Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care

Transforming the Patient-Provider Relationship Through Digitalized Peer Support in Japan

The recent explosion in online dissemination of health-related information, and its availability to more and more people around the world, has led to a situation in which both healthcare providers and patients are accepting new roles. This paper examines the transformations toward new roles for healthcare professionals and patients, with a focus on Japan, based on the assumption that one of the driving forces accelerating these changes may be the digitalization of patient peer support. The methods used in this study were: 1) questionnaires and interviews with patients and healthcare providers asking about their participation in peer support and the effectiveness of its implementation; and 2) observations, questionnaires, and interviews with three patient groups about the experience of digitalizing peer support (via implementation of peer support in a virtual reality space). Analysis of the data showed that peer support by patient groups has both challenges and benefits, and that peer support in virtual spaces has certain positive effects. The empowerment of patients through digitalized peer support is transforming the relationship between healthcare providers and patients, changing it from a traditional asymmetrical relationship (in which the healthcare professionals are in a dominant position) to a cooperative relationship on a more equal footing.

Development of web- and mobile-based shared decision-making tools in the neurological intensive care unit

In the neurological intensive care unit (neuroICU), patients with severe acute brain injury (SABI) are rendered unable to make their own healthcare decisions. The responsibility of making life-or-death decisions, such as goals of care, is carried by surrogate decision-makers, usually families. In addition to the burden of decision-making, the emotional burden on families is further compounded by prognostication uncertainty, time-pressure for decision-making, and difficulties in understanding and interpreting the patient's values and preferences, ultimately resulting in potential clinician-family communication breakdown. Despite these challenges, there is currently no guidance on how to best approach these difficult decisions. Shared decision-making (SDM) has emerged as the recommended approach to improve clinician-family communication, empowering surrogates to take an active role in decision-making by providing a structured framework for information exchange, deliberation, and treatment decisions. Decision aids (DAs) facilitate SDM by offering balanced, accessible, unbiased information and helping surrogates decide according to patients' values. This review highlights the potential advantage of digital over paper-based DAs, including improved accessibility, interactivity, and personalization, and the integration of emerging technologies to enhance DA effectiveness. Additionally, we review the current digital DAs developed for the neuroICU setting.

Infographic summaries for clinical practice guidelines: results from user testing of the BMJ Rapid Recommendations in primary care

OBJECTIVES

Infographics have the potential to enhance knowledge translation and implementation of clinical practice guidelines at the point of care. They can provide a synoptic view of recommendations, their rationale and supporting evidence. They should be understandable and easy to use. Little evaluation of these infographics regarding user experience has taken place. We explored general practitioners' experiences with five selected BMJ Rapid Recommendation infographics suited for primary care.

METHODS

An iterative, qualitative user testing design was applied on two consecutive groups of 10 general practitioners for five selected infographics. The physicians used the infographics before clinical encounters and we performed hybrid think-aloud interviews afterwards. 20 interviews were analysed using the Qualitative Analysis Guide of Leuven.

RESULTS

Many clinicians reported that the infographics were simple and rewarding to use, time-efficient and easy to understand. They were perceived as innovative and their knowledge basis as trustworthy and supportive for decision-making. The interactive, expandable format was preferred over a static version as general practitioners focused mainly on the core message. Rapid access through the electronic health record was highly desirable. The main issues were about the use of complex scales and terminology. Understanding terminology related to evidence appraisal as well as the interpretation of statistics and unfamiliar scales remained difficult, despite the infographics.

CONCLUSIONS

General practitioners perceive infographics as useful tools for guideline translation and implementation in primary care. They offer information in an enjoyable and user friendly format and are used mainly for rapid, tailored and just in time information retrieval. We recommend future infographic producers to provide information as concise as possible, carefully define the core message and explore ways to enhance the understandability of statistics and difficult concepts related to evidence appraisal.

TRIAL REGISTRATION NUMBER

MP011977.