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Johnson LC, Stevens G, Cantrell M, Little NR, Holahan TJ, Saunders CH, Thomeer RP, Sheppard R, Elwyn G, Durand MA. Engaging Long-Term Care Workers in Research: Recruitment Approaches and Participant Characteristics From a Randomized Controlled Trial to Improve COVID-19 Vaccine Confidence. J Am Med Dir Assoc 2024:S1525-8610(24)00175-0. [PMID: 38588798 DOI: 10.1016/j.jamda.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To describe and compare the recruitment methods employed in a randomized controlled trial targeting long-term care workers, and resulting participant baseline characteristics. DESIGN We used a multifaceted recruitment process to enroll long-term care workers in our 3-arm randomized controlled trial comparing 2 interventions to enhanced usual practice, for improving COVID-19 vaccine confidence and other outcomes. SETTING AND PARTICIPANTS Adult long-term care workers living in the United States employed within the last 2 years were invited to join the study. Participants also had to meet specific screening criteria related to their degree of worry about the vaccine and/or their vaccination status. METHODS We used a participatory approach to engage our long-term care stakeholders in codesigning and executing a combination of recruitment methods, including targeted e-recruitment, paid e-recruitment, and in-person recruitment. Participants were screened, consented, and enrolled online. We implemented a participant verification process to ensure the integrity of our study data, and used a tailored participant management platform to manage enrollment. RESULTS We enrolled 1930 long-term care workers between May 2022 and January 2023. We met our enrollment target, despite each recruitment method having limitations. Total variable costs of approximately $102,700 were incurred and differed on a per-enrolled participant basis across methods: $25.72 for targeted e-recruitment, $57.12 for paid e-recruitment, and $64.92 for in-person methods. Our sample differed from the national population in age, gender, race/ethnicity, education, and role in long-term care. Differences were also observed between online and in-person recruitment methods. CONCLUSIONS AND IMPLICATIONS Our results support the feasibility of enrolling a large number of long-term care workers in a randomized controlled trial to increase COVID-19 vaccine confidence. Findings build upon the evidence base for engaging this important population in research, a critical step to improving long-term care resident health and well-being. Results from our trial are anticipated in 2024.
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Affiliation(s)
- Lisa C Johnson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | | | - N Ruth Little
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Timothy J Holahan
- Department of Geriatric Medicine, University of Rochester, Rochester, NY, USA
| | | | - Rachael P Thomeer
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- Unisanté Center for Primary Care and Public Health Department of Occupational and Environmental Medicine, Lausanne, Switzerland
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Chavin M, Latour G, Guyard-Boileau B, Durand MA. Evaluation of the Tuto’Tour pregnancy intervention among pregnant smokers in vulnerable situations. Sante Publique 2024; 36:45-72. [PMID: 38580466 DOI: 10.3917/spub.241.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION In France, pregnant women generally receive written information about their pregnancy. The efficacy of these materials is limited for socially disadvantaged women, who are more likely to have lower levels of health literacy. As an alternative tool, awareness-raising videos have become popular, and the “Tuto’Tour de la grossesse” health promotion intervention has been created, which includes videos about smoking. The study objective was to evaluate the acceptability, usability, and accessibility of two videos about smoking among pregnant smokers in vulnerable situations. METHODS We conducted semi-structured interviews with these women, using a participatory approach. We then carried out a hybrid qualitative analysis, combining an analysis based on a conceptual framework and an inductive analysis. RESULTS Out of twenty participants, nine were separated from their child’s father and nine were unemployed. Twelve participants had less than a baccalaureate level of education and seven had a mother tongue other than French. Participants found the videos acceptable, usable, and accessible. We received positive feedback about the efficacy of the videos in terms of participants’ ability, opportunity, and motivation to change their behavior. Suggestions for improving the videos were made. CONCLUSIONS Other studies have looked at health promotion with similar interventions, but acceptability, usability, and accessibility have not been tested with socially disadvantaged women. These videos, which are acceptable, usable, and accessible to socially disadvantaged people, seem to have an influence on two out of three factors leading to behavior change. They could now be tested on a larger scale in a randomized controlled study.
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Affiliation(s)
- Maëva Chavin
- UMR 1295 CERPOP, Inserm, université Toulouse-III-Paul-Sabatier, EQUITY, Toulouse, France
- CHU de Toulouse, Toulouse, France
| | - Gillien Latour
- UMR 5502 IMFT, Institut de mécanique des fluides de Toulouse, Toulouse, France
| | | | - Marie-Anne Durand
- UMR 5502 IMFT, Institut de mécanique des fluides de Toulouse, Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, États-Unis
- Unisanté, centre universitaire de médecine générale et santé publique, Lausanne, Suisse
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Durand MA, Selby K, Okan Y. Visualisation of evidence for shared decision making. BMJ Evid Based Med 2024; 29:117-120. [PMID: 37968088 DOI: 10.1136/bmjebm-2023-112565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Marie-Anne Durand
- Centre d'Epidémiologie et de Recherche en santé des Populations, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kevin Selby
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
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Yen RW, Hagedorn R, Durand MA, Leyenaar JK, O'Malley AJ, Saunders CH, Isaacs T, Elwyn G. Clinician-Spoken Plain Language in Health Care Encounters: A Qualitative Analysis to Assess Measurable Elements. Acad Med 2024:00001888-990000000-00770. [PMID: 38412476 DOI: 10.1097/acm.0000000000005666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE Good communication and use of plain language in health care encounters improves outcomes, including emotional health, symptom resolution, and functional status. Yet there is limited research on how to measure and report spoken plain language, which is the use of familiar, clear language. The authors aimed to describe key, measurable elements of spoken plain language that can be assessed and reported back to clinicians for self-reflection. METHOD The authors conducted secondary analysis of transcripts from recorded encounters between breast cancer surgeons and patients with early-stage breast cancer. Two coders used a hybrid qualitative analysis with a framework based on US Federal Plain Language Guidelines. To develop major themes, they examined (1) alignment with the Guidelines and (2) code frequencies within and across transcripts. They also noted minor themes. RESULTS From 74 transcripts featuring 13 surgeons, the authors identified two major themes representing measurable elements of spoken plain language: (1) clinicians had a propensity to use both explained and unexplained medical terms, and (2) clinicians delivered information using either short turns (one unit of someone speaking) with one topic or long turns with multiple topics. There were three minor themes that were not indicative of whether or not clinicians used spoken plain language. First, clinicians regularly used absolute risk communication techniques. Second, question-asking techniques varied and included open-ended, close-ended, and comprehension checks. Third, some clinicians used imagery to describe complex topics. CONCLUSIONS Clinicians' propensity to use medical terms with and without explanation and parse encounters into shorter or longer turns are measurable elements of spoken plain language. These findings will support further research on the development of a tool that can be used in medical education and other settings. This tool could provide direct and specific feedback to improve the plain language practices of clinicians in training and beyond.
