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Heisig J, Bücker B, Schmidt A, Heye AL, Rieckert A, Löscher S, Hirsch O, Donner-Banzhoff N, Wilm S, Barzel A, Becker A, Viniol A. Efficacy of a computer based discontinuation strategy to reduce PPI prescriptions: a multicenter cluster-randomized controlled trial. Sci Rep 2023; 13:21633. [PMID: 38062116 PMCID: PMC10703926 DOI: 10.1038/s41598-023-48839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Deprescribing of inappropriate long-term proton pump inhibitors (PPI) is challenging and there is a lack of useful methods for general practitioners to tackle this. The objective of this randomized controlled trial was to evaluate the effectiveness of the electronic decision aid tool arriba-PPI on reduction of long-term PPI intake. Participants (64.5 ± 12.9 years; 54.4% women) with a PPI intake of at least 6 months were randomized to receive either consultation with arriba-PPI from their general practitioner (n = 1256) or treatment as usual (n = 1131). PPI prescriptions were monitored 6 months before, 6 and 12 months after study initiation. In 49.2% of the consultations with arriba-PPI, the general practitioners and their patients made the decision to reduce or discontinue PPI intake. At 6 months, there was a significant reduction by 22.3% (95% CI 18.55 to 25.98; p < 0.0001) of defined daily doses (DDD) of PPI. A reduction of 3.3% (95% CI - 7.18 to + 0.62) was observed in the control group. At 12 months, the reduction of DDD-PPI remained stable in intervention patients (+ 3.5%, 95% CI - 0.99 to + 8.03), whereas control patients showed a reduction of DDD-PPI (- 10.2%, 95% CI - 6.01 to - 14.33). Consultation with arriba-PPI led to reduced prescription rates of PPI in primary care practices. Arriba-PPI can be a helpful tool for general practitioners to start a conversation with their patients about risks of long-term PPI intake, reduction or deprescribing unnecessary PPI medication.
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Affiliation(s)
- Julia Heisig
- Department of Primary Care, University of Marburg, Marburg, Germany.
| | - Bettina Bücker
- Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandra Schmidt
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care (IGPPC), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anne-Lisa Heye
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care (IGPPC), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anja Rieckert
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care (IGPPC), Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Susanne Löscher
- Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | | | - Stefan Wilm
- Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anne Barzel
- Department of General Practice and Primary Care, Ulm University Hospital, Ulm, Germany
| | - Annette Becker
- Department of Primary Care, University of Marburg, Marburg, Germany
| | - Annika Viniol
- Department of Primary Care, University of Marburg, Marburg, Germany
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Natsukari I, Higuchi M, Tsujimoto T. How do patients and families evaluate attitude of psychiatrists in Japan?: quantitative content analysis of open-ended items of patient responses from a large-scale questionnaire survey. BMC Psychiatry 2023; 23:253. [PMID: 37059984 PMCID: PMC10105434 DOI: 10.1186/s12888-023-04732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Patient and Public Involvement (PPI) has been widely advocated in psychiatric fields. In Japan, however, PPI has not been implemented in clinical practice. In order to improve quality of psychiatric service in Japan, it is essential to understand psychiatrists' attitudes from the patients' perspective as a first step in practicing PPI. This study aimed to investigate the patients' evaluation of psychiatrists' attitudes by illustrating themes appeared in the questionnaire survey. METHODS This study used the data obtained from the questionnaire survey responded by 2,683 patients with family members who belong to the family associations for psychiatric patients in Japan. Three open-ended question items in this survey, "criteria for selecting a psychiatrist (784 patient responses, response rate 29.2%)," "attitude of the psychiatrist in charge (929 patient responses, response rate 34.6%)," and "communication skills of the psychiatrist in charge (739 patient responses, response rate 27.5%)" were analyzed by co-occurrence network using KH Coder software. RESULTS The common theme observed in all three items was whether psychiatrist took sufficient consultation time. The criteria for selecting a psychiatrist were summarized whether psychiatrist provided appropriate advices for patients' problems, whether psychiatrist cared about patients' demands and whether psychiatrist informed to patients about diseases and medications. The attitudes of the psychiatrists in charge that patients had most wanted their psychiatrists to improve were: psychiatrists only watch the computer, make diagnosis according to the patients' individual condition, and try to build a relationship of trust with the patient. The patients' demands regarding communication skills of the psychiatrist in charge included: whether the psychiatrist communicated in a way that improves the patient's psychological state, whether the psychiatrist was attentive to the patients' family, and whether the psychiatrist could control his/her own mood during the consultation. CONCLUSION The results reflected the patients' demands that do not appear in closed-ended items. It was suggested that patients'open-ended responses to questionnaires and their involvement in the psychiatric research (PPI) may provide more insight into improving pshchiaric care in Japan.
