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Wang S, Lu Q, Ye Z, Liu F, Yang N, Pan Z, Li Y, Li L. Effects of a smartphone application named "Shared Decision Making Assistant" for informed patients with primary liver cancer in decision-making in China: a quasi-experimental study. BMC Med Inform Decis Mak 2022; 22:145. [PMID: 35641979 PMCID: PMC9152304 DOI: 10.1186/s12911-022-01883-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/16/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is well known that decision aids can promote patients' participation in decision-making, increase patients' decision preparation and reduce decision conflict. The goal of this study is to explore the effects of a "Shared Decision Making Assistant" smartphone application on the decision-making of informed patients with Primary Liver Cancer (PLC) in China. METHODS In this quasi-experimental study , 180 PLC patients who knew their real diagnoses in the Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China, from April to December 2020 were randomly assigned to a control group and an intervention group. Patients in the intervention group had an access to the "Shared Decision Making Assistant" application in decision-making, which included primary liver cancer treatment knowledge, decision aids path, continuing nursing care video clips, latest information browsing and interactive platforms. The study used decision conflict scores to evaluate the primary outcome, and the data of decision preparation, decision self-efficacy, decision satisfaction and regret, and knowledge of PLC treatment for secondary outcomes. Then, the data were entered into the SPSS 22.0 software and were analyzed by descriptive statistics, Chi-square, independent t-test, paired t-test, and Mann-Whitney tests. RESULTS Informed PLC patients in the intervention group ("SDM Assistant" group) had significantly lower decision conflict scores than those in the control group. ("SDM Assistant" group: 16.89 ± 8.80 vs. control group: 26.75 ± 9.79, P < 0.05). Meanwhile, the decision preparation score (80.73 ± 8.16), decision self-efficacy score (87.75 ± 6.87), decision satisfaction score (25.68 ± 2.10) and knowledge of PLC treatment score (14.52 ± 1.91) of the intervention group were significantly higher than those of the control group patients (P < 0.05) at the end of the study. However, the scores of "regret of decision making" between the two groups had no statistical significance after 3 months (P > 0.05). CONCLUSIONS Access to the "Shared Decision Making Assistant" enhanced the PLC patients' performance and improved their quality of decision making in the areas of decision conflict, decision preparation, decision self-efficacy, knowledge of PLC treatment and satisfaction. Therefore, we recommend promoting and updating the "Shared Decision Making Assistant" in clinical employment and future studies.
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Affiliation(s)
- Sitong Wang
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.,Officers' Ward, General Hospital of Northern Theater Command, Shenyang, 110016, Liaoning, People's Republic of China
| | - Qingwen Lu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Zhixia Ye
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Fang Liu
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China
| | - Ning Yang
- Department of No. 5 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Zeya Pan
- Department of No. 3 Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Yu Li
- Department of Organ Transplantation, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People's Republic of China
| | - Li Li
- Department of Nursing, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700 Moyu Road, Jiading District, Shanghai, 201805, People's Republic of China.
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Rieger EY, Kushner JNS, Sriram V, Klein A, Wiklund LO, Meltzer DO, Tang JW. Primary care physician involvement during hospitalisation: a qualitative analysis of perspectives from frequently hospitalised patients. BMJ Open 2021; 11:e053784. [PMID: 34853107 PMCID: PMC8638455 DOI: 10.1136/bmjopen-2021-053784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore frequently hospitalised patients' experiences and preferences related to primary care physician (PCP) involvement during hospitalisation across two care models. DESIGN Qualitative study embedded within a randomised controlled trial. Semistructured interviews were conducted with patients. Transcripts were analysed using qualitative template analysis. SETTING In the Comprehensive Care Programme (CCP) Study, in Illinois, USA, Medicare patients at increased risk of hospitalisation are randomly assigned to: (1) care by a CCP physician who serves as a PCP across both inpatient and outpatient settings or (2) care by a PCP as outpatient and by hospitalists as inpatients (standard care). PARTICIPANTS Twelve standard care and 12 CCP patients were interviewed. RESULTS Themes included: (1) Positive attitude towards PCP; (2) Longitudinal continuity with PCP valued; (3) Patient preference for PCP involvement in hospital care; (4) Potential for in-depth involvement of PCP during hospitalisation often unrealised (involvement rare in standard care; in CCP, frequent interaction with PCP fostered patient involvement in decision making); and (5) PCP collaboration with hospital-based providers frequently absent (no interaction for standard care patients; CCP patients emphasising PCP's role in interdisciplinary coordination). CONCLUSION Frequently hospitalised patients value PCP involvement in the hospital setting. CCP patients highlighted how an established relationship with their PCP improved interdisciplinary coordination and engagement with decision making. Inpatient-outpatient relational continuity may be an important component of programmes for frequently hospitalised patients. Opportunities for enhancing PCP involvement during hospitalisation should be considered.