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Affiliation(s)
- Renata W Yen
- R.W. Yen is research scientist at The Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. ORCID: http://orcid.org/0000-0002-6856-7631
| | - Robert Hagedorn
- R. Hagedorn is a medical student, University of Utah School of Medicine, Salt Lake City, Utah
| | - Marie-Anne Durand
- M.A. Durand is chercheure inserm at University Toulouse, France, an adjunct associate professor at The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, and an adjunct scientist at Unisanté, Lausanne, Switzerland. ORCID: http://orcid.org/0000-0002-1127-9348
| | - JoAnna K Leyenaar
- J.K. Leyenaar is professor of pediatrics, Geisel School of Medicine at Dartmouth College Lebanon, New Hampshire. ORCID: http://orcid.org/0000-0002-0555-0154
| | - A James O'Malley
- A.J. O'Malley is professor, The Dartmouth Institute for Health Policy and Clinical Practice and Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. ORCID: http://orcid.org/0000-0001-8389-6217
| | - Catherine H Saunders
- C.H. Saunders is assistant professor of medicine, Dartmouth Health and The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire. ORCID: http://orcid.org/0000-0003-0819-6610
| | - Talia Isaacs
- T. Isaacs is associate professor of applied linguistics and TESOL, IOE-UCL Faculty of Education and Society, University College London, 20 Bedford Way, London WC1H 0AL, United Kingdom. ORCID: http://orcid.org/0000-0003-4302-3379
| | - Glyn Elwyn
- G. Elwyn is professor, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire. ORCID: http://orcid.org/0000-0002-0917-6286
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Addamiano MC, Joannes C, Fonquerne L, Morel C, Lauzeille D, Belkadi L, Empereur F, Grosclaude P, Bauvin E, Delpierre C, Lamy S, Durand MA. Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France. BMC Public Health 2024; 24:231. [PMID: 38243214 PMCID: PMC10797742 DOI: 10.1186/s12889-024-17719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND With the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists. METHODS Firstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3). DISCUSSION We expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability. TRIAL REGISTRATION Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT05989776. Date of registration: 7th September 2023. URL: https://classic. CLINICALTRIALS gov/ct2/show/NCT05989776 . PROTOCOL VERSION Manuscript based on study protocol version 2.0, 21st may 2023.
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Affiliation(s)
- Maria Claudia Addamiano
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Camille Joannes
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Leslie Fonquerne
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Charlotte Morel
- Regional Cancer Network of Occitanie (Onco-Occitanie), Toulouse, France
| | | | - Lorène Belkadi
- Regional Cancer Network of Occitanie (Onco-Occitanie), Toulouse, France
| | - Fabienne Empereur
- Regional Cancer Network of Pays de la Loire (Onco-PL), Nantes, France
| | - Pascale Grosclaude
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
- Tarn Cancers Registry, Claudius Regaud Institute, Toulouse University Cancer Institute (IUCT- O), Toulouse, France
| | - Eric Bauvin
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
- Regional Cancer Network of Occitanie (Onco-Occitanie), Toulouse, France
| | - Cyrille Delpierre
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sébastien Lamy
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France
- Tarn Cancers Registry, Claudius Regaud Institute, Toulouse University Cancer Institute (IUCT- O), Toulouse, France
| | - Marie-Anne Durand
- EQUITY research team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, Toulouse, France.
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- Unisanté, University Center for General Medicine and Public Health, Lausanne, Switzerland.
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Durand MA, Bannier M, Aim MA, Mancini J. Adaptation and Implementation of Pictorial Conversation Aids for Early-Stage Breast Cancer Surgery and Reconstruction: A Quality Improvement Study. Patient Prefer Adherence 2023; 17:2463-2474. [PMID: 37817892 PMCID: PMC10560627 DOI: 10.2147/ppa.s421695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population. Patients and Methods In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons. Results In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future. Conclusion It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Lebanon, Lebanon, NH, USA
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | | | - Marie-Anastasie Aim
- AP-HM, Délégation à la Recherche Clinique et à l’Innovation, Marseille, France
- Aix-Marseille Univ, LPS, Aix-en-Provence, France
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, ISSPAM, SESSTIM, “Cancer, Biomedicine & Society” Group, Equipe Labellisée LIGUE, Hop Timone, Marseille, France
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Acquilano SC, Forcino RC, Schubbe D, Engel J, Tomaino M, Johnson LC, Durand MA, Elwyn G. The Costs of Implementing a Conversation Aid for Uterine Fibroids in Multiple Health Care Settings. Med Care 2023; 61:689-698. [PMID: 37943524 PMCID: PMC10478675 DOI: 10.1097/mlr.0000000000001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Health care organizations considering adopting a conversation aid (CA), a type of patient decision aid innovation, need information about the costs of implementation. OBJECTIVES The aims of this study were to: (1) calculate the costs of introducing a CA in a study of supported implementation in 5 gynecologic settings that manage individuals diagnosed with uterine fibroids and (2) estimate the potential costs of future clinical implementation efforts in hypothetical settings. RESEARCH DESIGN We used time-driven activity-based costing to estimate the costs of CA implementation at multiple steps: integration with an electronic health record, preimplementation, implementation, and sustainability. We then estimated costs for 2 disparate hypothetical implementation scenarios. SUBJECTS AND DATA COLLECTION We conducted semistructured interviews with participants and examined internal documentation. RESULTS We interviewed 41 individuals, analyzed 51 documents and 100 emails. Overall total implementation costs over ∼36 months of activities varied significantly across the 5 settings, ranging from $14,157 to $69,134. Factors influencing costs included size/complexity of the setting, urban/rural location, practice culture, and capacity to automate patient identification. Initial investments were substantial, comprising mostly personnel time. Settings that embedded CA use into standard workflows and automated identification of appropriate patients had the lowest initial investment and sustainability costs. Our estimates of the costs of sustaining implementation were much lower than initial investments and mostly attributable to CA subscription fees. CONCLUSION Initiation and implementation of the interventions require significant personnel effort. Ongoing costs to maintain use are much lower and are a small fraction of overall organizational operating costs.
