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Wilson L, Zheng P, Ionova Y, Denham A, Yoo C, Ma Y, Greco CM, Hanmer J, Williams DA, Hassett AL, Scheffler AW, Valone F, Mehling W, Berven S, Lotz J, O'Neill C. CAPER: patient preferences to inform nonsurgical treatment of chronic low back pain: a discrete-choice experiment. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:963-973. [PMID: 36975607 DOI: 10.1093/pm/pnad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE We developed and used a discrete-choice measure to study patient preferences with regard to the risks and benefits of nonsurgical treatments when they are making treatment selections for chronic low back pain. METHODS "CAPER TREATMENT" (Leslie Wilson) was developed with standard choice-based conjoint procedures (discrete-choice methodology that mimics an individual's decision-making process). After expert input and pilot testing, our final measure had 7 attributes (chance of pain relief, duration of relief, physical activity changes, treatment method, treatment type, treatment time burden, and risks of treatment) with 3-4 levels each. Using Sawtooth software (Sawtooth Software, Inc., Provo, UT, USA), we created a random, full-profile, balanced-overlap experimental design. Respondents (n = 211) were recruited via an emailed online link and completed 14 choice-based conjoint choice pairs; 2 fixed questions; and demographic, clinical, and quality-of-life questions. Analysis was performed with random-parameters multinomial logit with 1000 Halton draws. RESULTS Patients cared most about the chance of pain relief, followed closely by improving physical activity, even more than duration of pain relief. There was comparatively less concern about time commitment and risks. Gender and socioeconomic status influenced preferences, especially with relation to strength of expectations for outcomes. Patients experiencing a low level of pain (Pain, Enjoyment, and General Activity Scale [PEG], question 1, numeric rating scale score<4) had a stronger desire for maximally improved physical activity, whereas those in a high level of pain (PEG, question 1, numeric rating scale score>6) preferred both maximum and more limited activity. Highly disabled patients (Oswestry Disability Index score>40) demonstrated distinctly different preferences, placing more weight on achieving pain control and less on improving physical activity. CONCLUSIONS Individuals with chronic low back pain were willing to trade risks and inconveniences for better pain control and physical activity. Additionally, different preference phenotypes exist, which suggests a need for clinicians to target treatments to particular patients.
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Affiliation(s)
- Leslie Wilson
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Patricia Zheng
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Yelena Ionova
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Alina Denham
- Harvard Medical School, Boston, MA 02115, United States
| | - Connie Yoo
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Yanlei Ma
- Cornell University, Ithaca, NY 14853, United States
| | - Carol M Greco
- University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Janel Hanmer
- University of Pittsburgh, Pittsburgh, PA 15260, United States
| | | | | | | | - Frank Valone
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Wolf Mehling
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Sigurd Berven
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Jeffrey Lotz
- University of California San Francisco, San Francisco, CA 94143, United States
| | - Conor O'Neill
- University of California San Francisco, San Francisco, CA 94143, United States
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Herrera DJ, van de Veerdonk W, Berhe NM, Talboom S, van Loo M, Alejos AR, Ferrari A, Van Hal G. Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening. Cancers (Basel) 2023; 15:3867. [PMID: 37568683 PMCID: PMC10417450 DOI: 10.3390/cancers15153867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.