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Affiliation(s)
| | - Josef N S Kushner
- Department of Medicine, Lenox Hill Hospital, New York City, New York, USA
| | - Veena Sriram
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Abbie Klein
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lauren O Wiklund
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Joyce W Tang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Xyrichis A, Fletcher S, Philippou J, Brearley S, Terblanche M, Rafferty AM. Interventions to promote family member involvement in adult critical care settings: a systematic review. BMJ Open 2021; 11:e042556. [PMID: 33827833 PMCID: PMC8031009 DOI: 10.1136/bmjopen-2020-042556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise evidence of interventions designed to promote family member involvement in adult critical care units; and to develop a working typology of interventions for use by health professionals and family members. DESIGN Mixed-method systematic review. DATA SOURCES Bibliographic databases were searched without date restriction up to June 2019: MEDLINE, EMBASE and CINAHL; the Cochrane Central Register of Controlled Trials, Joanna Briggs and Cochrane Libraries. Back issues of leading critical care and patient experience journals were manually searched, as were the reference lists of included studies. All evaluation studies of relevant intervention activities were included; all research designs and outcome measures were eligible. Due to heterogeneity in interventions, designs and outcome measures, the synthesis followed a narrative approach. Service users met with the research team termly. RESULTS Out of 4962 possible citations, a total of 20 studies were included. The overall evidence base was assessed as moderate to weak. Six categories of interventions were identified: environmental unit changes (n=2), web-based support (n=4), discussion-based support (n=6), multicomponent support (n=4), participation in rounds (n=3) and participation in physical care (n=1). Clinical and methodological heterogeneity across studies hindered meta-analysis, hence a narrative synthesis was pursued. Six main outcomes were identified, grouped under two categories: (i) involvement outcomes: communication (mean difference ranged from 6.39 to 8.83), decision-making (mean difference ranged from -0.8 to 5.85), satisfaction (mean difference ranged from 0.15 to 2.48); and (ii) health outcomes: family trauma (mean difference ranged from -7.12 to 0.9), family well-being (mean difference ranged from -0.7 to -4), patient outcomes (relative risk ranged from 1.27 to 4.91). The findings from the qualitative studies were thematically analysed to identify features of the interventions that participants perceived to influence effectiveness. Synthesised into five overarching categories (practicality, development, interaction, reflexivity and bridging), these can serve as principles to inform the future design and development of more refined family member involvement interventions. CONCLUSIONS Future interventions should be developed with much closer family member input and designed by considering the key features we identified. We call for future interventions to be multilayered and allow for a greater or lesser level, and different kinds, of involvement for family members. Choice of intervention should be informed by a baseline diagnostic of family members' needs, readiness and preparedness for involvement. PROSPERO REGISTRATION CRD42018086325.
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Affiliation(s)
- Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Simon Fletcher
- Health, Social Care and Education, Kingston and St Georges University London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Sally Brearley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
| | - Marius Terblanche
- Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, England, UK
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Sahgal S, Yande A, Thompson BB, Chen EP, Fagerlin A, Morgenstern LB, Zahuranec DB. Surrogate Satisfaction with Decision Making After Intracerebral Hemorrhage. Neurocrit Care 2020; 34:193-200. [PMID: 32556855 DOI: 10.1007/s12028-020-01018-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND/OBJECTIVE Surrogate decision makers for patients with intracerebral hemorrhage (ICH) are frequently asked to make difficult decisions on use of life-sustaining treatments. We explored ICH surrogate satisfaction with decision making and experience of decision regret using validated measures in a prospective multicenter study. METHODS Cases of non-traumatic ICH were enrolled from three hospitals (September 2015-December 2016), and surrogate decision makers were invited to complete a self-administered survey. The primary outcome was the 10-item decision-making subscale of the Family Satisfaction in the Intensive Care Unit scale (FSICU-DM, range 0-100, higher is greater satisfaction), and the secondary outcome was the decision regret scale (range 0-100, higher is greater regret). Linear regression models were used to assess the association between satisfaction with decision making and pre-specified covariates using manual backward selection. RESULTS A total of 73 surrogates were approached for participation (in person or mail), with 48 surrogates returning a completed survey (median surrogate age 60.5 years, 63% female, 77% white). Patients had a median age of 72.5, 54% were female, with a median admission Glasgow coma scale of 10, in-hospital mortality of 31%, and 56% with an in-hospital DNR order. Physicians commonly made treatment recommendation (> 50%) regarding brain surgery or transitions to comfort measures, but rarely made recommendations (< 20%) regarding DNR orders. Surrogate satisfaction with decision making was generally high (median FSICU-DM 85, IQR 57.5-95). Factors associated with higher satisfaction on multivariable analysis included greater use of shared decision making (P < 0.0001), younger patient age (p = 0.02), ICH score of 3 or higher (p = 0.03), and surrogate relationship (spouse vs. other, p = 0.02). Timing of DNR orders was not associated with satisfaction (P > 0.25). Decision regret scores were generally low (median 12.5, IQR 0-31.3). CONCLUSIONS Considering the severity and abruptness of ICH, it is reassuring that surrogate satisfaction with decision making was generally high and regret was generally low. However, more work is needed to define the appropriate outcome measures and optimal methods of recruitment for studies of surrogate decision makers of ICH patients.