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Morisod K, Martin T, Rawlinson C, Grazioli VS, von Plessen C, Durand MA, Selby K, Le Pogam MA, Bühler N, Bodenmann P. Facing the COVID-19 Pandemic: A Mixed-Method Analysis of Asylum Seekers' Experiences and Worries in the Canton of Vaud, Switzerland. Int J Public Health 2023; 68:1606229. [PMID: 37829084 PMCID: PMC10564980 DOI: 10.3389/ijph.2023.1606229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Objectives: The clinical and social burden of the COVID-19 pandemic were high among asylum seekers (ASs). We aimed to understand better ASs' experiences of the pandemic and their sources of worries. Methods: Participants (n = 203) completed a survey about their worries, sleep disorders, and fear of dying. We also conducted semi-structured interviews with ASs living in a community center (n = 15), focusing on how social and living conditions affected their experiences and worries. Results: ASs in community centers experienced more sleep disorders related to the COVID-19 pandemic than those living in private apartments (aOR 2.01, p = 0.045). Similarly, those with lower education had greater fear for their life due to the COVID-19 pandemic (aOR 2.31, p = 0.015). Qualitative findings showed that sharing living spaces was an important source of worries for ASs and that protective measures were perceived to increase social isolation. Conclusion: Our study highlighted the impact of the COVID-19 pandemic for ASs and the importance of tailoring public health measures to their needs and living conditions.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Tiffany Martin
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Cloé Rawlinson
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Direction Générale de la Santé (DGS), Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marie-Anne Durand
- UMR1295 Centre d’Epidémiologie et de Recherche en Santé des Populations (CERPOP), Toulouse, France
- University Center of General Medicine and Public Health, Lausanne, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
| | - Kevin Selby
- Department of Ambulatory Care, Center for Primary Care and Public Health, University Center of General Medicine and Public Health, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Nolwenn Bühler
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, University Center of General Medicine and Public Health, Lausanne, Switzerland
- Chair of Medicine for Vulnerable Populations, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Plys E, Bulliard JL, Chaouch A, Durand MA, van Duuren LA, Brändle K, Auer R, Froehlich F, Lansdorp-Vogelaar I, Corley DA, Selby K. Colorectal Cancer Screening Decision Based on Predicted Risk: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46865. [PMID: 37676720 PMCID: PMC10514773 DOI: 10.2196/46865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Incidence of and mortality from colorectal cancer (CRC) can be effectively reduced by screening with the fecal immunochemical test (FIT) or colonoscopy. Individual risk to develop CRC within 15 years varies from <1% to >15% among people aged 50 to 75 years. Communicating personalized CRC risk and appropriate screening recommendations could improve the risk-benefit balance of screening test allocations and optimize the use of limited colonoscopy resources. However, significant uncertainty exists regarding the feasibility and efficacy of risk-based screening. OBJECTIVE We aim to study the effect of communicating individual CRC risk and a risk-based recommendation of the FIT or colonoscopy on participants' choice of screening test. We will also assess the feasibility of a larger clinical trial designed to evaluate the impact of personalized screening on clinical outcomes. METHODS We will perform a pilot randomized controlled trial among 880 residents aged 50 to 69 years eligible to participate in the organized screening program of the Vaud canton, Switzerland. Participants will be recruited by mail by the Vaud CRC screening program. Primary and secondary outcomes will be self-assessed through questionnaires. The risk score will be calculated using the open-source QCancer calculator that was validated in the United Kingdom. Participants will be stratified into 3 groups-low (<3%), moderate (3% to <6%), and high (≥6%) risk-according to their 15-year CRC risk and randomized within each risk stratum. The intervention group participants will receive a newly designed brochure with their personalized risk and screening recommendations. The control group will receive the usual brochure of the Vaud CRC screening program. Our primary outcome, measured using a self-administered questionnaire, is appropriate screening uptake 6 months after the intervention. Screening will be defined as appropriate if participants at high risk undertake colonoscopy and participants at low risk undertake the FIT. We will also measure the acceptability of the risk score and screening recommendations and the psychological factors influencing screening behavior. We will also assess the feasibility of a full-scale randomized controlled trial. RESULTS We expect that a total sample of 880 individuals will allow us to detect a difference of 10% (α=5%) between groups. The main outcome will be analyzed using a 2-tailed chi-squared test. We expect that appropriate screening uptake will be higher in the intervention group. No difference in overall screening uptake is expected. CONCLUSIONS We will test the impact of personalized risk information and screening recommendations on participants' choice of screening test in an organized screening program. This study should advance our understanding of the feasibility of large-scale risk-based CRC screening. Our results may provide insights into the optimization of CRC screening by offering screening options with a better risk-benefit balance and optimizing the use of resources. TRIAL REGISTRATION ClinicalTrials.gov NCT05357508; https://www.clinicaltrials.gov/study/NCT05357508. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46865.
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Affiliation(s)
- Ekaterina Plys
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Aziz Chaouch
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Center for Epidemiology and Research in Population Health, UMR1295 Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Luuk A van Duuren
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Karen Brändle
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Florian Froehlich
- Department of Gastroenterology, University Hospital of Basel, Basel, Switzerland
| | | | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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10
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Lamouroux-Delay A, Casanova C, Redmond NM, Clastres N, Rotily M, Dordonne M, Journet P, Laffont C, Laffont E, Linon C, Netens B, Witkowski V, Durand MA. [Acceptability of interventional materials: public participation in public health interventional research]. Sante Publique 2023; 35:159-170. [PMID: 37558621 DOI: 10.3917/spub.232.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The uptake rate of colorectal cancer screening remains insufficient in France and decreases as the level of deprivation increases. Participants’ health literacy appears to be an important determinant of screening uptake. AIM OF THE STUDY The aim of this study, nested in our multicenter-randomized controlled trial, was to present the development and acceptability of interventional material (training and a pictorial brochure) for general practitioners and healthcare users in disadvantaged geographical areas using a participatory involvement approach. METHODS The development of the brochure and the training was carried out in three stages, two for the development, usability, and acceptability testing and a third for its evaluation with the target audience. We used a qualitative approach based on focus groups and cognitive interviews. The qualitative analysis was based on Morville’s “Honeycomb” conceptual model and the COREQ checklist. RESULTS The development and test of the acceptability of the material enabled us to adjust the content of the training by proposing examples that were more rooted in professional reality, and to produce a brochure that was easy to read, understand, acceptable and adapted to the intervention’s targeted audience. CONCLUSIONS This experience illustrates in a concrete way the feasibility of public participation and its value in the context of interventional research, and more generally in the creation of interventional material.
