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Ameen D, Kynoch K, Khalil H. Experiences and challenges of acute coronary syndrome patients in care provision: a qualitative systematic review. Syst Rev 2024; 13:184. [PMID: 39020407 PMCID: PMC11253477 DOI: 10.1186/s13643-024-02578-1] [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: 06/06/2023] [Accepted: 06/06/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Coronary artery disease including acute coronary syndrome (ACS) constitutes the most common cause of death in people with cardiovascular disease. Prompt diagnosis and early initiation of treatment significantly impact on patient outcomes. Positive patient experience with their initial care is linked to positive clinical outcomes. OBJECTIVE This qualitative review aimed to investigate patients' experience of care provision and the challenges faced by them during their different stages of care following an ACS. METHODS Searches of four databases - MEDLINE, Embase, CINAHL and PsychINFO - were conducted from inception until July 13, 2022, and were limited to English-language publications. Assessment of methodological quality of studies was performed using the Jonna Briggs Institute (JBI) qualitative assessment and review instrument. Data were extracted using the standardised data extraction tool from JBI. Data synthesis following the JBI approach of meta-aggregation was performed. The level of confidence for each synthesised finding was established based on ConQual. RESULTS Overall, from 578 records, 10 studies were included with 39 findings extracted from the included studies. The main synthesised findings were the need to provide tailored information and appropriate management at different stages of care, and that timely management and trust in health care workers are associated with greater patient satisfaction and more positive experiences. CONCLUSION Patients with an ACS experience many challenges during different stages of their care. Clinicians should be aware of the challenges they face and provide tailored information to patients that is appropriate for their different stages of management in order to best optimise patient experience and improve patient outcomes.
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Affiliation(s)
- Daniel Ameen
- Faculty of Medicine, Nursing and Health Sciences, Monash School of Medicine, Monash University, Melbourne, Australia.
| | - Kate Kynoch
- Mater Health, Queensland University of Technology (School of Nursing), Queensland Centre for Evidence-Based Nursing and Midwifery: A JBI Centre of Excellence, Brisbane, QLD, Australia
| | - Hanan Khalil
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Marshall DA, Suryaprakash N, Lavallee DC, McCarron TL, Zelinsky S, Barker KL, MacKean G, Santana MJ, Moayyedi P, Bryan S. Studying How Patient Engagement Influences Research: A Mixed Methods Study. THE PATIENT 2024; 17:379-395. [PMID: 38488995 PMCID: PMC11189989 DOI: 10.1007/s40271-024-00685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND There is evidence supporting the value of patient engagement (PE) in research to patients and researchers. However, there is little research evidence on the influence of PE throughout the entire research process as well as the outcomes of research engagement. The purpose of our study is to add to this evidence. METHODS We used a convergent mixed method design to guide the integration of our survey data and observation data to assess the influence of PE in two groups, comprising patient research partners (PRPs), clinicians, and researchers. A PRP led one group (PLG) and an academic researcher led the other (RLG). Both groups were given the same research question and tasked to design and conduct an inflammatory bowel disease (IBD)-related patient preference study. We administered validated evaluation tools at three points and observed PE in the two groups conducting the IBD study. RESULTS PRPs in both groups took on many operational roles and influenced all stages of the IBD-related qualitative study: launch, design, implementation, and knowledge translation. PRPs provided more clarity on the study design, target population, inclusion-exclusion criteria, data collection approach, and the results. PRPs helped operationalize the project question, develop study material and data collection instruments, collect data, and present the data in a relevant and understandable manner to the patient community. The synergy of collaborative partnership resulted in two projects that were patient-centered, meaningful, understandable, legitimate, rigorous, adaptable, feasible, ethical and transparent, timely, and sustainable. CONCLUSION Collaborative and meaningful engagement of patients and researchers can influence all stages of qualitative research including design and approach, and outputs.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada.
