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Halley MC, Halverson CME, Tabor HK, Goldenberg AJ. Rare Disease, Advocacy and Justice: Intersecting Disparities in Research and Clinical Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:17-26. [PMID: 37204146 PMCID: PMC10321139 DOI: 10.1080/15265161.2023.2207500] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges.
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Affiliation(s)
- Meghan C. Halley
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Colin M. E. Halverson
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, IN, USA
- Charles Warren Fairbanks Center for Medical Ethics, Indianapolis, Indiana, USA
| | - Holly K. Tabor
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aaron J. Goldenberg
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Peters LJ, Torres-Castaño A, van Etten-Jamaludin FS, Perestelo Perez L, Ubbink DT. What helps the successful implementation of digital decision aids supporting shared decision-making in cardiovascular diseases? A systematic review. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:53-62. [PMID: 36743877 PMCID: PMC9890083 DOI: 10.1093/ehjdh/ztac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/31/2022] [Indexed: 11/12/2022]
Abstract
Aims Although digital decision aids (DAs) have been developed to improve shared decision-making (SDM), also in the cardiovascular realm, its implementation seems challenging. This study aims to systematically review the predictors of successful implementation of digital DAs for cardiovascular diseases. Methods and results Searches were conducted in MEDLINE, Embase, PsycInfo, CINAHL, and the Cochrane Library from inception to November 2021. Two reviewers independently assessed study eligibility and risk of bias. Data were extracted by using a predefined list of variables. Five good-quality studies were included, involving data of 215 patients and 235 clinicians. Studies focused on DAs for coronary artery disease, atrial fibrillation, and end-stage heart failure patients. Clinicians reported DA content, its effectivity, and a lack of knowledge on SDM and DA use as implementation barriers. Patients reported preference for another format, the way clinicians used the DA and anxiety for the upcoming intervention as barriers. In addition, barriers were related to the timing and Information and Communication Technology (ICT) integration of the DA, the limited duration of a consultation, a lack of communication among the team members, and maintaining the hospital's number of treatments. Clinicians' positive attitude towards preference elicitation and implementation of DAs in existing structures were reported as facilitators. Conclusion To improve digital DA use in cardiovascular diseases, the optimum timing of the DA, training healthcare professionals in SDM and DA usage, and integrating DAs into existing ICT structures need special effort. Current evidence, albeit limited, already offers advice on how to improve DA implementation in cardiovascular medicine.
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Affiliation(s)
- Loes J Peters
- Department of Surgery, Location Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Faridi S van Etten-Jamaludin
- Research Support Medical Library, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Dirk T Ubbink
- Department of Surgery, Location Academic Medical Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Tractenberg RE, Groah SL, Rounds AK, Ljungberg IH, Schladen MM. Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC): A patient-centered patient reported outcome. PLoS One 2018; 13:e0197568. [PMID: 29990375 PMCID: PMC6038997 DOI: 10.1371/journal.pone.0197568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/04/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We developed a Urinary Symptom Questionnaire for individuals with neurogenic bladder due to spinal cord injury (SCI) and spina bifida (SB) who manage their bladders with intermittent catheterization, the USQNB-IC. This project followed an approach to patient-centered patient reported outcomes development that we created and published in 2017, specifically to ensure the primacy of the patient's perspective and experience. PARTICIPANTS Two sets of responses were collected from individuals with neurogenic bladder due to either SCI (n = 336) and SB (patients, n = 179; and caregivers of patients with NB, n = 66), and three sets of "controls", individuals with neurogenic bladder who do not have a history of UTIs (n = 49) individuals with chronic mobility impairments (neither SCI nor SB) and without neurogenic bladder (n = 46), and those with no mobility impairment, no neurogenic bladder, and no history of UTIs (n = 64). METHOD Data were collected from all respondents to estimate these psychometric or measurement domains characterizing a health related PRO: Reliability (minimization of measurement error; internal consistency or interrelatedness of the items; and maximization of variability that is due to "true" difference between levels of the symptoms across patients), and validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured; and criterion, association with a gold standard). RESULTS Evidence from these five groups of respondents suggest the instrument has face, content, criterion, convergent, and divergent validity, as well as reliability. The items were all more descriptive of our patient (focus) groups and were only weakly endorsed by the control groups. CONCLUSIONS The instrument is unique in its emphasis on, and origination from, the lived experiences of patients with neurogenic bladder who use intermittent catheterization; this preliminary psychometric evidence suggests the instrument could be useful for research and in the clinic. These results justify further development of the instrument, including formal exploration of the scoring and estimation of responsivity of these items to clinical interventions as well as patient-directed self care.