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Affiliation(s)
- Deborah Jael Herrera
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Wessel van de Veerdonk
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Neamin M Berhe
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Société Générale de Surveillance (SGS), 2800 Mechelen, Belgium
| | - Sarah Talboom
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Marlon van Loo
- Expertise Unit People and Wellbeing, Campus Zandpoortvest Thomas More University of Applied Sciences, 2800 Mechelen, Belgium
| | - Andrea Ruiz Alejos
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
| | - Allegra Ferrari
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16123 Genoa, Italy
| | - Guido Van Hal
- Social Epidemiology and Health Policy (SEHPO), Family Medicine and Population Health (FAMPOP) Department, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 2610 Antwerp, Belgium
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Aouad P, Ahmed MU, Nassar N, Miskovic-Wheatley J, Touyz S, Maguire S, Cunich M. Appraisal of the costs, health effects, and cost-effectiveness of screening, prevention, treatment and policy-indicated evidence-based interventions for eating disorders: a systematic review protocol. J Eat Disord 2023; 11:83. [PMID: 37226270 DOI: 10.1186/s40337-023-00802-2] [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: 12/24/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Having reliable information to make decisions about the allocation of healthcare resources is needed to improve well-being and quality-of-life of individuals with eating disorders (EDs). EDs are a main concern for healthcare administrators globally, particularly due to the severity of health effects, urgent and complex healthcare needs, and relatively high and long-term healthcare costs. A rigorous assessment of up-to-date health economic evidence on interventions for EDs is essential for informing decision-making in this area. To date, health economic reviews on this topic lack a comprehensive assessment of the underlying clinical utility, type and amount of resources used, and methodological quality of included economic evaluations. The current review aims to (1) detail the type of costs (direct and indirect), costing approaches, health effects, and cost-effectiveness of interventions for EDs; (2) assess the nature and quality of available evidence to provide meaningful insights into the health economics associated with EDs. METHODS All interventions for screening, prevention, treatment, and policy-based approaches for all Diagnostic and Statistics Manual (DSM-IV and DSM-5) listed EDs among children, adolescents, and adults will be included. A range of study designs will be considered, including randomised controlled trials, panel studies, cohort studies, and quasi-experimental trials. Economic evaluations will consider key outcomes, including type of resources used (time and valued in a currency), costs (direct and indirect), costing approach, health effects (clinical and quality-of-life), cost-effectiveness, economic summaries used, and reporting and quality assessments. Fifteen general academic and field-specific (psychology and economics) databases will be searched using subject headings and keywords that consolidate costs, health effects, cost-effectiveness and EDs. Quality of included clinical studies will be assessed using risk-of-bias tools. Reporting and quality of the economic studies will be assessed using the widely accepted Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies frameworks, with findings of the review presented in tables and narratively. DISCUSSION Results emanating from this systematic review are expected to highlight gaps in healthcare interventions/policy-focused approaches, under-estimates of the economic costs and disease-burden, potential under-utilisation of ED-related resources, and a pressing need for more complete health economic evaluations.
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Affiliation(s)
- Phillip Aouad
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia.
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia.
| | - Moin Uddin Ahmed
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Stephen Touyz
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Michelle Cunich
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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Hochstenbach LM, Determann D, Fijten RR, Bloemen-van Gurp EJ, Verwey R. Taking shared decision making for prostate cancer to the next level: Requirements for a Dutch treatment decision aid with personalized risks on side effects. Internet Interv 2023; 31:100606. [PMID: 36844795 PMCID: PMC9945792 DOI: 10.1016/j.invent.2023.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/16/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Different curative treatment modalities need to be considered in case of localized prostate cancer, all comparable in terms of survival and recurrence though different in side effects. To better inform patients and support shared decision making, the development of a web-based patient decision aid including personalized risk information was proposed. This paper reports on requirements in terms of content of information, visualization of risk profiles, and use in practice. METHODS Based on a Dutch 10-step guide about the setup of a decision aid next to a practice guideline, an iterative and co-creative design process was followed. In collaboration with various groups of experts (health professionals, usability and linguistic experts, patients and the general public), research and development activities were continuously alternated. RESULTS Content requirements focused on presenting information only about conventional treatments and main side effects; based on risk group; and including clear explanations about personalized risks. Visual requirements involved presenting general and personalized risks separately; through bar charts or icon arrays; and along with numbers or words, and legends. Organizational requirements included integration into local clinical pathways; agreement about information input and output; and focus on patients' numeracy and graph literacy skills. CONCLUSIONS The iterative and co-creative development process was challenging, though extremely valuable. The translation of requirements resulted in a decision aid about four conventional treatment options, including general or personalized risks for erection, urinary and intestinal problems that are communicated with icon arrays and numbers. Future implementation and validation studies need to inform about use and value in practice.
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Affiliation(s)
- Laura M.J. Hochstenbach
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands,Corresponding author at: Maastricht University, Department of Health Services Research, P.O. Box 616, 6200 MD, the Netherlands.