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Affiliation(s)
- Ikuko Natsukari
- Yakitsubeno-Michi Clinic, 162 Nakazato, Yaizu City, Shizuoka, 425-0014, Japan.
| | - Mari Higuchi
- Faculty of Humanities and Human Sciences, Hokkaido University, Kita 10, Nishi 7, Kita-Ku, Sapporo City, 060-0810, Japan
| | - Tai Tsujimoto
- Nanzan University Institute for Social Ethics, 18 Yamazato-cho, Syowa-Ku, Nagoya City, Aichi, 466-8673, Japan
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Angelow A, Klötzer C, Donner-Banzhoff N, Haasenritter J, Oliver Schmidt C, Dörr M, Chenot JF. Validation of Cardiovascular Risk Prediction by the Arriba Instrument. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:476-482. [PMID: 35635438 PMCID: PMC9664993 DOI: 10.3238/arztebl.m2022.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/21/2021] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND It is recommended in cardiovascular prevention guidelines that treatment should be based on overall cardiovascular risk. The arriba instrument has been widely used for this purpose in Germany. The aim of this study is to validate risk prediction by arriba with the aid of morbidity and mortality data from the population- based Study of Health in Pomerania. METHODS In a longitudinal analysis, the arriba instrument was used to calculate the 10-year overall cardiovascular risk at baseline for subjects who had not sustained any prior cardiovascular event. Cardiovascular event rates were determined from follow-up data, and discrimination and calibration measures for the risk determination algorithm were calculated. RESULTS Data from 1973 subjects (mean age 51 ± 13 years, 48% men) were included in the analysis. After a median follow-up of 10.9 years, cardiovascular events had occurred in 196 subjects, or 9.8%. The ratio of predicted to observed event rate was 0.8 (95% confidence interval: [0.5; 1.1]), 1.3 [1.0; 1.8], and 1.1 [0.8; 1.4] for subjects at low, intermediate, and high cardiovascular risk, respectively. Arriba underestimated cardiovascular event rates in women and overestimated them in persons aged 30-44 and 45-59. The area under curve was 0.84 [95% CI 0.81; 0.86]. CONCLUSION The discrimination scores of the arriba instrument resemble those of SCORE-Germany and PROCAM, but a better adjustment to the target population would be desirable. The results support the recommendation of the German Guideline for Cardiovascular Risk Counseling in General Practice for the use of the arriba instrument. An unresolved problem is the failure to consider intervention effects, resulting in an overall mild overestimation of risk.
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Affiliation(s)
- Aniela Angelow
- University Hospital of Greifswald, Department of General Practice, Institute for Community Medicine, Greifswald,*Universitätsmedizin Greifswald Abteilung Allgemeinmedizin Institut für Community Medicine Fleischmannstraße 6, 17475 Greifswald
| | - Christine Klötzer
- University Hospital of Greifswald, Department of General Practice, Institute for Community Medicine, Greifswald
| | | | - Jörg Haasenritter
- Philipps-University Marburg, Department of General Practice, Marburg
| | - Carsten Oliver Schmidt
- University Hospital of Greifswald, Department SHIP/KEF, Institute for Community Medicine, Greifswald
| | - Marcus Dörr
- University Hospital of Greifswald, Department of Internal Medicine B, German Centre for Cardiovascular Research, Greifswald,German Centre for Cardiovascular Research e. V. (DZHK), Standort Greifswald
| | - Jean-François Chenot
- University Hospital of Greifswald, Department of General Practice, Institute for Community Medicine, Greifswald
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Tiedje D, Borowski M, Simbrich A, Schlößler K, Kruse K, Bothe C, Kuss K, Adarkwah CC, Maisel P, Jendyk R, Kurosinski MA, Gerß J, Tschuschke C, Becker R, Roobol MJ, Bangma CH, Hense HW, Donner-Banzhoff N, Semjonow A. Decision aid and cost compensation influence uptake of PSA-based early detection without affecting decisional conflict: a cluster randomised trial. Sci Rep 2021; 11:23503. [PMID: 34873188 PMCID: PMC8648904 DOI: 10.1038/s41598-021-02696-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
International guidelines recommend to inform men about the benefits and harms of prostate specific antigen (PSA) based early detection of prostate cancer. This study investigates the influence of a transactional decision aid (DA) or cost compensation (CC) for a PSA test on the decisional behaviour of men. Prospective, cluster-randomised trial to compare two interventions in a 2 × 2 factorial design: DA versus counselling as usual, and CC versus noCC for PSA-testing. 90 cluster-randomised physicians in the administrative district of Muenster, Germany recruited 962 participants aged 55-69 yrs. in 2018. Primary endpoint: the influence of the DA and CC on the decisional conflict. Secondary endpoints: factors which altered the involvement of the men regarding their decision to take a PSA-test. The primary endpoint was analysed by a multivariate regression model. The choice to take the PSA test was increased by CC and reduced by the DA, the latter also reduced PSA uptake in men who were offered CC. The DA led to an increase of the median knowledge about early detection, changed willingness to perform a PSA test without increasing the level of shared decision, giving participants a stronger feeling of having made the decision by themselves. The DA did not alter the decisional conflict, as it was very low in all study groups. DA reduced and CC increased the PSA uptake. The DA seemed to have a greater impact on the participants than CC, as it led to fewer PSA tests even if CC was granted.Trial registration: German Clinical Trial Register (Deutsches Register Klinischer Studien DRKS00007687). Registered: 06/05/2015. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007687 .