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Affiliation(s)
- Aurore Lamouroux-Delay
- Assistance Publique des Hôpitaux de Marseille, Centre de santé universitaire des Aygalades - Marseille - France
- Comité Départemental d’Éducation pour la Santé (CoDES) – Avignon – France
| | - Clémence Casanova
- Aix-Marseille Université (AMU) SESSTIM – UMR 1252 – Marseille – France
- Institut Paoli-Calmette (IPC) – Marseille – France
| | | | | | - Michel Rotily
- Assistance Publique des Hôpitaux de Marseille, Centre de santé universitaire des Aygalades - Marseille - France
- CeReSS-Health Service Research and Quality of Life Center – Marseille – France
| | | | | | | | - Eric Laffont
- Association Patient Expert (AMU) – Marseille – France
| | - Carole Linon
- Association Patient Expert (AMU) – Marseille – France
| | | | | | - Marie-Anne Durand
- CERPOP – INSERM UPS – Université Paul Sabatier III – Toulouse – France
- Unisanté, Centre universitaire de médecine générale – Lausanne – Suisse
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11
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Schubbe D, Yen RW, Leavitt H, Forcino RC, Jacobs C, Friedman EB, McEvoy M, Rosenkranz KM, Rojas KE, Bradley A, Crayton E, Jackson S, Mitchell M, O'Malley AJ, Politi M, Tosteson ANA, Wong SL, Margenthaler J, Durand MA, Elwyn G. Implementing shared decision making for early-stage breast cancer treatment using a coproduction learning collaborative: the SHAIR Collaborative protocol. Implement Sci Commun 2023; 4:79. [PMID: 37452387 PMCID: PMC10349513 DOI: 10.1186/s43058-023-00453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) in breast cancer care improves outcomes, but it is not routinely implemented. Results from the What Matters Most trial demonstrated that early-stage breast cancer surgery conversation aids, when used by surgeons after brief training, improved SDM and patient-reported outcomes. Trial surgeons and patients both encouraged using the conversation aids in routine care. We will develop and evaluate an online learning collaborative, called the SHared decision making Adoption Implementation Resource (SHAIR) Collaborative, to promote early-stage breast cancer surgery SDM by implementing the conversation aids into routine preoperative care. Learning collaboratives are known to be effective for quality improvement in clinical care, but no breast cancer learning collaborative currently exists. Our specific aims are to (1) provide the SHAIR Collaborative resources to clinical sites to use with eligible patients, (2) examine the relationship between the use of the SHAIR Collaborative resources and patient reach, and (3) promote the emergence of a sustained learning collaborative in this clinical field, building on a partnership with the American Society of Breast Surgeons (ASBrS). METHODS We will conduct a two-phased implementation project: phase 1 pilot at five sites and phase 2 scale up at up to an additional 32 clinical sites across North America. The SHAIR Collaborative online platform will offer free access to conversation aids, training videos, electronic health record and patient portal integration guidance, a feedback dashboard, webinars, support center, and forum. We will use RE-AIM for data collection and evaluation. Our primary outcome is patient reach. Secondary data will include (1) patient-reported data from an optional, anonymous online survey, (2) number of active sites and interviews with site champions, (3) Normalization MeAsure Development questionnaire data from phase 1 sites, adaptations data utilizing the Framework for Reporting Adaptations and Modifications-Extended/-Implementation Strategies, and tracking implementation facilitating factors, and (4) progress on sustainability strategy and plans with ASBrS. DISCUSSION The SHAIR Collaborative will reach early-stage breast cancer patients across North America, evaluate patient-reported outcomes, engage up to 37 active sites, and potentially inform engagement factors affecting implementation success and may be sustained by ASBrS.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA.
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Hannah Leavitt
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Christopher Jacobs
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Erica B Friedman
- Department of Surgery, New York University Langone Health, Bellevue Hospital, New York, NY, 10016, USA
| | - Maureen McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, 10467, USA
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Kristin E Rojas
- Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ann Bradley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | | | | | - Myrtle Mitchell
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, 10467, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Mary Politi
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Sandra L Wong
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
- Centre Universitaire de Médecine Générale Et Santé Publique, Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- UMR 1295, CERPOP, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
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12
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Saunders CH, Durand MA, Scalia P, Kirkland KB, MacMartin MA, Barnato AE, Milne DW, Collison J, Bennett A, Wasp G, Nelson E, Elwyn G. "It helps us say what's important..." Developing Serious Illness Topics: A clinical visit agenda-setting tool. Patient Educ Couns 2023; 113:107764. [PMID: 37150152 DOI: 10.1016/j.pec.2023.107764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Skillful communication with attention to patient and care partner priorities can help people with serious illnesses. Few patient-facing agenda-setting tools exist to facilitate such communication. OBJECTIVE To develop a tool to facilitate prioritization of patient and care partner concerns during serious illness visits. PATIENT OR FAMILY INVOLVEMENT Two family members of seriously ill individuals advised. METHODS We performed a literature review and developed a prototype agenda-setting tool. We modified the tool based on cognitive interviews with patients, families and clinicians. We piloted the tool with patients, care partners and clinicians to gain an initial impression of its perceived value. RESULTS Interviews with eight patients, eight care partners and seven clinicians, resulted in refinements to the initial tool, including supplementation with visual cues. In the pilot test, seven clinicians used the tool with 11 patients and 12 family members. Qualitatively, patients and care partners reported the guide helped them consider and assert their priorities. Clinicians reported the tool complemented usual practice. Most participants reported no distress, disruption or confusion. DISCUSSION Patients, care partners and clinicians appreciated centering patient priorities in serious illness visits using the agenda-setting tool. More thorough evaluation is required. PRACTICAL VALUE The agenda-setting tool may operationalize elements of good serious illness care.
