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Tsai CC, Liu CF, Lin HJ, Lin TC, Kuo KM, Lin JJ, Chen CJ, Lee MC. Implementation of a patient-centered mobile shared decision making platform and healthcare workers' evaluation: a case in a medical center. Inform Health Soc Care 2023; 48:68-79. [PMID: 35348045 DOI: 10.1080/17538157.2022.2054344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other.
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Affiliation(s)
- Chang-Chih Tsai
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Tzu-Chi Lin
- Department of Nursing, Chi Mei Medical Center, Liouying, Taiwan
| | - Kuang-Ming Kuo
- Department of Business Management, National United University, Miaoli, Taiwan
| | - Jing-Jia Lin
- Department of Information Systems, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Jung Chen
- Department of Information Systems, Chi Mei Medical Center, Tainan, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Ayivi-Vinz G, Bakwa Kanyinga F, Bergeron L, Décary S, Adisso ÉL, Zomahoun HTV, Daniel SJ, Tremblay M, Plourde KV, Guay-Bélanger S, Légaré F. Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review. JMIR MEDICAL EDUCATION 2022; 8:e36948. [PMID: 35318188 PMCID: PMC9112082 DOI: 10.2196/36948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory-informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory-informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. OBJECTIVE We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. METHODS We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). CONCLUSIONS The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. TRIAL REGISTRATION PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492.
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Affiliation(s)
- Gloria Ayivi-Vinz
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Felly Bakwa Kanyinga
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Lysa Bergeron
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Évèhouénou Lionel Adisso
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Unité de Soutien SSA Québec, Université Laval, Quebec, QC, Canada
| | - Sam J Daniel
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Martin Tremblay
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Karine V Plourde
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Unité de Soutien SSA Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Agbadje TT, Rahimi SA, Côté M, Tremblay AA, Diallo MP, Elidor H, Herron AP, Djade CD, Légaré F. Evaluation of a prenatal screening decision aid: A mixed methods pilot study. PATIENT EDUCATION AND COUNSELING 2022; 105:474-485. [PMID: 34088585 DOI: 10.1016/j.pec.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND We developed a decision aid (DA) to help pregnant women and their partners make informed decisions about prenatal screening for trisomy. We aimed to determine its usefulness for preparing for decision-making and its acceptability among end-users. METHODS In this mixed-methods pilot study, we recruited participants in three prenatal care settings in Quebec City. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. We asked them about the usefulness of the DA using an interview grid based on the Technology Acceptance Model. We performed descriptive statistics and deductive analysis. RESULTS Thirty-nine dyads or individuals participated in the study. Mean usefulness score was 86.2 ± 13. Most participants found the amount of information in the DA just right (79.5%), balanced (89.7%), and very useful (61.5%). They were less satisfied with the presentation and the values worksheet and suggested different values clarification methods. CONCLUSION Rigorous pilot tests of DAs with patients are an important stage in their development before the more formal assessments that precede scaling up the DA in clinical practice. PRACTICE IMPLICATIONS The next version of the DA will integrate the suggestions of end-users for better decision-making processes about prenatal screening for trisomy.
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Affiliation(s)
- Titilayo Tatiana Agbadje
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Mélissa Côté
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Andrée-Anne Tremblay
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada
| | - Mariama Penda Diallo
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada
| | - Hélène Elidor
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Alex Poulin Herron
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Codjo Djignefa Djade
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Laval University, Quebec, QC, Canada; Centre de recherche en santé durable (VITAM), Quebec, QC, Canada; Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
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Farrell RM, Pierce M, Collart C, Edmonds BT, Chien E, Coleridge M, Rose SL, Perni U, Frankel R. Making the most of the first prenatal visit: The challenge of expanding prenatal genetic testing options and limited clinical encounter time. Prenat Diagn 2020; 40:1265-1271. [PMID: 32441820 PMCID: PMC10114520 DOI: 10.1002/pd.5752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Advances in prenatal genetics place additional challenges as patients must receive information about a growing array of screening and testing options. This raises concerns about how to achieve a shared decision-making process that prepares patients to make an informed decision about their choices about prenatal genetic screening and testing options, calling for a reconsideration of how healthcare providers approach the first prenatal visit. METHODS We conducted interviews with 40 pregnant women to identify components of decision-making regarding prenatal genetic screens and tests at this visit. Analysis was approached using grounded theory. RESULTS Participants brought distinct notions of risk to the visit, including skewed perceptions of baseline risk for a fetal genetic condition and the implications of screening and testing. Participants were very concerned about financial considerations associated with these options, ranking out-of-pocket costs on par with medical considerations. Participants noted diverging priorities at the first visit from those of their healthcare provider, leading to barriers to shared decision-making regarding screening and testing during this visit. CONCLUSION Research is needed to determine how to restructure the initiation of prenatal care in a way that best positions patients to make informed decisions about prenatal genetic screens and tests.
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Affiliation(s)
- Ruth M Farrell
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Madelyn Pierce
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christina Collart
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Edward Chien
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Susannah L Rose
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA.,Office of Patient Experience, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Uma Perni
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Frankel
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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