Island, Palma 07122, Illes Balears, Spain
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Shelswell J, Patel VA, Barber S. The effectiveness of interventions to increase patient involvement in decision-making in orthodontics: A systematic review. J Orthod 2021; 49:129-142. [PMID: 34569333 DOI: 10.1177/14653125211048202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the effectiveness of interventions that aim to increase patient involvement in treatment decisions in orthodontic, orthognathic and cleft treatment, based on patient-reported outcomes and patient knowledge. DESIGN Systematic review. DATA SOURCES OVID databases (MEDLINE, EMBASE and EBM reviews), CENTRAL, WHO's International Clinical Trials Registry Platform and reference lists of included studies. DATA SELECTION Studies were selected by two reviewers independently and in duplicate based on pre-defined eligibility criteria: Population: People considering or undergoing orthodontic, orthognathic or cleft treatment. Intervention: Any intervention that aims to increase patient involvement in decision-making. Outcomes: Patient-reported outcomes and patient knowledge. Studies: All experimental studies published in English from January 2000 to October 2019 were eligible. DATA EXTRACTION Standardised data extraction of study information and assessment of risk of bias using the Cochrane Risk of Bias Tool for RCTs and ROBINS-I for non-randomised studies of interventions. DATA SYNTHESIS 13 randomised controlled trials were included. Due to heterogeneity in the studies, a narrative synthesis was undertaken. The majority (n=11) of studies involved orthodontic patients, with one study of cleft patients and one study of orthognathic and orthodontic patients. Six included studies reported significant differences between intervention and control groups with improved patient knowledge or better patient-reported outcomes. CONCLUSIONS A variety of different interventions and outcome measures were used making data synthesis challenging. There is some evidence that interventions to increase patient involvement in decision-making can improve patient-reported outcomes and patient knowledge.
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Affiliation(s)
| | | | - Sophy Barber
- University of Leeds, Leeds, UK.,Mid Yorkshire NHS Hospitals Trust, Wakefield, UK
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Shunnmugam B, Ng CJ, Aishah Mohd Taib N, Chinna K. Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions. Asia Pac J Public Health 2021; 33:914-922. [PMID: 34467767 DOI: 10.1177/10105395211036625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts' opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.
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Affiliation(s)
- Bairave Shunnmugam
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Rivero-Santana A, Torrente-Jiménez RS, Perestelo-Pérez L, Torres-Castaño A, Ramos-García V, Bilbao A, Escobar A, Serrano-Aguilar P, Feijoo-Cid M. Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2021; 29:1265-1274. [PMID: 34174455 DOI: 10.1016/j.joca.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/03/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. METHOD Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). RESULTS The PtDA produced a significant immediate improvement of decisional conflict (MD = -11.65, 95%CI: -14.93, -8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. CONCLUSION The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.
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Affiliation(s)
- A Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - R S Torrente-Jiménez
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - L Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - A Torres-Castaño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - V Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - A Bilbao
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza/Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain.
| | - A Escobar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza/Basque Health Service, Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - P Serrano-Aguilar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - M Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017SGR 917), Barcelona, Spain.