- IMAGINE SPOR Chronic Disease Network, Hamilton, ON, Canada.
| | - Nitya Suryaprakash
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Tamara L McCarron
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Sandra Zelinsky
- Alberta Strategy for Patient Oriented Research (SPOR) Support Unit, Edmonton, AB, Canada
| | - Karis L Barker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Maria J Santana
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Moayyedi
- IMAGINE SPOR Chronic Disease Network, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Health Research, British Columbia, Vancouver, BC, Canada
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Instenes I, Fridlund B, Borregaard B, Larsen AI, Allore H, Bendz B, Deaton C, Rotevatn S, Fålun N, Norekvål TM. 'When age is not a barrier': an explorative study of nonagenarian patients' experiences of undergoing percutaneous coronary intervention. Eur J Cardiovasc Nurs 2024:zvad132. [PMID: 38243638 DOI: 10.1093/eurjcn/zvad132] [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: 08/27/2023] [Revised: 10/29/2023] [Accepted: 12/09/2023] [Indexed: 01/21/2024]
Abstract
AIMS The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. METHODS AND RESULTS Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. CONCLUSION Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Universitetsplatsen 1, 352 52 Växjö, Sweden
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Campus vej 55, 5230 Odense C, Denmark
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate, 4011 Stavanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, Yale University, 300 George St 7th FL, New Haven, CT 06437, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, 300 George St 7th FL, New Haven, CT 06437, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Søsterhjemmet, Kirkeveien 166, 0450 Oslo, Norway
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, UK
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Wilson TA, Hazlewood GS, Sajobi TT, Wilton SB, Pearson WE, Connolly C, Javaheri PA, Finlay JL, Levin A, Graham MM, Tonelli M, James MT. Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment. J Am Heart Assoc 2023; 12:e028492. [PMID: 36892063 PMCID: PMC10111540 DOI: 10.1161/jaha.122.028492] [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: 03/10/2023]
Abstract
Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m2. Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.
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Affiliation(s)
- Todd A Wilson
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Glen S Hazlewood
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Calgary Alberta Canada
| | - Winnie E Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Carol Connolly
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | | | - Juli L Finlay
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Adeera Levin
- Division of Nephrology University of British Columbia Vancouver British Columbia Canada
| | - Michelle M Graham
- Department of Medicine, Division of Cardiology University of Alberta Edmonton Alberta Canada
| | - Marcello Tonelli
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
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6
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McCarron TL, Clement F, Rasiah J, Moran C, Moffat K, Gonzalez A, Wasylak T, Santana M. Patients as partners in health research: A scoping review. Health Expect 2021; 24:1378-1390. [PMID: 34153165 PMCID: PMC8369093 DOI: 10.1111/hex.13272] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/10/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The role of patient involvement in health research has evolved over the past decade. Despite efforts to engage patients as partners, the role is not well understood. We undertook this review to understand the engagement practices of patients who assume roles as partners in health research. METHODS Using a recognized methodological approach, two academic databases (MEDLINE and EMBASE) and grey literature sources were searched. Findings were organized into one of the three higher levels of engagement, described by the Patient and Researcher Engagement framework developed by Manafo. We examined and quantified the supportive strategies used during involvement, used thematic analysis as described by Braun and Clarke and themed the purpose of engagement, and categorized the reported outcomes according to the CIHR Engagement Framework. RESULTS Out of 6621 records, 119 sources were included in the review. Thematic analysis of the purpose of engagement revealed five themes: documenting and advancing PPI, relevance of research, co-building, capacity building and impact on research. Improved research design was the most common reported outcome and the most common role for patient partners was as members of the research team, and the most commonly used strategy to support involvement was by meetings. CONCLUSION The evidence collected during this review advanced our understanding of the engagement of patients as research partners. As patient involvement becomes more mainstream, this knowledge will aid researchers and policy-makers in the development of approaches and tools to support engagement. PATIENT/USER INVOLVEMENT Patients led and conducted the grey literature search, including the synthesis and interpretation of the findings.
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Affiliation(s)
- Tamara L. McCarron
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Fiona Clement
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Jananee Rasiah
- Faculty of Nursing3‐141 Edmonton Clinic Health Academy (ECHA)University of AlbertaEdmontonABCanada
| | - Chelsea Moran
- The Department PsychologyUniversity of CalgaryCalgaryABCanada
| | - Karen Moffat
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
- Patient PartnerCalgaryABCanada
| | - Andrea Gonzalez
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
| | - Tracy Wasylak
- Alberta Health ServicesCalgaryABCanada
- Faculty of NursingUniversity of CalgaryCalgaryABCanada
| | - Maria Santana
- The Department Community Health SciencesCalgaryABCanada
- O’Brien Institute for Public HealthCalgaryABCanada
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7
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Grant EV, Summapund J, Matlock DD, Vaughan Dickson V, Iqbal S, Patel S, Katz SD, Chaudhry SI, Dodson JA. Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction. Med Decis Making 2021; 40:279-288. [PMID: 32428431 DOI: 10.1177/0272989x20912293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients' and cardiologists' perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients' and cardiologists' perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients' age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as "the only choice," whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.