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Affiliation(s)
- Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; McGill Faculty of Medicine and Health Sciences, 1010 Sherbrooke West, Suite 1230, Montreal, H3A 2R7, QC Canada
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Meredith A MacMartin
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA
| | - David Wilson Milne
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Joan Collison
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Ashleigh Bennett
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Nova Southeastern University, Department of Public Health, Dr. Kiran C. Patel College of Osteopathic Medicine, US
| | - Garrett Wasp
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA
| | - Eugene Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA
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13
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Stevens G, Johnson LC, Saunders CH, Schmidt P, Sierpe A, Thomeer RP, Little NR, Cantrell M, Yen RW, Pogue JA, Holahan T, Schubbe DC, Forcino RC, Fillbrook B, Sheppard R, Wooten C, Goldmann D, O’Malley AJ, Dubé E, Durand MA, Elwyn G. The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines. BMC Public Health 2023; 23:384. [PMID: 36823559 PMCID: PMC9948785 DOI: 10.1186/s12889-023-15266-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs' characteristics and other factors mediate and moderate the interventions' effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. METHODS We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. DISCUSSION Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. TRIAL REGISTRATION NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.
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Affiliation(s)
- Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, US.
| | - Lisa C. Johnson
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Catherine H. Saunders
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Peter Schmidt
- grid.137628.90000 0004 1936 8753Department of Neurology, Grossman School of Medicine, New York University, New York, NY US
| | - Ailyn Sierpe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachael P. Thomeer
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - N. Ruth Little
- grid.255364.30000 0001 2191 0423Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC US
| | - Matthew Cantrell
- National Association of Health Care Assistants, Carl Junction, MO US
| | - Renata W. Yen
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Jacqueline A. Pogue
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Timothy Holahan
- grid.16416.340000 0004 1936 9174Department of Geriatric Medicine, University of Rochester, Rochester, NY US
| | - Danielle C. Schubbe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachel C. Forcino
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | | | | | | | - Don Goldmann
- grid.418700.a0000 0004 0614 6393Institute for Healthcare Improvement, Boston, MA US
| | - A. James O’Malley
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Eve Dubé
- grid.23856.3a0000 0004 1936 8390Department of Anthropology, Faculty of Social Sciences, Laval University, Quebec City, QC Canada
| | - Marie-Anne Durand
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US ,grid.511931.e0000 0004 8513 0292Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, Lausanne Switzerland ,CERPOP, Université de Toulouse, Inserm, Toulouse, UPS France
| | - Glyn Elwyn
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
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14
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Gosteli M, Selby K, Von Plessen C, Agoritsas T, Giguère A, Abreha S, Bilien M, Durand MA. [Can we increase the availability of decision aids in French-speaking Switzerland?]. Rev Med Suisse 2023; 19:186-191. [PMID: 36723644 DOI: 10.53738/revmed.2023.19.812.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Models of shared decision making recommend the use of patient decision aids. Hundreds of such aids exist worldwide but scaling up of their use in French-speaking Switzerland requires their translation to French and their adaptation to the clinical context. We review seven sources of tools that we assume relevant for French-speaking Switzerland. A short survey on a selection of three decision aids of general practitioners in the canton of Vaud confirmed their general interest in using such tools. They preferred a limited amount and a simple presentation of information in the decision aids to facilitate integration in clinical practice. Given the complexity of the required translations and adaptations, the medical community should develop a collaborative approach to lift this important task.
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Affiliation(s)
- Marine Gosteli
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Kevin Selby
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Christian Von Plessen
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Thomas Agoritsas
- Département de médecine, Hôpitaux universitaire de Genève, 1211 Genève
| | - Anik Giguère
- Département de médecine familiale et de médecine d'urgence de l'Université Laval, QC G1V 0A6, Québec, Canada
| | - Samuel Abreha
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Magali Bilien
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Marie-Anne Durand
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne.,CERPOP, Université de Toulouse, Inserm, UPS, Faculté de médecine, 37 allées Jules Guesde, 31000 Toulouse, France.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Hanover, Lebanon, NH 03755, États-Unis
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15
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Morisod K, Durand MA, Selby K, Le Pogam MA, Grazioli VS, Sanchis Zozaya J, Bodenmann P, von Plessen C. Asylum Seekers' Responses to Government COVID-19 Recommendations: A Cross-sectional Survey in a Swiss Canton. J Immigr Minor Health 2022; 25:570-579. [PMID: 36508030 PMCID: PMC9743178 DOI: 10.1007/s10903-022-01436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/14/2022]
Abstract
Asylum seekers face multiple language, cultural and administrative barriers that could result in the inappropriate implementation of COVID-19 measures. This study aimed to explore their knowledge and attitudes to recommendations about COVID-19. We conducted a cross-sectional survey among asylum seekers living in the canton of Vaud, Switzerland. We used logistic regressions to analyze associations between knowledge about health recommendations, the experience of the pandemic and belief to rumors, and participant sociodemographic characteristics. In total, 242 people participated in the survey, with 63% of men (n = 150) and a median age of 30 years old (IQR 23-40). Low knowledge was associated with linguistic barriers (aOR 0.36, 95% CI 0.14-0.94, p = 0.028) and living in a community center (aOR 0.43, 95% CI 0.22-0.85, p = 0.014). Rejected asylum seekers were more likely to believe COVID-19 rumors (aOR 2.81, 95% CI 1.24-6.36, p = 0.013). This survey underlines the importance of tailoring health recommendations and interventions to reach asylum seekers, particularly those living in community centers or facing language barriers.