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Knoepke CE, Chaussee EL, Matlock DD, Thompson JS, McIlvennan CK, Ambardekar AV, Schaffer EM, Khazanie P, Scherer L, Arnold RM, Allen LA. Changes over Time in Patient Stated Values and Treatment Preferences Regarding Aggressive Therapies: Insights from the DECIDE-LVAD Trial. Med Decis Making 2021; 42:404-414. [PMID: 34296623 PMCID: PMC8783927 DOI: 10.1177/0272989x211028234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Patient-centered care includes matching treatments to patient values and preferences. This assumes clarity and consistency of values and preferences relevant to major medical decisions. We sought to describe stability of patient-reported values regarding aggressiveness of care and preferences for left ventricular assist devices (LVADs) for advanced heart failure. Methods and Results We conducted a secondary analysis of patients undergoing LVAD evaluation at 6 US centers. Surveys at baseline, 1 month, and 6 months included a single 10-point scale on the value of aggressive care (score 1 = “do everything,” 10 = “live with whatever time I have left”) and treatment preference (LVAD, unsure, no LVAD). Data were captured for 232 patients, of whom 196 were ultimately deemed medically eligible for LVAD, and 161 were surgically implanted by 1 month. Values at baseline favored aggressive care (mean [SD], 2.49 [2.63]), trending toward less aggressive over time (1 month, 2.63 [2.05]; 6 months, 3.22 [2.70]). Between baseline and 1 month, values scores changed by ≥2 points in 28% (50/176), as did treatment preferences for 18% (29/161) of patients. Values score changes over time were associated with lower illness acceptance, depression, and eventual LVAD ineligibility. Treatment preference change was associated with values score change. Conclusion Most patients considering LVAD were stable in their values and treatment preferences. This stability, as well as the association between unstable treatment preferences and changes to stated values, highlighted the clinical utility of the values scale of aggressiveness. However, a substantial minority reported significant changes over time that may complicate the process of shared decision making. Improved methods to elicit and clarify values, including support to those with depression and low illness acceptance, is critical for patient-centered care. Highlights Self-reported values and preferences change significantly over time in about a quarter of patients actively considering left ventricular assist device implantation. Instability in stated values and preferences challenges clinicians who want to maximally match patient preferences to the treatments they receive. For most patients, clinicians can normalize the desire to maximize survival and empathize with the difficulty of making the decision. For others, clinicians may want to help patients explore the benefits and tradeoffs of therapy, including whether values other than the ones being asked about dominate their consideration.
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Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA.,Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Erin L Chaussee
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel D Matlock
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA.,Division of Geriatric Medicine, School of Medicine, University of Colorado, Aurora, CO, USA.,Section of Palliative Care and Medical Ethics, Division of General Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jocelyn S Thompson
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Colleen K McIlvennan
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA.,Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Amrut V Ambardekar
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Elisabeth M Schaffer
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Prateeti Khazanie
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Laura Scherer
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA.,Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Division of General Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Larry A Allen
- Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA.,Adult & Child Consortium for Health Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA
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Manners D, Pettigrew S, Lake FR, Piccolo F, McWilliams AM, Brims FJH. Development and evaluation of a consumer information resource, including Patient Decision Aid, for lung cancer screening: a quasi-experimental study. Transl Behav Med 2021; 10:404-412. [PMID: 30855087 DOI: 10.1093/tbm/ibz029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lung cancer screening of high-risk individuals with computed tomography is a promising intervention to reduce lung cancer mortality. Patient Decision Aids (PtDAs) may assist eligible individuals assess the risks and benefits associated with screening. Screening preference is high among lower-risk, screening-ineligible individuals and strategies are needed to reduce screening demand among this group. We developed and evaluated a resource comprising a recruitment pamphlet combined with either a PtDA for screening-eligible individuals or an education pamphlet for screening-ineligible individuals. Quasi-experimental pre-post pamphlet exposure design. Ever-smokers aged 55-80 years attending hospital outpatient clinics were invited. Among screening-eligible participants, the assessed outcome was change in score on the Decisional Conflict Scale (DCS). Among screening-ineligible participants, the assessed outcomes were change in screening preference. In the study 51% (55/107) of invited individuals participated, with mean ± standard deviation age 66.9 ± 6.4 years, 53% (29/55) male, and 65% (36/55) eligible for screening. Median (interquartile range) DCS among screening-eligible participants reduced from 28.9 (22.7-45.3) pre-PtDA to 25 (1.6-29.7) post-PtDA (p < .001), but there was no significant change in the proportion that reached the accepted threshold for decisional certainty (DCS < 25, 10/36 [28%] pre-exposure vs. 14/36 [39%] post-exposure, p = .1). Screening preference among screening-ineligible individuals reduced after viewing the screening-ineligible brochure (pre-exposure median of "Prefer" to post-exposure median of "Unsure," p = .001). Our consumer information pamphlets about lung cancer screening may reduce decisional conflict and improve alignment of screening preference with eligibility.