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Affiliation(s)
- Dorothee Tiedje
- Prostate Center, University Hospital Muenster, Muenster, Germany.
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Alexandra Simbrich
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany.,Department of General Practice/Family Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Kruse
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Christiane Bothe
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Katrin Kuss
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Peter Maisel
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Ralf Jendyk
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Marc-André Kurosinski
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Christian Tschuschke
- Berufsverband der Deutschen Urologen, Landesverband Westfalen-Lippe, Muenster, Germany
| | - Ralf Becker
- Hausaerzteverbund Muenster, Muenster, Germany
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Centre, Cancer Institute, Rotterdam, The Netherlands
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | - Axel Semjonow
- Prostate Center, University Hospital Muenster, Muenster, Germany
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Berkowitz J, Martinez-Camblor P, Stevens G, Elwyn G. The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice. PATIENT EDUCATION AND COUNSELING 2021; 104:2327-2337. [PMID: 33744056 DOI: 10.1016/j.pec.2021.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice. METHODS incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance. RESULTS The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations. CONCLUSIONS incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice. PRACTICE IMPLICATIONS incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.
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Affiliation(s)
- Julia Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Gültzow T, Zijlstra DN, Bolman C, de Vries H, Dirksen CD, Muris JWM, Smit ES, Hoving C. Decision aids to facilitate decision making around behavior change in the field of health promotion: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:1266-1285. [PMID: 33531158 DOI: 10.1016/j.pec.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed. METHODS Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively. RESULTS Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA's effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1). CONCLUSIONS This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making. PRACTICE IMPLICATIONS DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking.
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Affiliation(s)
- Thomas Gültzow
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | - Daniëlle N Zijlstra
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, the Netherlands
| | - Hein de Vries
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Carmen D Dirksen
- CAPHRI Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W M Muris
- CAPHRI Care and Public Health Research Institute, Department of General Practice, Maastricht University, Maastricht, the Netherlands
| | - Eline S Smit
- University of Amsterdam, Amsterdam School of Communication Research/ASCoR, Department of Communication Science, Amsterdam, the Netherlands
| | - Ciska Hoving
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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Coates D, Thirukumar P, Henry A. The experiences of shared decision-making of women who had an induction of labour. PATIENT EDUCATION AND COUNSELING 2021; 104:489-495. [PMID: 32843263 DOI: 10.1016/j.pec.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/02/2020] [Accepted: 08/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The importance of shared decision-making (SDM) in relation to induction of labour (IOL) is recognised, little is known about women's experiences of and satisfaction with decision-making and how this can be improved. The aim of this study was to 1) gain insight into women's experiences of SDM in relation to IOL, 2) understand the factors associated with satisfaction versus dissatisfaction during SDM, and 3) identify recommendations for service improvement. METHODS Qualitative semi-structured telephone interviews were conducted with 32 women who had a recent IOL at one of eight public hospitals in Sydney, Australia. An inductive approach to coding and categorisation of themes was used. RESULTS While women reported varied experiences with SDM, many reported not feeling that they had a choice about IOL, not being presented with the risks and benefits of different birth options, and receiving insufficient information about the IOL process and methods. Satisfaction versus dissatisfaction with SDM appeared more closely related to a woman's willingness to have an IOL and their willingness to defer decision-making, rather than the process of SDM. Recommendations for improvement included improved SDM practices, access to guidelines and continuity of care. CONCLUSION There is a need to improve SDM processes around IOL. PRACTICE IMPLICATIONS Particular areas for improvement include more comprehensive discussions surrounding the pros and cons of different birth methods and the IOL process. Decision aids and clinician training may assist with SDM.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Sydney, Australia.
| | | | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Shepherd V, Wood F, Griffith R, Sheehan M, Hood K. Development of a decision support intervention for family members of adults who lack capacity to consent to trials. BMC Med Inform Decis Mak 2021; 21:30. [PMID: 33509169 PMCID: PMC7842028 DOI: 10.1186/s12911-021-01390-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Informed consent is required for participation in clinical trials, however trials involving adults who lack capacity to consent require different enrolment processes. A family member usually acts as a proxy to make a decision based on the patient's 'presumed will', but these decisions can be challenging and families may experience an emotional and decisional burden. Decisions made on behalf of others are conceptually different from those made for ourselves. Innovations have been developed to improve informed consent processes for research, including a number of decision aids, however there are no interventions for proxies who are faced with more complex decisions. This article outlines the development of a novel decision aid to support families making decisions about research participation on behalf of an adult who lacks capacity to consent. METHODS Decision support interventions should be developed using rigorous and evidence-based methods. This intervention was developed using MRC guidance for the development of complex interventions, and a conceptual framework for the development and evaluation of decision aids for people considering taking part in a clinical trial. The intervention was informed by a systematic review and analysis of existing information provision. Previous qualitative research with families who acted as proxies enabled the development of a theoretical framework to underpin the intervention. The intervention was iteratively developed with the involvement of lay advisors and relevant stakeholders. RESULTS Previous research, theoretical frameworks, and decision aid development frameworks were used to identify and develop the intervention components. The decision aid includes information about the proxy's role and utilises a values clarification exercise and decision support methods to enable a more informed and better-quality decision. Stakeholders, including those representing implementers and receivers of the intervention, contributed to the design and comprehensibility of the decision aid to ensure that it would be acceptable for use. CONCLUSIONS Frameworks for the development of decision aids for people considering participating in a clinical trial can be used to develop interventions for family members acting as proxy decision-makers. The decision support tool is acceptable to users. Feasibility testing and outcome measure development is required prior to any evaluation of its effectiveness.
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Affiliation(s)
- Victoria Shepherd
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Fiona Wood
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Richard Griffith
- College of Human and Health Studies, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Mark Sheehan
- Ethox Centre, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Coates D, Clerke T. Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:100-119. [PMID: 32433322 DOI: 10.1097/ceh.0000000000000289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
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Affiliation(s)
- Dominiek Coates
- Dr. Coates: Senior Research Fellow, University of Technology Sydney, Faculty of Health, Sydney, Australia.Clerke: Project Officer, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia
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Rieckert A, Becker A, Donner-Banzhof N, Viniol A, Bücker B, Wilm S, Sönnichsen A, Barzel A. Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool (arriba-PPI): study protocol for a randomized controlled trial. Trials 2019; 20:636. [PMID: 31752978 PMCID: PMC6868794 DOI: 10.1186/s13063-019-3728-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are increasingly being prescribed, although long-term use is associated with multiple side effects. Therefore, an electronic decision support tool with the aim of reducing the long-term use of PPIs in a shared decision-making process between general practitioners (GPs) and their patients has been developed. The developed tool is a module that can be added to the so-called arriba decision support tool, which is already used by GPs in Germany in routine care. In this large-scale cluster-randomized controlled trial we evaluate the effectiveness of this arriba-PPI tool. METHODS The arriba-PPI tool is an electronic decision support system that supports shared decision-making and evidence-based decisions around the long-term use of PPIs at the point of care. The tool will be evaluated in a cluster-randomized controlled trial involving 210 GP practices and 3150 patients in Germany. GP practices will be asked to recruit 20 patients aged ≥ 18 years regularly taking PPIs for ≥ 6 months. After completion of patient recruitment, each GP practice with enrolled patients will be cluster-randomized. Intervention GP practices will get access to the software arriba-PPI, whereas control GPs will treat their patients as usual. After an observation period of six months, GP practices will be compared regarding the reduction of cumulated defined daily doses of PPI prescriptions per patient. DISCUSSION Our principal hypothesis is that the application of the arriba-PPI tool can reduce PPI prescribing in primary care by at least 15% compared to conventional strategies used by GPs. A positive result implies the implementation of the arriba-PPI tool in routine care. TRIAL REGISTRATION German Clinical Trials Register, DRKS00016364. Registered on 31 January 2019.