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Affiliation(s)
- Kevin Morisod
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France ,Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Kevin Selby
- Department Training, Research and Innovation, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Javier Sanchis Zozaya
- grid.8515.90000 0001 0423 4662Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Chair of Medicine for Vulnerable Populations, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland ,Direction Générale de La Santé (DGS), Lausanne, Switzerland ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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16
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Abstract
BACKGROUND Rectal cancer patients often face complex surgical treatment decisions, but there are few available tools to aid in decision-making. OBJECTIVE We aimed to identify content and delivery preferences of rectal cancer patients and colorectal surgeons to guide future surgical decision aid creation. DESIGN Qualitative study: inductive thematic analysis of semi-structured interviews. SETTING In-person and phone interviews. PATIENTS We purposively sampled 15 rectal cancer survivors based on demographics and surgery type. Five caregivers also participated. We purposively selected 10 surgeons based on practice type and years of experience. INTERVENTIONS Semi-structured interviews. MAIN OUTCOME MEASURES Major and minor themes for survivors and surgeons with thematic saturation. RESULTS Interviews were a median of 61 minutes (41-93) for patients and 35 minutes (25-59) for surgeons. Nine survivors were younger than 65 years; 7 were female. Surgeons had been practicing for a mean of 10 years (SD 7.4), with 7 in academic and 3 in private settings. Participating survivors and surgeons wanted a comprehensive educational tool-not just a surgical decision aid. Survivors wanted more information on rectal cancer basics and lifestyle, care timelines, and resources during treatment. Surgeons thought patients mostly desired information about surgical options and bowel function. Both patients and surgeons wanted a tool that was personalized, simple, understandable, visually appealing, interactive, short, and in multiple formats. LIMITATIONS Results may not be generalizable due to selection bias of participants. CONCLUSION Rectal cancer survivors, their caregivers, and colorectal surgeons wanted an educational support tool that would address substantial educational needs through the continuum of disease rather than a surgical decision aid focusing on a discrete surgical choice only. See Video Abstract at http://links.lww.com/DCR/C20 . UNA AYUDA PARA LA DECISIN QUIRRGICA DEL CNCER DE RECTO NO ES SUFICIENTE UN ESTUDIO CUALITATIVO ANTECEDENTES:Los pacientes con cáncer de recto a menudo enfrentan decisiones de tratamiento quirúrgico complejas, pero hay pocas herramientas disponibles para ayudar en la toma de decisiones.OBJETIVO:Nuestro objetivo fue identificar el contenido y las preferencias de entrega de los pacientes con cáncer de recto y los cirujanos colorrectales para guiar la futura creación de ayuda para la toma de decisiones quirúrgicas.DISEÑO:Estudio cualitativo: análisis temático inductivo de entrevistas semiestructuradas.ESCENARIO:Entrevistas en persona y por teléfono.PACIENTES:Tomamos muestras intencionalmente de 15 sobrevivientes de cáncer de recto, según la demografía y el tipo de cirugía. También participaron cinco cuidadores. Seleccionamos intencionalmente a 10 cirujanos según el tipo de práctica y los años de experiencia.INTERVENCIONES:Entrevistas semiestructuradas.PRINCIPALES MEDIDAS DE RESULTADO:Temas principales y secundarios para sobrevivientes y cirujanos con saturación temática.RESULTADOS:Las entrevistas tuvieron una mediana de 61 minutos (41-93) para pacientes y 35 minutos (25-59) para cirujanos. Nueve sobrevivientes tenían menos de 65 años; siete eran mujeres. Los cirujanos habían estado ejerciendo una media de 10 años (DE 7,4), con siete en entornos académicos y 3 en entornos privados. Los sobrevivientes y cirujanos participantes querían una herramienta educativa comprensible, no solo una ayuda para la decisión quirúrgica. Los sobrevivientes querían más información sobre los conceptos básicos y el estilo de vida del cáncer de recto, los plazos de atención y los recursos durante el tratamiento. Los cirujanos pensaron que los pacientes en su mayoría deseaban información sobre las opciones quirúrgicas y la función intestinal. Tanto los pacientes como los cirujanos querían una herramienta que fuera personalizada, simple, comprensible, visualmente atractiva, interactiva, corta y en múltiples formatos.LIMITACIONES:Los resultados pueden no ser generalizables debido al sesgo de selección de los participantes.CONCLUSIÓN:Los sobrevivientes de cáncer rectal, sus cuidadores y los cirujanos colorrectales querían una herramienta de apoyo educativo que cubriera las necesidades educativas sustanciales a lo largo del tratamiento de la enfermedad en lugar de una ayuda para la decisión quirúrgica que se centre solo en una opción quirúrgica discreta. Consulte Video Resumen en http://links.lww.com/DCR/C20 . (Traducción-Dr. Yolanda Colorado ).
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Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jackson T Read
- University of Texas at Austin Dell Medical School, Austin, TX
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,University of Texas at Austin Dell Medical School, Austin, TX
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Hempel-Bruder C, Habfast-Robertson I, Durand MA, Berlin I, Marti J, Khazaal Y, Quinto C, Faouzi M, Selby K. Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial. BMC Prim Care 2022; 23:246. [PMID: 36151529 PMCID: PMC9508762 DOI: 10.1186/s12875-022-01859-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients' "readiness" to quit, an "opt-in" strategy, but only a minority of tobacco users are ready to quit on a given day. An "opt-out" strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care. METHODS This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an 'opt-out' approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05. DISCUSSION GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.
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Affiliation(s)
- Christina Hempel-Bruder
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Inès Habfast-Robertson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- UMR 1295, CERPOP, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Yasser Khazaal
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- Department of Addiction Medicine, CHUV, Lausanne, Switzerland
| | | | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland.
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18
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Saunders C, Sierpe A, Stevens G, Elwyn G, Cantrell M, Engel J, Gonzalez M, Hayward M, Huebner J, Johnson L, Jimenez A, Little R, McKenna C, Onteeru M, Oo Khine M, Pogue J, Salinas Vargas JL, Schmidt P, Thomeer R, Durand MA. "Something for us": Co-development of the COVID-19 Social Site, a web app for long-term care workers. J Med Internet Res 2022; 24:e38359. [PMID: 35926074 PMCID: PMC9506501 DOI: 10.2196/38359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population. Objective We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway). Methods Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3). Results In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application. Conclusions An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals.
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Affiliation(s)
- Catherine Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Ailyn Sierpe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Matthew Cantrell
- National Association of Health Care Assistants, Carl Junction, US
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Melissa Gonzalez
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | | | | | - Lisa Johnson
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | | | | | | | - Manu Onteeru
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - May Oo Khine
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Jacqueline Pogue
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - José Luis Salinas Vargas
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Peter Schmidt
- Department of Neurology, NYU Grossman School of Medicine, New York City, US
| | - Rachael Thomeer
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US.,Centre for Epidemiology and Research in Population Health, Université de Toulouse, Toulouse, FR
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19
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Saunders CH, Durand MA, Kirkland KB, MacMartin MA, Barnato AE, Elwyn G. Psychometric assessment of the consideRATE questions, a new measure of serious illness experience, with an online simulation study. Patient Educ Couns 2022; 105:2581-2589. [PMID: 35260261 DOI: 10.1016/j.pec.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the psychometric properties of the consideRATE questions, a measure of serious illness experience. METHODS We recruited people at least 50 years old via paid panels online, with US-Census-based quotas. We randomized participants to a patient experience story at two time points. Participants completed a series of measures, including the consideRATE questions. We assessed convergent (Pearson's correlation), discriminative (one-way ANOVA with Tukey's test for multiple comparisons) and divergent (Pearson's correlation) validity. We also assessed intra-rater reliability (intra-class correlation) and responsiveness to change (t-tests). RESULTS We included 809 individuals in our analysis. We established convergent validity (r = 0.77; p < 0.001); discriminative validity (bad/neutral stories [mean diff=0.4; p < 0.001]; neutral/ good stories [mean diff=1.3; p < 0.001]) and moderate divergent validity (r = 0.57; p < 0.001). We established sensitivity to change in all stories (bad/good [mean diff=1.52; p < 0.001]; good/bad [mean diff= -1.68; p < 0.001]; neutral/bad [mean diff= -0.57; p < 0.001]; good/neutral [mean diff= -1.11; p < 0.001]; neutral/good [mean diff= 1.1; p < 0.001]) but one (bad/neutral [mean diff= 0.4; p < 0.07]). Intra-rater reliability was demonstrated between time points (r = 0.77; p < 0.001). CONCLUSIONS the consideRATE questions were reliable and valid in a simulated online test. PRACTICE IMPLICATIONS the consideRATE questions may be a practical way to measure serious illness experience and the effectiveness of interventions to improve it.