| | | | - Rianne R.R. Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Esther J. Bloemen-van Gurp
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Expertise Center Empowering Healthy Behavior, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, the Netherlands
| | - Renée Verwey
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands
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Ahonen‐Jonnarth U, Andersson H, Bökman F. How do people aggregate value? An experiment with relative importance of criteria and relative goodness of alternatives as inputs. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2021. [DOI: 10.1002/mcda.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Hanna Andersson
- Department of Computer and Geospatial Sciences University of Gävle Gävle Sweden
- Department of Building Engineering, Energy Systems and Sustainability Science, Faculty of Engineering and Sustainable Development University of Gävle Gävle Sweden
| | - Fredrik Bökman
- Department of Computer and Geospatial Sciences University of Gävle Gävle Sweden
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Guni A, Normahani P, Davies A, Jaffer U. Harnessing Machine Learning to Personalize Web-Based Health Care Content. J Med Internet Res 2021; 23:e25497. [PMID: 34665146 PMCID: PMC8564651 DOI: 10.2196/25497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023] Open
Abstract
Web-based health care content has emerged as a primary source for patients to access health information without direct guidance from health care providers. The benefit of this approach is dependent on the ability of patients to access engaging high-quality information, but significant variability in the quality of web-based information often forces patients to navigate large quantities of inaccurate, incomplete, irrelevant, or inaccessible content. Personalization positions the patient at the center of health care models by considering their needs, preferences, goals, and values. However, the traditional methods used thus far in health care to determine the factors of high-quality content for a particular user are insufficient. Machine learning (ML) uses algorithms to process and uncover patterns within large volumes of data to develop predictive models that automatically improve over time. The health care sector has lagged behind other industries in implementing ML to analyze user and content features, which can automate personalized content recommendations on a mass scale. With the advent of big data in health care, which builds comprehensive patient profiles drawn from several disparate sources, ML can be used to integrate structured and unstructured data from users and content to deliver content that is predicted to be effective and engaging for patients. This enables patients to engage in their health and support education, self-management, and positive behavior change as well as to enhance clinical outcomes.
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Affiliation(s)
- Ahmad Guni
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alun Davies
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Usman Jaffer
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
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Remmers S, Roobol MJ. Personalized strategies in population screening for prostate cancer. Int J Cancer 2020; 147:2977-2987. [PMID: 32394421 PMCID: PMC7586980 DOI: 10.1002/ijc.33045] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
This review discusses evidence for population-based screening with contemporary screening tools. In Europe, prostate-specific antigen (PSA)-based screening led to a relative reduction of prostate cancer (PCa) mortality, but also to a substantial amount of overdiagnosis and unnecessarily biopsies. Risk stratification based on a single variable (a clinical variable or based on the presence of a lesion on prostate imaging) or based on multivariable approaches can aid in reducing unnecessary prostate biopsies and overdiagnosis by selecting men who can benefit from further clinical assessment. Multivariable approaches include clinical variables, and biomarkers, often combined in risk calculators or nomograms. These risk calculators can also incorporate the result of MRI imaging. In general, as compared to a purely PSA based approach, the combination of relevant prebiopsy information results in superior selection of men at higher risk of harboring clinically significant prostate cancer. Currently, it is not possible to draw any conclusions on the superiority of these multivariable risk-based approaches since head-to-head comparisons are virtually lacking. Recently initiated large population-based screening studies in Finland, Germany and Sweden, incorporating various multivariable risk stratification approaches will hopefully give more insight in whether the harm-benefit ratio can be improved, that is, maintain (or improving) the ability to reduce metastatic disease and prostate cancer mortality while reducing harm caused by unnecessary testing and overdiagnosis including related overtreatment.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Jeon YH, Flaherty I, Urban H, Wortley S, Dickson C, Salkeld G, Hunter DJ. Qualitative Evaluation of Evidence-Based Online Decision Aid and Resources for Osteoarthritis Management: Understanding Patient Perspectives. Arthritis Care Res (Hoboken) 2019; 71:46-55. [PMID: 29609208 DOI: 10.1002/acr.23572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To qualitatively examine the experiences with, and impact of, evidence-based online resources in self-management among Australians with osteoarthritis. METHODS Telephone interviews were conducted with 36 users of a novel osteoarthritis resource, the Osteoarthritis Awareness Hub. Rogers' 5 attributes of innovation (relative advantage, compatibility, complexity, trialability, and observability) and outcomes guided the semistructured interview and analysis. Maximum variation sampling was used, and data saturation occurred after 33 interviews. A coding scheme was agreed upon and all interview data were entered into NVivo for qualitative content analysis. RESULTS Study participants had high levels of literacy and health literacy. For adoption and implementation of an innovation, the participants' narratives confirmed and underscored the fact that it was important that it come from an authoritative and trusting voice and that its perceived benefits align with participants' values and existing practices (relative advantage and compatibility). The participants also valued seeing the practical benefits of the innovation, such as its capacity to impart quality and balanced new insights and information, and to maintain and monitor their personal progress. Notably, many participants spoke about the mental and physical health benefits that they derived from engagement with the online resources. CONCLUSION Our study findings confirm that web-based tools can be a useful adjunct to patients adopting self-management strategies. Rogers' theory provides a framework for a deeper appreciation of the how, why, and what questions concerning the adoption and implementation processes, especially among people with good technology and health literacy.