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Affiliation(s)
- Anja Rieckert
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Annette Becker
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Karl-von-Frisch Str. 4, 35043 Marburg, Germany
| | - Norbert Donner-Banzhof
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Karl-von-Frisch Str. 4, 35043 Marburg, Germany
| | - Annika Viniol
- Department of General Medicine, Preventive and Rehabilitation Medicine, University of Marburg, Karl-von-Frisch Str. 4, 35043 Marburg, Germany
| | - Bettina Bücker
- Institute of General Practice, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090 Vienna, Austria
| | - Anne Barzel
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
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Semjonow A, Hense HW, Schlößler K, Simbrich A, Borowski M, Bothe C, Kruse K, Tiedje D, Kuss K, Adarkwah CC, Maisel P, Jendyk R, Kurosinski MA, Gerß J, Heidinger O, Tschuschke C, Becker R, Roobol MJ, Bangma C, Donner-Banzhoff N. Development and Prospective Randomized Evaluation of a Decision Aid for Prostate-specific Antigen-based Early Detection of Prostate Cancer in Men Aged Between 55 and 69Yr: The PSAInForm Trial. Eur Urol 2019; 76:1-3. [PMID: 30665815 DOI: 10.1016/j.eururo.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022]
Abstract
For men interested in early detection of prostate cancer, the potential impact on decisional conflict of a decision aid with or without cost compensation for the prostate-specific antigen test will be investigated.
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Affiliation(s)
- Axel Semjonow
- Prostate Center, University Hospital Muenster, Muenster, Germany.
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
| | - Alexandra Simbrich
- Institute of Epidemiology and Social Medicine, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Matthias Borowski
- Institute of Biostatistics and Clinical Research, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Christiane Bothe
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Klaus Kruse
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Dorothee Tiedje
- Prostate Center, University Hospital Muenster, Muenster, Germany
| | - Kathrin Kuss
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
| | - Charles Christian Adarkwah
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany; Department of Health Services Research and General Practice, University of Siegen, Siegen, Germany
| | - Peter Maisel
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Ralf Jendyk
- Department of General Medicine, University Hospital Muenster, Muenster, Germany
| | - Marc-André Kurosinski
- Institute of Epidemiology and Social Medicine, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, Westfalian Wilhelms-University Muenster, Muenster, Germany
| | | | - Christian Tschuschke
- Berufsverband der Deutschen Urologen, Landesverband Westfalen-Lippe, Muenster, Germany
| | - Ralf Becker
- Hausaerzteverbund Muenster, Muenster, Germany
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Erasmus University Rotterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus University Medical Center, Erasmus University Rotterdam, The Netherlands
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine University of Marburg, Philipps-University Marburg, Marburg, Germany
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Syed A, Mohd Don Z, Ng CJ, Lee YK, Khoo EM, Lee PY, Lim Abdullah K, Zainal A. Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor-patient conversations in primary care consultations in Malaysia. BMJ Open 2017; 7:e014260. [PMID: 28490553 PMCID: PMC5623402 DOI: 10.1136/bmjopen-2016-014260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate whether the use of apatient decision aid (PDA) for insulin initiation fulfils its purpose of facilitating patient-centred decision-making through identifying how doctors and patients interact when using the PDA during primary care consultations. DESIGN Conversation analysis of seven single cases of audio-recorded/video-recorded consultations between doctors and patients with type 2 diabetes, using a PDA on starting insulin. SETTING Primary care in three healthcare settings: (1) one private clinic; (2) two public community clinics and (3) one primary care clinic in a public university hospital, in Negeri Sembilan and the Klang Valley in Malaysia. PARTICIPANTS Clinicians and seven patients with type 2 diabetes to whom insulin had been recommended. Purposive sampling was used to select a sample high in variance across healthcare settings, participant demographics and perspectives on insulin. PRIMARY OUTCOME MEASURES Interaction between doctors and patients in a clinical consultation involving the use of a PDA about starting insulin. RESULTS Doctors brought the PDA into the conversation mainly by asking information-focused 'yes/no' questions, and used the PDA for information exchange only if patients said they had not read it. While their contributions were limited by doctors' questions, some patients disclosed issues or concerns. Although doctors' PDA-related questions acted as a presequence to deliberation on starting insulin, their interactional practices raised questions on whether patients were informed and their preferences prioritised. CONCLUSIONS Interactional practices can hinder effective PDA implementation, with habits from ordinary conversation potentially influencing doctors' practices and complicating their implementation of patient-centred decision-making. Effective interaction should therefore be emphasised in the design and delivery of PDAs and in training clinicians to use them.