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Affiliation(s)
- Eleonore V Grant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Finlay J, Wilson T, Javaheri PA, Pearson W, Connolly C, Elliott MJ, Graham MM, Norris CM, Wilton SB, James MT. Patient and physician perspectives on shared decision-making for coronary procedures in people with chronic kidney disease: a patient-oriented qualitative study. CMAJ Open 2020; 8:E860-E868. [PMID: 33303572 PMCID: PMC7867031 DOI: 10.9778/cmajo.20200039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and heart disease face challenging treatment decisions. We sought to explore the perceptions of patients and physicians about shared decision-making for coronary procedures for people with CKD, as well as opinions about strategies and tools to improve these decisions. METHODS We partnered with 4 patients with CKD and 1 caregiver to design and conduct a qualitative descriptive study using semi-structured interviews and content analysis. Patient participants with CKD and either acute coronary syndrome or cardiac catheterization in the preceding year were recruited from a provincial cardiac registry, cardiology wards and clinics in Calgary between March and September 2018. Cardiologists from the region also participated in the study. Data analysis emphasized identifying, organizing and describing themes found within the data. RESULTS Twenty patients with CKD and 10 cardiologists identified several complexities related to bidirectional information exchange needed for shared decision-making. Themes identified by both patients and physicians included challenges synthesizing best evidence, variable patient knowledge seeking, timeliness in the acute care setting and influence of roles on decision-making. Themes identified by physicians related to processes and tools to help support shared decision-making in this setting included personalization to reflect the variability of risks and heterogeneity of patient preferences as well as allowing for physicians to share their clinical judgment. INTERPRETATION There are complexities related to bidirectional information exchange between patients with CKD and their physicians for shared decision-making about coronary procedures. Processes and tools to facilitate shared decision-making in this setting require personalization and need to be time sensitive.
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Affiliation(s)
- Juli Finlay
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Todd Wilson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Pantea Amin Javaheri
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Winnie Pearson
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Carol Connolly
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Meghan J Elliott
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Michelle M Graham
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Colleen M Norris
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Stephen B Wilton
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta
| | - Matthew T James
- Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta.
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Green AR. How Can We Optimize Care and Outcomes for Patients with Mild Cognitive Impairment and Acute Myocardial Infarction? J Gen Intern Med 2020; 35:5-7. [PMID: 31659666 PMCID: PMC6957667 DOI: 10.1007/s11606-019-05484-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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10
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Visvanathan A, Mead G, Dennis M, Whiteley W, Doubal F, Lawton J. Maintaining hope after a disabling stroke: A longitudinal qualitative study of patients' experiences, views, information needs and approaches towards making treatment decisions. PLoS One 2019; 14:e0222500. [PMID: 31518369 PMCID: PMC6743774 DOI: 10.1371/journal.pone.0222500] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/01/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some treatments after a disabling stroke increase the likelihood patients will survive longer but with significant disability. Patients and doctors should make collaborative decisions regarding these treatments. However, this can be challenging. To better understand treatment decision-making in acute disabling stroke, we explored the experiences, views and needs of stroke survivors in hospital and six months later. METHODS Fifteen patients who had a disabling stroke were interviewed within a week of their diagnosis; eleven were re-interviewed six months later. Data were analysed thematically and longitudinally. RESULTS Patients' functional abilities prior to their stroke and need for hope of functional recovery appeared to impact on their involvement in decision-making. In the early period post stroke, patients who were functionally independent pre- stroke described being emotionally devastated and ill-prepared for the consequences of stroke. They appeared unaware that treatments offered might extend their life but with significant disability and took all treatments in the hope of functional recovery. Those who were dependent pre-stroke appeared to be more stoic, had considered treatment implications and decided against such treatments. At follow-up, all patients had varying unmet psychological needs which appeared to contribute to poor quality of life. In the early period post stroke, patients looked for various ways to cultivate and maintain hope of functional recovery. While patients continued to look for hope at six months, they also reported wishing they had been given realistic information in the early period after stroke in order to prepare for the consequences. CONCLUSION Stroke survivors may benefit from psychological support. A collaborative approach towards treatment decision-making may not be realistic in all patients especially when they may be emotionally distressed and looking to maintain a positive outlook. Communication strategies to balance maintaining hope without providing false hope may be appropriate. Patients' information needs may need reassessed at different time points.
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Affiliation(s)
- Akila Visvanathan
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian Mead
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Martin Dennis
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - William Whiteley
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Julia Lawton
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
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