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Affiliation(s)
- Yun-Hee Jeon
- University of Sydney, Camperdown, New South Wales, Australia
| | - Ian Flaherty
- University of Sydney, Camperdown, New South Wales, Australia
| | - Hema Urban
- Royal North Shore Hospital, St Leonards, and University of Sydney, Camperdown, New South Wales, Australia
| | - Sally Wortley
- University of Sydney, Camperdown, New South Wales, Australia
| | - Chris Dickson
- Arthritis Australia and Chris O'Brien Lifehouse Hospital, Camperdown, New South Wales, Australia
| | - Glenn Salkeld
- University of Wollongong, Wollongong, New South Wales, Australia
| | - David J Hunter
- Royal North Shore Hospital, St Leonards, and University of Sydney, Camperdown, New South Wales, Australia
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Scalia P, Elwyn G, Kremer J, Faber M, Durand MA. Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid. JMIR Cancer 2018; 4:e11102. [PMID: 30463840 PMCID: PMC6282011 DOI: 10.2196/11102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023] Open
Abstract
Background Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. Objective The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. Methods Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. Results Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. Conclusions Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Jan Kremer
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, Netherlands
| | - Marjan Faber
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud university medical center, Nijmegen, Netherlands
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
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James LJ, Wong G, Craig JC, Hanson CS, Ju A, Howard K, Usherwood T, Lau H, Tong A. Men's perspectives of prostate cancer screening: A systematic review of qualitative studies. PLoS One 2017; 12:e0188258. [PMID: 29182649 PMCID: PMC5705146 DOI: 10.1371/journal.pone.0188258] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 11/01/2017] [Indexed: 02/01/2023] Open
Abstract
Background Prostate cancer is the most commonly diagnosed non-skin cancer in men. Screening for prostate cancer is widely accepted; however concerns regarding the harms outweighing the benefits of screening exist. Although patient’s play a pivotal role in the decision making process, men may not be aware of the controversies regarding prostate cancer screening. Therefore we aimed to describe men’s attitudes, beliefs and experiences of prostate cancer screening. Methods Systematic review and thematic synthesis of qualitative studies on men’s perspectives of prostate cancer screening. Electronic databases and reference lists were searched to October 2016. Findings Sixty studies involving 3,029 men aged from 18–89 years, who had been screened for prostate cancer by Prostate Specific Antigen (PSA) or Digital Rectal Examination (DRE) and not screened, across eight countries were included. Five themes were identified: Social prompting (trusting professional opinion, motivation from family and friends, proximity and prominence of cancer); gaining decisional confidence (overcoming fears, survival imperative, peace of mind, mental preparation, prioritising wellbeing); preserving masculinity (bodily invasion, losing sexuality, threatening manhood, medical avoidance); avoiding the unknown and uncertainties (taboo of cancer-related death, lacking tangible cause, physiological and symptomatic obscurity, ambiguity of the procedure, confusing controversies); and prohibitive costs. Conclusions Men are willing to participate in prostate cancer screening to prevent cancer and gain reassurance about their health, particularly when supported or prompted by their social networks or healthcare providers. However, to do so they needed to mentally overcome fears of losing their masculinity and accept the intrusiveness of screening, the ambiguities about the necessity and the potential for substantial costs. Addressing the concerns and priorities of men may facilitate informed decisions about prostate cancer screening and improve patient satisfaction and outcomes.