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Affiliation(s)
- Ayeshah Syed
- Department of English Language, Faculty of Languages and Linguistics, University of Malaya, Kuala Lumpur, Malaysia
| | - Zuraidah Mohd Don
- Department of English Language, Faculty of Languages and Linguistics, University of Malaya, Kuala Lumpur, Malaysia
- Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Azlin Zainal
- Department of English Language, Faculty of Languages and Linguistics, University of Malaya, Kuala Lumpur, Malaysia
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Barrett B, Ricco J, Wallace M, Kiefer D, Rakel D. Communicating statin evidence to support shared decision-making. BMC FAMILY PRACTICE 2016; 17:41. [PMID: 27048421 PMCID: PMC4822230 DOI: 10.1186/s12875-016-0436-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/22/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND The practice of clinical medicine rests on a foundation of ethical principles as well as scientific knowledge. Clinicians must artfully balance the principle of beneficence, doing what is best for patients, with autonomy, allowing patients to make their own well-informed health care decisions. The clinical communication process is complicated by varying degrees of confidence in scientific evidence regarding patient-oriented benefits, and by the fact that most medical options are associated with possible harms as well as potential benefits. DISCUSSION Evidence-based clinical guidelines often neglect patient-oriented issues involved with the thoughtful practice of shared decision-making, where individual values, goals, and preferences should be prioritized. Guidelines on the use of statin medications for preventing cardiovascular events are a case in point. Current guidelines endorse the use of statins for people whose 10-year risk of cardiovascular events is as low as 7.5%. Previous guidelines set the 10-year risk benchmark at 20%. Meta-analysis of randomized trials suggests that statins can reduce cardiovascular event rates by about 25%, bringing 10-year risk from 7.5 to 5.6%, for example, or from 20 to 15%. Whether or not these benefits should justify the use of statins for individual patients depends on how those advantages are valued in comparison with disadvantages, such as side effect risks, and with inconveniences associated with taking a pill each day and visiting clinicians and laboratories regularly. CONCLUSIONS Whether or not the overall benefit-harm balance justifies the use of a medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not taking a drug is worthwhile. Researchers and professional organizations should endeavor to develop shared decision-making tools that provide up-to-date best evidence in easily understandable formats, so as to assist clinicians in helping their patients to make the decisions that are right for them.
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Affiliation(s)
- Bruce Barrett
- />Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Court, Madison, WI 53715 USA
| | - Jason Ricco
- />Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55455 USA
| | | | - David Kiefer
- />Group Health Cooperative, Madison, Wisconsin 53703 USA
| | - Dave Rakel
- />Department of Family Medicine & Community Health, University of Wisconsin, Madison, WI 53715 USA
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Washington K, Shacklady C. Patients' Experience of Shared Decision Making Using an Online Patient Decision Aid for Osteoarthritis of the Knee--A Service Evaluation. Musculoskeletal Care 2015; 13:116-126. [PMID: 25345930 DOI: 10.1002/msc.1086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS The aims of the present study were to gain a perspective of patients' experience of an online patient decision aid (PDA) for osteoarthritis of the knee (OA knee) as a method of shared decision making in a Musculoskeletal Clinical Assessment and Treatment Service (MSK CATS). METHODS In the MSK CATS, patients with OA knee discuss their condition and treatment options with the clinician. In the present study, patients, in addition to this discussion, used an online patient decision aid and subsequently completed a questionnaire regarding their experience of both of these processes. RESULTS Most patients felt that both the clinical discussion and the PDA were easy to understand, user friendly, and not biased towards any treatment, but thought that the PDA gave a better understanding of OA knee. Most patients had already decided on their treatment following the clinical discussion alone, but one found that the PDA helped them change their mind about treatment. CONCLUSION The PDA was a useful adjunct to the clinical discussion and could be best used for a selection of patients within the MSK CATS setting at a point where further clinical discussion could take place if necessary.