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics; and Department of Neurology; Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, United States of America
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
| | - Amanda K. Rounds
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
| | - Inger H. Ljungberg
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
- MedStar Health Research Health Institute, Hyattsville, Maryland, United States of America
| | - Manon M. Schladen
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, United States of America
- MedStar National Rehabilitation Hospital, Washington, DC, United States of America
- MedStar Health Research Health Institute, Hyattsville, Maryland, United States of America
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Schumock GT, Pickard AS. Comparative effectiveness and patient-centered outcomes research: enhancing uptake and use by patients, clinicians and payers. J Comp Eff Res 2018; 7:177-180. [PMID: 29464965 DOI: 10.2217/cer-2017-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Evidence from comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) studies are increasingly available in the literature. However, there remain opportunities to better integrate that evidence into decision-making. An invitation-only conference held in January 2017, titled "Comparative Effectiveness and Patient-Centered Outcomes Research: Enhancing Uptake and Use by Patients, Clinicians and Payers", sought to identify and discuss both gaps in the uptake and use of CER/PCOR, and approaches to enhance the uptake and use of CER/PCOR evidence by patients, clinicians and payers. In this article, we summarize the conference proceedings, and highlight the themes and recommendations that resulted from the sessions. This paper also introduces other articles in this issue of CER from that conference.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood Street (MC 871), Chicago, IL 60612, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood Street (MC 871), Chicago, IL 60612, USA
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Rennke S, Yuan P, Monash B, Blankenburg R, Chua I, Harman S, Sakai DS, Khan A, Hilton JF, Shieh L, Satterfield J. The SDM 3 Circle Model: A Literature Synthesis and Adaptation for Shared Decision Making in the Hospital. J Hosp Med 2017; 12:1001-1008. [PMID: 29073314 PMCID: PMC5709161 DOI: 10.12788/jhm.2865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient engagement through shared decision-making (SDM) is increasingly seen as a key component for patient safety, patient satisfaction, and quality of care. Current SDM models do not adequately account for medical and environmental contexts, which may influence medical decisions in the hospital. We identified leading SDM models and reviews to inductively construct a novel SDM model appropriate for the inpatient setting. A team of medicine and pediatric hospitalists reviewed the literature to integrate core SDM concepts and processes and iteratively constructed a synthesized draft model. We then solicited broad SDM expert feedback on the draft model for validation and further refinement. The SDM 3 Circle Model identifies 3 core categories of variables that dynamically interact within an "environmental frame." The resulting Venn diagram includes overlapping circles for (1) patient/family, (2) provider/team, and (3) medical context. The environmental frame includes all external, contextual factors that may influence any of the 3 circles. Existing multistep SDM process models were then rearticulated and contextualized to illustrate how a shared decision might be made. The SDM 3 Circle Model accounts for important environmental and contextual characteristics that vary across settings. The visual emphasis generated by each "circle" and by the environmental frame direct attention to often overlooked interactive forces and has the potential to more precisely define, promote, and improve SDM. This model provides a framework to develop interventions to improve quality and patient safety through SDM and patient engagement for hospitalists.
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Affiliation(s)
- Stephanie Rennke
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Yuan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brad Monash
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca Blankenburg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ian Chua
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center, George Washington School of Medicine, Washington, DC, USA
| | - Stephanie Harman
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Debbie S Sakai
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Adeena Khan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Lisa Shieh
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Jason Satterfield
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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Badaczewski A, Bauman LJ, Blank AE, Dreyer B, Abrams MA, Stein REK, Roter DL, Hossain J, Byck H, Sharif I. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters. PATIENT EDUCATION AND COUNSELING 2017; 100:1345-1352. [PMID: 28254516 PMCID: PMC5466453 DOI: 10.1016/j.pec.2017.02.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. METHODS Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. RESULTS Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. CONCLUSIONS Teach-back was associated with more patient-centered communication and increased affective engagement of parents. PRACTICE IMPLICATIONS Standardizing Teach-back use may strengthen patient-centered communication.
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Affiliation(s)
- Adam Badaczewski
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Laurie J Bauman
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY, USA
| | - Arthur E Blank
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY, USA
| | - Benard Dreyer
- New York University School of Medicine, New York, NY, USA
| | - Mary Ann Abrams
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ruth E K Stein
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY, USA
| | - Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jobayer Hossain
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Hal Byck
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; The Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Sharif
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; The Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Tractenberg RE, Garver A, Ljungberg IH, Schladen MM, Groah SL. Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes. PLoS One 2017; 12:e0171114. [PMID: 28257414 PMCID: PMC5336216 DOI: 10.1371/journal.pone.0171114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/16/2017] [Indexed: 02/03/2023] Open
Abstract
The objectives of this study were to describe and demonstrate a new model of developing patient reported outcomes (PROs) that are patient-centered, and to test the hypothesis that following this model would result in a qualitatively different PRO than if the typical PRO development model were followed. The typical process of developing PROs begins with an initial list of signs or symptoms originating from clinicians or PRO developers; patient validation of this list ensures that the list (i.e., the new PRO) is interpretable by patients, but not that patient perspectives are central or even represented. The new model begins with elicitation from clinicians and patients independently and separately. These perspectives are formally analyzed qualitatively, and the results are iteratively integrated by researchers, supporting clinical relevance and patient centeredness. We describe the application of this new model to the development of a PRO for urinary signs and symptoms in individuals with neuropathic bladder, and test the hypothesis that the two processes generate qualitatively different instruments using a national validation sample of 300 respondents. Of its 29 items, the new instrument included 13 signs/symptoms derived from existing clinical practice guidelines, with 16 others derived from the patient/focus groups. The three most-endorsed items came from the patients, and the three least-endorsed items came from clinical guidelines. Thematic qualitative analysis of the elicitation process, as well as the results from our national sample, support the conclusion that the new model yields an instrument that is clinically interpretable, but more patient-centered, than the typical model would have done in this context.