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Affiliation(s)
- David Manners
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Bentley, Western Australia, Australia
| | - Fiona R Lake
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Francesco Piccolo
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
| | - Annette M McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fraser J H Brims
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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43
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Michel J, Ballon J, Connor SE, Johnson DC, Bergman J, Saigal CS, Litwin MS, Alden DL. Improving Shared Decision Making in Latino Men With Prostate Cancer: A Thematic Analysis. MDM Policy Pract 2021; 6:23814683211014180. [PMID: 34104782 PMCID: PMC8165846 DOI: 10.1177/23814683211014180] [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: 10/19/2019] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background. Multiple studies have shown that digitally mediated decision aids help prepare patients for medical decision making with their providers. However, few studies have investigated whether decision-support preferences differ between non-English-speaking and English-speaking Latino men with limited literacy. Objective. To identify and compare health information seeking patterns, preferences for information presentation, and interest in digital decision aids in a sample of Southern Californian underserved Latino men with newly diagnosed prostate cancer at a county hospital. Methods. We conducted semistructured, in-depth telephone interviews with 12 Spanish-speaking and 8 English-speaking Latino men using a purposive sampling technique. Following transcription of taped interviews, Spanish interviews were translated. Using a coding protocol developed by the team, two bilingual members jointly analyzed the transcripts for emerging themes. Coder agreement exceeded 80%. Differences were resolved through discussion. Results. Thematic differences between groups with different preferred languages emerged. Most respondents engaged in online health information seeking using cellphones, perceived a paternalistic patient-provider relationship, and expressed willingness to use hypothetical digital decision aids if recommended by their provider. English speakers reported higher digital technology proficiency for health-related searches. They also more frequently indicated family involvement in digital search related to their condition and preferred self-guided, web-based decision aids. In comparison, Spanish speakers reported lower digital technology proficiency and preferred family-involved, coach-guided, paper and visual decision aids. English speakers reported substantially higher levels of formal education. Conclusion. Preferences regarding the use of digital technology to inform prostate cancer treatment decision making among underserved Latino men varied depending on preferred primary language. Effective preparation of underserved Latino men for shared decision making requires consideration of alternative approaches depending on level of education attainment and preferred primary language.
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Affiliation(s)
- Joaquin Michel
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jorge Ballon
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David C Johnson
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christopher S Saigal
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Dana L Alden
- Department of Marketing, Shidler College of Business, University of Hawai'i, Honolulu, Hawai'i
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Bowen E, Nayfe R, Milburn N, Mayo H, Reid MC, Fraenkel L, Weiner D, Halm EA, Makris UE. Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review. PAIN MEDICINE 2021; 21:951-969. [PMID: 31880805 DOI: 10.1093/pm/pnz280] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. METHODS We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. RESULTS Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format. CONCLUSIONS Decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.
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Affiliation(s)
- Emily Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Rabih Nayfe
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Nathaniel Milburn
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, Texas
| | - M C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, New York
| | - Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut
| | - Debra Weiner
- Geriatric Research, Education and Clinical Center, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine, Psychiatry, Anesthesiology and Clinical & Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ethan A Halm
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.,Department of Medicine, VA North Texas Health Care System, Dallas, Texas, USA
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45
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Trenaman L, Jansen J, Blumenthal-Barby J, Körner M, Lally J, Matlock DD, Perestelo-Perez L, Ropka M, Stirling C, Valentine K, Vo H, Wills CE, Thomson R, Sepucha K. Are We Improving? Update and Critical Appraisal of the Reporting of Decision Process and Quality Measures in Trials Evaluating Patient Decision Aids. Med Decis Making 2021; 41:954-959. [PMID: 33966534 PMCID: PMC8474325 DOI: 10.1177/0272989x211011120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In 2014, a systematic review found large gaps in the quality of reporting of
measures used in 86 published trials evaluating the effectiveness of patient
decision aids (PtDAs). The purpose of this study was to update that
review. Methods We examined measures of decision making used in 49 randomized controlled
trials included in the 2014 and 2017 Cochrane Collaboration systematic
review of PtDAs. Data on development of the measures, reliability, validity,
responsiveness, precision, interpretability, feasibility, and acceptability
were independently abstracted by 2 paired reviewers. Results Information from 273 measures was abstracted, and 109 of these covered the
core domains of decision processes (n = 55) and decision
quality including informed choice/knowledge (n = 48) and
values-choice concordance (n = 12). Very few studies
reported data on the performance and clinical sensibility of measures, with
reliability (23%) and validity (6%) being the most common. Studies using new
measures were less likely to include information about their psychometric
performance compared with previously published measures. Limitations The review was limited to reporting of measures in studies included in the
Cochrane review and did not consult prior publications. Conclusion There continues to be very little reported about the development or
performance of measures used to evaluate the effectiveness of PtDAs in
published trials. Minimum reporting standards have been published, and
efforts to require investigators to use them are needed.