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Affiliation(s)
- Savina Sahgal
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, USA
| | - Aneesha Yande
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, USA
| | - Bradford B Thompson
- Departments of Neurology and Neurosurgery, Alpert Medical School at Brown University, Providence, USA
| | - Emily P Chen
- Stroke Program, Department of Neurology, University of Michigan Medical Center, 1500 E Medical Center Dr. CVC 3392, SPC 5855, Ann Arbor, MI, 48109-5855, USA.,Center for Bioethics and Social Sciences in Medicine, Michigan Medicine, Ann Arbor, USA
| | - Angela Fagerlin
- Center for Bioethics and Social Sciences in Medicine, Michigan Medicine, Ann Arbor, USA.,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA.,Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, USA
| | - Lewis B Morgenstern
- Stroke Program, Department of Neurology, University of Michigan Medical Center, 1500 E Medical Center Dr. CVC 3392, SPC 5855, Ann Arbor, MI, 48109-5855, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA.,Department of Emergency Medicine, Michigan Medicine, Ann Arbor, USA
| | - Darin B Zahuranec
- Stroke Program, Department of Neurology, University of Michigan Medical Center, 1500 E Medical Center Dr. CVC 3392, SPC 5855, Ann Arbor, MI, 48109-5855, USA. .,Center for Bioethics and Social Sciences in Medicine, Michigan Medicine, Ann Arbor, USA.
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Zee J, Zhao J, Subramanian L, Perry E, Bryant N, McCall M, Restovic Y, Torres D, Robinson BM, Pisoni RL, Tentori F. Perceptions about the dialysis modality decision process among peritoneal dialysis and in-center hemodialysis patients. BMC Nephrol 2018; 19:298. [PMID: 30373558 PMCID: PMC6206892 DOI: 10.1186/s12882-018-1096-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients reaching end-stage renal disease must make a difficult decision regarding renal replacement therapy (RRT) options. Because the choice between dialysis modalities should include patient preferences, it is critical that patients are engaged in the dialysis modality decision. As part of the Empowering Patients on Choices for RRT (EPOCH-RRT) study, we assessed dialysis patients' perceptions of their dialysis modality decision-making process and the impact of their chosen modality on their lives. METHODS A 39-question survey was developed in collaboration with a multi-stakeholder advisory panel to assess perceptions of patients on either peritoneal dialysis (PD) or in-center hemodialysis (HD). The survey was disseminated to participants in the large US cohorts of the Dialysis Outcomes and Practice Patterns Study (DOPPS) and the Peritoneal DOPPS (PDOPPS). Survey responses were compared between PD and in-center HD patients using descriptive statistics, adjusted logistic generalized estimating equation models, and linear mixed regression models. RESULTS Six hundred fourteen PD and 1346 in-center HD participants responded. Compared with in-center HD participants, PD participants more frequently reported that they were engaged in the decision-making process, were provided enough information, understood differences between dialysis modalities, and felt satisfied with their modality choice. PD participants also reported more frequently than in-center HD participants that partners or spouses (79% vs. 70%), physician assistants (80% vs. 66%), and nursing staff (78% vs. 60%) had at least some involvement in the dialysis modality decision. Over 35% of PD and in-center HD participants did not know another dialysis patient at the time of their modality decision and over 60% did not know the disadvantages of their modality type. Participants using either dialysis modality perceived a moderate to high impact of dialysis on their lives. CONCLUSIONS PD participants were more engaged in the modality decision process compared to in-center HD participants. For both modalities, there is room for improvement in patient education and other support for patients choosing a dialysis modality.
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Affiliation(s)
- Jarcy Zee
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
| | - Junhui Zhao
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
| | - Lalita Subramanian
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
| | - Erica Perry
- University of Michigan Health System, Ann Arbor, MI USA
| | | | | | | | | | - Bruce M. Robinson
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
| | - Ronald L. Pisoni
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
| | - Francesca Tentori
- Arbor Research Collaborative for Health, 340 E. Huron Street Suite 300, Ann Arbor, MI 48104 USA
- Vanderbilt University Medical Center, Nashville, TN USA
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