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Affiliation(s)
- Rochelle E. Tractenberg
- Collaborative for Research on Outcomes and –Metrics, Georgetown University Medical Center, Washington, D.C., United States of America
- Department of Neurology, Georgetown University Medical Center, Washington, D.C., United States of America
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, D.C., United States of America
- * E-mail:
| | - Amanda Garver
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., United States of America
| | - Inger H. Ljungberg
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., United States of America
- MedStar National Rehabilitation Hospital, Washington, D.C., United States of America
| | - Manon M. Schladen
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., United States of America
- MedStar National Rehabilitation Hospital, Washington, D.C., United States of America
- MedStar Health Research Health Institute, Hyattsville, Maryland, United States of America
| | - Suzanne L. Groah
- Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, D.C., United States of America
- MedStar National Rehabilitation Hospital, Washington, D.C., United States of America
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Hsu C, Liss DT, Frosch DL, Westbrook EO, Arterburn D. Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties. Med Decis Making 2016; 37:113-126. [PMID: 27899745 DOI: 10.1177/0272989x16671933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. DESIGN In-depth, qualitative interviews with specialty care providers in two specialties-orthopedics and cardiology-at two time points during DA implementation. Data were analyzed using a thematic analysis approach. RESULTS We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. LIMITATIONS Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. CONCLUSIONS Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.
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Affiliation(s)
- Clarissa Hsu
- Group Health Research Institute, Seattle, WA (CH, EOW, DA)
| | - David T Liss
- Feinberg School of Medicine, Northwestern University, Chicago, IL (DTL)
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA (DLF).,Department of Medicine, University of California, Los Angeles, CA (DLF)
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Dempsey AF, Zimet GD. Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Am J Prev Med 2015; 49:S445-54. [PMID: 26272849 DOI: 10.1016/j.amepre.2015.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
Since the development of the "adolescent platform" of vaccination in 1997, hundreds of studies have been conducted, identifying barriers to and facilitators of adolescent vaccination. More recent research has focused on developing and evaluating interventions to increase uptake of adolescent vaccines. This review describes a selection of recent intervention studies for increasing adolescent vaccination, divided into three categories: those with promising results that may warrant more widespread implementation, those with mixed results requiring more research, and those with proven effectiveness in other domains that have not yet been tested with regard to adolescent vaccination.
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Affiliation(s)
- Amanda F Dempsey
- Adult and Child Center for Outcomes Research and Dissemination Science program, University of Colorado Denver, Aurora, Colorado.
| | - Gregory D Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Halley MC, Rendle KAS, Gillespie KA, Stanley KM, Frosch DL. An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives. Health Expect 2014; 18:2880-91. [PMID: 25263630 DOI: 10.1111/hex.12273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The last 15 years have witnessed considerable progress in the development of decision support interventions (DESIs). However, fundamental questions about design and format of delivery remain. METHODS An exploratory, randomized mixed-method crossover study was conducted to compare a DVD- and Web-based DESI. Randomized participants used either the Web or the DVD first, followed by the alternative format. Participants completed a questionnaire to assess decision-specific knowledge at baseline and a questionnaire and structured qualitative interview after viewing each format. Tracking software was used to capture Web utilization. Transcripts were analyzed using integrated inductive and deductive approaches. Quantitative data were analyzed using exploratory bivariate and multivariate analyses. RESULTS Exploratory knowledge analyses suggest that both formats increased knowledge, with limited evidence that the DVD increased knowledge more than the Web. Format preference varied across participants: 44% preferred the Web, 32% preferred the DVD and 24% preferred 'both'. Patient discussions of preferences for DESI information structure and the importance of a patients' stage of a given decision suggest these characteristics may be important factors underlying variation in utilization, format preferences and knowledge outcomes. CONCLUSIONS Our results suggest that both DESI formats effectively increase knowledge. Patients' perceptions of these two formats further suggest that there may be no single 'best' format for all patients. These results have important implications for understanding why different DESI formats might be preferable to and more effective for different patients. Further research is needed to explore the relationship between these factors and DESI utilization outcomes across diverse patient populations.
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Affiliation(s)
- Meghan C Halley
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Katharine A S Rendle
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.,University of Michigan, Ann Arbor, MI, USA
| | | | | | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.,Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA, USA.,University of California, Los Angeles, CA, USA
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