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Affiliation(s)
- Logan Trenaman
- University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Jesse Jansen
- Maastricht University, Maastricht, The Netherlands
| | | | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs- University, Freiburg, Baden-Wurttemberg, Germany
| | - Joanne Lally
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel D Matlock
- University of Colorado, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | | | - Mary Ropka
- University of Virginia, Charlottesville, VA, USA
| | | | - Kathrene Valentine
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Ha Vo
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Thomson
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Sepucha
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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46
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Betz ME, Omeragic F, Meador L, DiGuiseppi CG, Fowler NR, Han SD, Hill L, Johnson RL, Knoepke CE, Matlock DD, Moran R. The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers. Inj Epidemiol 2021; 8:23. [PMID: 33934709 PMCID: PMC8088834 DOI: 10.1186/s40621-021-00310-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult's health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. The impact of decision aids regarding driving cessation for older adults is unknown. METHODS The Advancing Understanding of Transportation Options (AUTO) study is a multi-site, two-armed randomized controlled trial that will test the impact of a decision aid on older adults' decisions about changes in driving behaviors and cessation. AUTO will enroll 300 drivers age ≥ 70 years with a study partner (identified by each driver); the dyads will be randomized into two groups (n = 150/group). The decision aid group will view the web-based decision aid created by Healthwise at baseline and the control group will review information about driving that does not include evidence-based elements on risks and benefits and values clarification about driving decisions. The AUTO trial will compare the effect of the decision aid, versus control, on a) immediate decision quality (measured by the Decisional Conflict Scale; primary outcome); b) longitudinal psychosocial outcomes at 12 and 24 months (secondary outcomes); and c) longitudinal driving behaviors (including reduction or cessation) at 12 and 24 months (secondary outcomes). Planned stratified analyses will examine the effects in subgroups defined by cognitive function, decisional capacity, and readiness to stop driving. DISCUSSION The AUTO study is the first large-scale randomized trial of a driving decision aid for older adults. Results from this study will directly inform clinical practice about how best to support older adults in decision-making about driving. TRIAL REGISTRATION ClinicalTrials.gov : NCT04141891 . Registered on October 28, 2019. Located at https://clinicaltrials.gov/ct2/show/NCT04141891.
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Affiliation(s)
- Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA.
| | - Faris Omeragic
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren Meador
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole R Fowler
- Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | - S Duke Han
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | - Linda Hill
- School of Public Health, University of California San Diego, San Diego, CA, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher E Knoepke
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel D Matlock
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Moran
- School of Public Health, University of California San Diego, San Diego, CA, USA
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Karunaratne S, Harris IA, Trevena L, Horsley M, Fajardo M, Solomon M. Online Decision Aids for Knee Arthroplasty: An Environmental Scan. JBJS Rev 2021; 9:01874474-202104000-00006. [PMID: 33830958 DOI: 10.2106/jbjs.rvw.20.00088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Knee arthroplasty is a high-risk, resource-intensive procedure that should be reserved for patients in whom the benefit will outweigh the risks. The provision of high-quality, publicly available decision aids can help patients to balance the benefits against the harms of treatments and to assist informed decision-making. The aim of this study was to identify and evaluate the content and readability of freely available knee arthroplasty decision aids. METHODS A systematic search using an environmental scan methodology of publicly available online materials was performed in December 2018. Included materials were assessed for quality using the International Patient Decision Aid Standards instrument (IPDASi), understandability and actionability from a patient's perspective using the Patient Education Materials Assessment Tool (PEMAT), and readability grade level using the Flesch-Kincaid Grade Level and the Gunning Fog Index. RESULTS Of 761 online materials screened, 26 decision aids were identified. Only 18 (69%) may be considered to meet criteria to be defined as a decision aid and 4 (15%) met criteria suggesting that the material did not introduce potential harmful bias according to the IPDASi. The mean score (and standard deviation) for all decision aids was 74% ± 12% for understandability and 44% ± 19% for actionability using the PEMAT. Readability indices indicated a mean minimum reading level of Grade 10 (10.8 ± 2.5). No decision aid included a wait-and-see option. CONCLUSIONS Few high-quality decision aids exist for patients considering knee arthroplasty and none include a wait-and-see option. Many do not provide actionable options and are pitched at above-average reading levels. Developers need to address these issues to encourage high-quality decision-making, especially for those with low health literacy.