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Affiliation(s)
- Laura J. James
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
- * E-mail:
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
| | - Jonathan C. Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
| | - Camilla S. Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
| | - Kirsten Howard
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Howard Lau
- Department of Urology, Westmead Hospital, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia
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Raffin E, Onega T, Bynum J, Austin A, Carmichael D, Bronner K, Goodney P, Hyams ES. Are there regional tendencies toward controversial screening practices? A study of prostate and breast cancer screening in a Medicare population. Cancer Epidemiol 2017; 50:68-75. [PMID: 28822325 DOI: 10.1016/j.canep.2017.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Prostate and breast cancer screening in older patients continue to be controversial. Balancing the desire for early detection with avoidance of over-diagnosis has led to competing and contradictory guidelines for both practices. Despite similarities, it is not known how these screening practices are related at the regional level. In this study, we examined how screening PSA and mammography are related within healthcare regions, and, to better understand what may be driving these practices, whether they are associated with local intensity of care. METHODS We performed a retrospective cross-sectional study of fee-for-service Medicare beneficiaries in 2012. For each of 306 hospital referral regions (HRRs), we calculated rates of PSA screening for men aged ≥68 years, as well as rates of screening mammography for women aged ≥75 years, adjusted for age and race. Additionally, we determined regional rates of "healthcare intensity", including spending on tests and procedures, and intensity of end-of-life care. Pearson correlations of adjusted rates were calculated within HRRs. RESULTS The mean adjusted rate of PSA screening was 22%. The mean age of screened and unscreened patients was 75.0 and 77.4 years, respectively (p<0.0001). The mean adjusted rate of screening mammography was 23%; mean ages of screened and non-screened women were 79.95 and 83.67, respectively (p<0.0001). HRR-level PSA screening rates were independent of screening mammography rates (r=0.06, p=0.31). PSA screening rates were associated with spending on testing and procedures (r=0.42, p<0.0001) and various measures of intensity of EOL care (e.g. r=0.40, p<0.0001 for mechanical ventilator use). Screening mammography had low correlation with both health care spending and EOL care intensity measures (all r-values <0.3). CONCLUSIONS Regional rates of PSA screening rates were independent of screening mammography, thus these practices appear to be driven by different factors. Unlike mammography, PSA screening was associated with local enthusiasm for testing and treatment. Efforts to reduce over-testing should contemplate these practices differently, and future research should examine the factors motivating these screening practices.
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Affiliation(s)
- Eric Raffin
- Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Suite 5B, Lebanon, NH 03756, United States.
| | - Tracy Onega
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Julie Bynum
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Andrea Austin
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Donald Carmichael
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Kristen Bronner
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States
| | - Philip Goodney
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, United States; Department of Surgery, Dartmouth Hitchcock Medical Center, United States
| | - Elias S Hyams
- Department of Urology, Columbia University Medical Center, United States
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Eiring Ø, Nytrøen K, Kienlin S, Khodambashi S, Nylenna M. The development and feasibility of a personal health-optimization system for people with bipolar disorder. BMC Med Inform Decis Mak 2017; 17:102. [PMID: 28693482 PMCID: PMC5504814 DOI: 10.1186/s12911-017-0481-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/02/2017] [Indexed: 01/14/2023] Open
Abstract
Background People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. Methods Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. Results Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines. Conclusion We have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient’s health on a shared platform. User tests indicate that the feasibility of the system is acceptable. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0481-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Øystein Eiring
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway.,Norwegian Institute of Public Health, Postbox 4404, Nydalen, N-0403, Oslo, Norway.,Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway. .,Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway. .,Oslo University Hospital, Postbox 4950, Nydalen, N-0424, Oslo, Norway.
| | - Simone Kienlin
- Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Postbox 404, N-2303, Hamar, Norway.,Department of Medicine, University Hospital of North Norway, Postbox 6050, N-9037, Langnes, Tromsø, Norway
| | | | - Magne Nylenna
- Faculty of Medicine, University of Oslo, Postbox 1072, Blindern, N-0316, Oslo, Norway.,Norwegian Institute of Public Health, Postbox 4404, Nydalen, N-0403, Oslo, Norway
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Axelrod DA, Kynard-Amerson CS, Wojciechowski D, Jacobs M, Lentine KL, Schnitzler M, Peipert JD, Waterman AD. Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12944] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 01/05/2023]
Affiliation(s)
- David A. Axelrod
- Brody School of Medicine; East Carolina University; Greenville NC USA
- XynManagement Inc; Boerne TX USA
| | | | | | - Marie Jacobs
- Department of Medicine; Massachusetts General Hospital; Boston MA USA
| | - Krista L. Lentine
- XynManagement Inc; Boerne TX USA
- Abdominal Transplant Center; St. Louis University; St. Louis MO USA
| | - Mark Schnitzler
- XynManagement Inc; Boerne TX USA
- Abdominal Transplant Center; St. Louis University; St. Louis MO USA
| | - John D. Peipert
- David Geffen School of Medicine; University of California at Los Angeles; Los Angeles CA USA
| | - Amy D. Waterman
- David Geffen School of Medicine; University of California at Los Angeles; Los Angeles CA USA
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