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Bae JM. Development and application of patient decision aids. Epidemiol Health 2015; 37:e2015018. [PMID: 25868639 PMCID: PMC4430759 DOI: 10.4178/epih/e2015018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022] Open
Abstract
With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Kramer L, Hirsch O, Becker A, Donner-Banzhoff N. Development and validation of a generic questionnaire for the implementation of complex medical interventions. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc08. [PMID: 24696674 PMCID: PMC3972438 DOI: 10.3205/000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/09/2014] [Indexed: 11/30/2022]
Abstract
Introduction: The implementation of complex medical interventions in daily practice is often fraught with difficulties. According to the iterative phase model proposed by the British Medical Research Council (MRC), the development, implementation and evaluation of complex interventions should be theory-driven. A conceptual model that seems to be a promising framework is the Theory of planned behaviour (TPB). In our study we aimed to develop and validate a generic and multifaceted questionnaire based on the TPB to detect physicians’ willingness to implement complex medical interventions and the factors influencing this willingness. Methods: The questionnaire was developed according to the literature and was informed by previous qualitative research of our department. It was validated on the example of an electronic library of decision aids, arriba-lib. The sample consisted of 181 General Practitioners (GPs) who received a training regarding arriba-lib and subsequently filled in the questionnaire, assessing the TPB variables attitude, subjective norm, perceived behaviour control and intention. Follow-up assessments were conducted after two (assessing retest reliability) and eight weeks (assessing target behaviour). We performed a confirmatory factor analysis investigating the factorial structure of our questionnaire according to the TPB. Beside the calculation of the questionnaire’s psychometric properties we conducted a structural equation model and an ordinal regression to predict actual behaviour regarding the installation and application of arriba-lib. Results: The postulated three factorial model (attitude, subjective norm, perceived behaviour control) of our questionnaire based on the TPB was rejected. A two factorial model with a combined factor subjective norm/perceived behaviour control was accepted. The explained variance in the ordinal regression was low (Nagelkerke’s R2=.12). Neither attitude nor intention were able to predict the use or non-use of arriba-lib (attitude: p=.68, intention: p=.44). For the combined factor subjective norm/perceived behaviour control a significant, but small effect (p=.03) was shown. Conclusions: The TPB is not an adequate theoretical framework to guide the development of a generic questionnaire in the context of the implementation of complex interventions. To enable the successful implementation of complex medical interventions evaluators have to go through the whole development and evaluation process according to the MRC-model, without short cuts. Further, it has to be discussed if a generic instrument can be valid and useful. Regarding the TPB a publication bias regarding the theory’s applicability might have to be considered.
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Affiliation(s)
- Lena Kramer
- Department of General Practice/Family Medicine, University of Marburg, Germany
| | - Oliver Hirsch
- Department of General Practice/Family Medicine, University of Marburg, Germany
| | - Annette Becker
- Department of General Practice/Family Medicine, University of Marburg, Germany
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Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C, Légaré F, Weijden TVD, Lewis CL, Wexler RM, Frosch DL. "Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S14. [PMID: 24625083 PMCID: PMC4044318 DOI: 10.1186/1472-6947-13-s2-s14] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. METHODS An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. RESULTS After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. CONCLUSIONS It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.
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Affiliation(s)
- Glyn Elwyn
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D - 20246 Hamburg, Germany
| | - Caroline Tietbohl
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, California, 94301, USA
| | - Mala Mann
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Adrian GK Edwards
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Catharine Clay
- Office of Professional Education and Outreach, The Dartmouth Institute of Health Policy and Clinical Practice, 46 Centerra Parkway, Suite 203, Lebanon, New Hampshire, 03766, USA
| | - France Légaré
- Knowledge Transfer and Health Technology Assessment Research Group, Research Centre of Centre Hospitalier Universitaire de Québec, Hôpital Saint-François D'Assise, 10, rue de l’Espinay, Québec, QC, G1L 3L5, Canada
| | - Trudy van der Weijden
- Department of General Practice, School CAPHRI, Peter Debyeplein 1, 6229 HA, Maastricht, The Netherlands
| | - Carmen L Lewis
- University of North Carolina, Campus Box 7110, Chapel Hill, North Carolina, 27599, USA
| | - Richard M Wexler
- Informed Medical Decisions Foundation, 40 Court Street, Suite 300, Boston, Massachusetts, 02108, USA
| | - Dominick L Frosch
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, California, 94301, USA
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Datta J, Petticrew M. Challenges to evaluating complex interventions: a content analysis of published papers. BMC Public Health 2013; 13:568. [PMID: 23758638 PMCID: PMC3699389 DOI: 10.1186/1471-2458-13-568] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is continuing interest among practitioners, policymakers and researchers in the evaluation of complex interventions stemming from the need to further develop the evidence base on the effectiveness of healthcare and public health interventions, and an awareness that evaluation becomes more challenging if interventions are complex.We undertook an analysis of published journal articles in order to identify aspects of complexity described by writers, the fields in which complex interventions are being evaluated and the challenges experienced in design, implementation and evaluation. This paper outlines the findings of this documentary analysis. METHODS The PubMed electronic database was searched for the ten year period, January 2002 to December 2011, using the term "complex intervention*" in the title and/or abstract of a paper. We extracted text from papers to a table and carried out a thematic analysis to identify authors' descriptions of challenges faced in developing, implementing and evaluating complex interventions. RESULTS The search resulted in a sample of 221 papers of which full text of 216 was obtained and 207 were included in the analysis. The 207 papers broadly cover clinical, public health and methodological topics. Challenges described included the content and standardisation of interventions, the impact of the people involved (staff and patients), the organisational context of implementation, the development of outcome measures, and evaluation. CONCLUSIONS Our analysis of these papers suggests that more detailed reporting of information on outcomes, context and intervention is required for complex interventions. Future revisions to reporting guidelines for both primary and secondary research may need to take aspects of complexity into account to enhance their value to both researchers and users of research.