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Affiliation(s)
- Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian A Harris
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Fajardo
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Stacey D, Légaré F, Boland L, Lewis KB, Loiselle MC, Hoefel L, Garvelink M, O'Connor A. 20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework. Med Decis Making 2021; 40:379-398. [PMID: 32428429 DOI: 10.1177/0272989x20911870] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction. The Ottawa Decision Support Framework (ODSF) has guided practitioners and patients facing difficult decisions for 20 years. It asserts that decision support interventions that address patients' decisional needs improve decision quality. Purpose. To update the ODSF based on a synthesis of evidence. Methods. We conducted an overview of systematic reviews, searching 9 electronic databases. Eligible reviews included decisional needs assessments, decision support interventions, and decisional outcome measures guided by the ODSF. We extracted data and synthesized results narratively. Eight ODSF developers/expert users from 4 disciplines revised the ODSF. Results. Of 4656 citations, we identified 4 eligible reviews (>250 studies, >100 different decisions, >50,000 patients, 18 countries, 5 continents). They reported current ODSF decisional needs and their most frequent manifestations in the areas of inadequate knowledge/information, unclear values, decisional conflict/uncertainty, and inadequate support. They uncovered 11 new manifestations of 6 decisional needs. Using the Decisional Conflict Scale (DCS) to assess decisional needs, average scores were elevated at baseline and declined shortly after decision making, even without information interventions. Patient decision aids were superior to usual care in reducing total DCS scores and improving decision quality. We revised the ODSF by refining definitions of 6 decisional needs and adding new interventions to address 4 needs. We added a decision process outcome and eliminated secondary outcomes unlikely to improve across a range of decisions, retaining the implementation/continuance of the chosen option and appropriate use/costs of health services. Conclusions. We updated the ODSF to reflect the current evidence and identified implications for practice and further research.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada
| | - Laura Boland
- Western University, School of Health Studies, London, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Marie-Chantal Loiselle
- School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada
| | - Lauren Hoefel
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Mirjam Garvelink
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, the Netherlands
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Pryce H, Ward M, Turton L, Stanley J, Goss J. A multi-site service evaluation of the tinnitus care decision aid. Int J Audiol 2021; 61:84-87. [PMID: 33752559 DOI: 10.1080/14992027.2021.1898684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Shared decision-making is a principle of health care delivery across the world. The first international standard decision aid for tinnitus care was developed in 2018. This decision aid is in use across the UK. It is free to use and access from the British Tinnitus Association website. Our objective was to compare routine care with the care that also included the decision aid as part of care for their patients. DESIGN A multi-site service evaluation included pre-post comparison of decisional conflict in sequential new patients seeking help with tinnitus. Informal interviews with staff and service managers explored how practical and feasible the decision aid was in routine practice. STUDY SAMPLE We present data from four contrasting clinical services, including services in England and Wales, acute and community services and those operated by Hearing Therapists and Audiologists. RESULTS Across these contrasting services, the inclusion of the decision aid was associated with a reduction in decisional conflict in patients. The decision aid was feasible to administer, acceptable to patients and clinicians without creating a burden in appointments. CONCLUSIONS These evaluations suggest that the decision aid is feasible to administer and reduces patient decisional conflict. It appears to benefit clinical services in practice.
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Affiliation(s)
- Helen Pryce
- Audiology Department, College of Health and Life Sciences, Aston University, Birmingham, UK.,Hearing Therapy and Audiology Service, St Martins Hospital, Bath, UK
| | - Melanie Ward
- Hearing Therapy and Audiology Service, St Martins Hospital, Bath, UK
| | - Laura Turton
- Audiology Department, South Warwickshire Foundation NHS Trust, Warwick Hospital, Warwick, UK
| | - Joanne Stanley
- Audiology Department, Worcestershire Acute NHS Trust, Alexandra Hospital, Redditch, UK
| | - Joanne Goss
- Audiology Department, Betsi Cadwaladr University Health Board, Wales, UK
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Kostick KM, Blumenthal-Barby JS. Avoiding "toxic knowledge": the importance of framing personalized risk information in clinical decision-making. Per Med 2021; 18:91-95. [PMID: 33616460 DOI: 10.2217/pme-2020-0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX 77030, USA
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