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Affiliation(s)
- Jessica Datta
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
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Hirsch O, Keller H, Krones T, Donner-Banzhoff N. Arriba-lib: association of an evidence-based electronic library of decision aids with communication and decision-making in patients and primary care physicians. INT J EVID-BASED HEA 2012; 10:68-76. [PMID: 22405418 DOI: 10.1111/j.1744-1609.2012.00255.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM In shared decision-making, patients are empowered to actively ask questions and participate in decisions about their healthcare based on their preferences and values. Decision aids should help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes; however, they have rarely been field tested, especially in the primary care context. We therefore evaluated associations between the use of an interactive, transactional and evidence-based library of decision aids (arriba-lib) and communication and decision-making in patients and physicians in the primary care context. METHODS Our electronic library of decision aids ('arriba-lib') includes evidence-based modules for cardiovascular prevention, diabetes, coronary heart disease, atrial fibrillation and depression. Twenty-nine primary care physicians recruited 192 patients. We used questionnaires to ask patients and physicians about their experiences with and attitudes towards the programme. Patients were interviewed via telephone 2 months after the consultation. Data were analysed by general estimation equations, cross tab analyses and by using effect sizes. RESULTS Only a minority (8.9%) of the consultations were felt to be too long because physicians said consultations were unacceptably extended by arriba-lib. We found a negative association between the detailedness of the discussion of the clinical problem's definition and the age of the patients. Physicians discuss therapeutic options in less detail with patients who have a formal education of less than 8 years. Patients who were counselled by a physician with no experience in using a decision aid more often reported that they do not remember being counselled with the help of a decision aid or do not wish to be counselled again with a decision aid. CONCLUSIONS Arriba-lib has positive associations to the decision-making process in patients and physicians. It can also be used with older age groups and patients with less formal education. Physicians seem to adapt their counselling strategy to different patient groups. Prior experience with the use of decision aids has an influence on the acceptance of arriba-lib in patients but not on their decision-making or decision implementation.
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Affiliation(s)
- Oliver Hirsch
- Department of General Practice/Family Medicine, Philipps University Marburg, Marburg, Germany.
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Elwyn G, Rix A, Holt T, Jones D. Why do clinicians not refer patients to online decision support tools? Interviews with front line clinics in the NHS. BMJ Open 2012. [PMID: 23204075 PMCID: PMC3532981 DOI: 10.1136/bmjopen-2012-001530] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess whether clinical teams would direct patients to use web-based patient decision support interventions (DESIs) and whether patients would use them. DESIGN Retrospective semistructured interviews and web server log analysis. PARTICIPANTS AND SETTINGS 57 NHS professionals (nurses, doctors and others) in orthopaedic, antenatal, breast, urology clinics and in primary care practices across 22 NHS sites given access to DESIs hosted on the NHS Direct website. RESULTS Fewer than expected patients were directed to use the web tools. The most significant obstacles to referral to the tools were the attitudes of clinicians and clinical teams. Technical problems contributed to the problems but the low uptake was mainly explained by clinicians' limited understanding of how patient DESIs could be helpful in clinical pathways, their perception that 'shared decision-making' was already commonplace and that, in their view, some patients are resistant to being involved in treatment decisions. External factors, such as efficiency targets and 'best practice' recommendations were also cited being significant barriers. Clinicians did not feel the need to refer patients to use decision support tools, web-based or not, and, as a result, felt no requirement to change existing practice routines. Uptake is highest when clinicians set expectations that these tools are integral to practice and embed their use into clinical pathways. CONCLUSIONS Existing evidence of patient benefit and the free availability of patient DESIs via the web are not sufficient drivers to achieve routine use. Health professionals were not motivated to refer patients to these interventions. Clinicians will not use these interventions simply because they are made available, despite good evidence of benefit to patients. These attitudes are deep seated and will not be modified by solely developing web-based interventions: a broader strategy will be required to embed DESIs into routine practice.
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Affiliation(s)
- Glyn Elwyn
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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