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Affiliation(s)
- Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA.
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | | | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA; Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, USA.
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20
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Schneiter D, Habfast-Robertson I, Adam A, Hempel-Bruder C, Durand MA, Selby K. [Decision aids for addictions: the example of smoking cessation]. Rev Med Suisse 2022; 18:1149-1153. [PMID: 35678345 DOI: 10.53738/revmed.2022.18.785.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Decision aids (DAs) help patients participate in healthcare decisions by improving knowledge and clarifying values and preferences, thus favoring a more active role in the decision process. DAs exist as a physical support (paper, DVD, audio) or computerized formats. They can be used independently by patients before and after consultations, or with a health professional during consultations. Unisanté has created a DA for use during consultations presenting available smoking cessation aids (www.howtoquit.ch). A local study showed that the DA is considered easy to use and useful by the doctors interviewed. The use of DAs in addictions to other substances, in conjunction with shared decision making, shows a favourable effect on the involvement of patients in their health and therapeutic adherence.
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Affiliation(s)
- Deborah Schneiter
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | | | - Angéline Adam
- Service de médecine des addictions, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | | | - Marie-Anne Durand
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- CERPOP, Inserm, Université Toulouse III - Paul Sabatier, 31062 Toulouse, France
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, États-Unis
| | - Kevin Selby
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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21
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Selby K, Durand MA, von Plessen C, Auer R, Biller-Andorno N, Krones T, Agoritsas T, Cornuz J. Shared decision-making and patient and public involvement: Can they become standard in Switzerland? Z Evid Fortbild Qual Gesundhwes 2022; 171:135-138. [PMID: 35610134 DOI: 10.1016/j.zefq.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
The Swiss healthcare system is highly decentralized, making implementation of shared decision making (SDM) and patient and public involvement (PPI) quite slow; nonetheless, change is happening. SDM is now a core communication competency for medical school graduates, as reflected by a dedicated station on the federal exam, and is endorsed by several national societies. Multiple local initiatives are contributing to international best practices, local implementation, and increased capacity. PPI is also gaining momentum, most notably in research, with the development of a national platform for clinical research and inclusion of patients in the evaluation committees for funding. The challenge now is going from example projects by motivated early adopters in academia to making SDM and PPI standard practice.
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland.
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; CERPOP, Université de Toulouse, Inserm, Université Toulouse III - Paul-Sabatier, Toulouse, France
| | - Christian von Plessen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Department of Clinical Research, University of Southern Denmark, C Odense, Denmark
| | - Reto Auer
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | | | | | | | - Jacques Cornuz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
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22
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Affiliation(s)
- Marie-Anne Durand
- Centre d'Epidémiologie et de Recherche en santé des Populations, UMR 1295, Universite Toulouse III Paul Sabatier, Toulouse, France
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Peter Scalia
- Coproduction Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- Coproduction Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
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23
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Moumjid N, Durand MA, Carretier J, Charuel E, Daumer J, Haesebaert J, Hild S, Mancini J, Marsico G, Rat C, Zerbib Y, Vincent YM, Blot F. Implementation of shared decision-making and patient-centered care in France: Towards a wider uptake in 2022. Z Evid Fortbild Qual Gesundhwes 2022; 171:42-48. [PMID: 35606309 DOI: 10.1016/j.zefq.2022.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
We present the evolution of patient-centered care (PCC) and shared decision-making (SDM) in France since 2017, highlighting advantages and drawbacks of their implementation at the macro level. We then focus on several key policy and legislative milestones that are aimed to develop PCC and SDM. These milestones underline the importance of patient movements to support and fund the development of research and practice in the field. We shall conclude by presenting the growing research agenda and selected key topics. These key topics notably include the increase in both patient and healthcare professional trainings on PCC and SDM provided by healthcare users' and patients' representatives. PCC and SDM continue to be central preoccupations at the macro level, supported by public health policies and patients/healthcare users' actions. This overview, however, suggests that although implementation initiatives have increased since 2017, implementation remains scarce in routine clinical practice. Funding, not only for research projects, but for the implementation of PCC and SDM in real-life settings (e-decision aids, clinical guidelines integrating PCC/SDM, human resources dedicated to PCC/SDM, etc.) are needed to promote sustained adoption. More systematic training for both healthcare professionals and patients is also warranted for a true acculturation to occur.
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Affiliation(s)
- Nora Moumjid
- Univ Lyon, Claude Bernard Lyon 1 University, Lyon, France.
| | - Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul-Sabatier, Toulouse, France; Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Medical Center Dr, Lebanon, NH, USA
| | | | - Elodie Charuel
- Clermont Auvergne University, Faculty of Medicine Department of General Practice, Clermont-Ferrand, France; Research Unit ACCePPT, Clermont Auvergne University, Clermont-Ferrand, France
| | | | - Julie Haesebaert
- Univ Lyon, Claude Bernard Lyon 1 University, Lyon University Hospital HCL, RESHAPE, Inserm, Lyon, France
| | - Sandrine Hild
- University of Nantes, Faculty of Medicine, Department of General Practice, Nantes, France; French National College of Teachers in General Practice, Paris, France
| | - Julien Mancini
- Aix-Marseille University, Institut Paoli-Calmettes, SESSTIM, Marseille, France
| | - Giovanna Marsico
- National Center for Palliative Care end End of Life, Paris, France
| | - Cédric Rat
- University of Nantes, Faculty of Medicine, Department of General Practice, Nantes, France; French National College of Teachers in General Practice, Paris, France
| | - Yves Zerbib
- French National College of Teachers in General Practice, Paris, France; Univ Lyon 1, Claude Bernard Lyon 1 University, Faculty of Medicine, Department of General Practice, Lyon, France
| | - Yves-Marie Vincent
- French National College of Teachers in General Practice, Paris, France; University of Bordeaux, Faculty of Medicine, Department of General Practice, Bordeaux, France
| | - François Blot
- Gustave Roussy-Cancer Campus, Ethics committee and Interdisciplinary Cancer Course Department (DIOPP), Paris-Saclay University, Villejuif, France
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Selby K, Marti J, Durand MA. We are all choice architects: using behavioral economics to improve smoking cessation in primary care. J Gen Intern Med 2022; 37:1783-1785. [PMID: 35018565 PMCID: PMC9130388 DOI: 10.1007/s11606-021-07322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,University of Toulouse III Paul Sabatier, Toulouse, France.,Dartmouth University, Lebanon, New Hampshire, USA
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25
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Samusure J, Horisberger D, Diserens C, Ducros C, Auer R, Bodenmann P, Durand MA, Selby K. [Information materials for colorectal cancer screening for citizens with low health literacy]. Rev Med Suisse 2022; 18:616-620. [PMID: 35353458 DOI: 10.53738/revmed.2022.18.775.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
For multiple reasons, certain socially disadvantaged populations are more affected by colorectal cancer but have lower screening rates than wealthier populations. The Vaud colorectal cancer screening program (CCR) provides a 20-page decision support tool for the 50-69-year-old population. Three new tools have now been designed specifically for citizens with a low level of health literacy: a simplified 6-page leaflet presenting the choice of a Fecal Occult Blood Test (FIT) and colonoscopy; a 2-page leaflet presenting the detection and screening of 4 common cancers; and a short video presenting the FIT test. By adapting our approach to each individual's level of health literacy, we can ensure a shared decision for all.
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Affiliation(s)
- Jérémie Samusure
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | | | | | - Cyril Ducros
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Reto Auer
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- Institut bernois de médecine de famille (BIHAM), Université de Berne, 3012 Berne
| | - Patrick Bodenmann
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
| | - Marie-Anne Durand
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
- CERPOP, Université de Toulouse, Inserm, UPS, 5, Allée Antonio-Machado, 31058 Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766, États-Unis
| | - Kevin Selby
- Unisanté, Centre universitaire de médecine générale et santé publique, 1011 Lausanne
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Oman K, Durand MA, Elwyn G, Yen RW, Marx C, Politi MC. Unexpected Outcomes of Measuring Decision Regret: Using a Breast Cancer Decision-Making Case Example. Patient 2022; 15:151-155. [PMID: 34337674 PMCID: PMC10599632 DOI: 10.1007/s40271-021-00543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Shared decision making can help patients feel supported and empowered when deciding between healthcare options. Decision regret can be a meaningful measure of the quality of that encounter. However, in a patient-engaged research study examining shared decision making for breast cancer surgery, decision regret was a difficult construct to assess, and asking questions about decision regret caused the patient to experience that emotion upon reflection. In this article, we consider the complexity of decision regret, and discuss the difficulty of measuring that emotion through existing instruments. We call for clarity in definitions of decision regret and offer suggestions for developing a set of questions that can capture regret in a more meaningful way.
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Affiliation(s)
- Kelly Oman
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA.
| | - Marie-Anne Durand
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- UM1295, CERPOP, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Glyn Elwyn
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Renata West Yen
- Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | - Christine Marx
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, Saint Louis, MO, USA
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Gauna F, Bendiane MK, Aim MA, Rousseau F, Rey D, Lecourtois D, Bonnet N, Durand MA, Tallet A, Mancini J. Lived experience and perceived advantages of therapeutic De-escalation: A qualitative study of older patients with breast cancer. J Geriatr Oncol 2022; 13:600-605. [PMID: 35115271 DOI: 10.1016/j.jgo.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION One option for therapeutic de-escalation in older women with early breast cancer (EBC) is partial breast irradiation (PBI) instead of whole-breast irradiation (WBI) when the latter has no clear advantages. We aimed to explore the decision-making processes and the lived experiences of WBI and PBI from the perspectives of older women with EBC. MATERIALS AND METHODS Thematic content analysis was performed on qualitative data collected using narrative interviews. RESULTS Twenty-two women aged 65 and over participated (ten patients who underwent WBI and twelve who underwent PBI). We identified three themes from their narratives: 1) Acceptance of a paternalistic relationship with physicians, 2) Strong need for an informed choice, and 3) PBI can help people conceal cancer-related physical marks. Narratives underlined participants' preferences for each of the two treatments and their perceptions about therapeutic de-escalation. Misconceptions about therapeutic de-escalation were observed. DISCUSSION When providing information about EBC treatment options, patients' perceived burden of side effects should be considered. Moreover, eliciting the value older patients place on available breast cancer treatments, as well as their related goals and preferences, could foster their participation in the therapeutic de-escalation decision-making process.
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Affiliation(s)
- Fatima Gauna
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Marie-Anastasie Aim
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; LPS EA 849, Aix Marseille Univ, Aix-en-Provence, France; Delegation for Clinical Research and Innovation, APHM, Marseille, France
| | | | - Dominique Rey
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | - Delphine Lecourtois
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France
| | | | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; UMR 1027, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society group, Ligue 2019 labelled team, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France.
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Politi MC, Saunders CH, Grabinski VF, Yen RW, Cyr AE, Durand MA, Elwyn G. An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery. PLoS One 2021; 16:e0260704. [PMID: 34914705 PMCID: PMC8675712 DOI: 10.1371/journal.pone.0260704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p<0.001). Conversation aids can facilitate offers of comparable options, but other conversational actions can inhibit aspects of shared decision-making.
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Affiliation(s)
- Mary C. Politi
- Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, MO, United States of America
- * E-mail:
| | - Catherine H. Saunders
- Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
| | - Victoria F. Grabinski
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Renata W. Yen
- Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
| | - Amy E. Cyr
- Department of Medicine, Division of Medical Oncology, Washington University in St Louis School of Medicine, St Louis, MO, United States of America
| | - Marie-Anne Durand
- Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
- Centre d’Epidémiologie et de Recherche en santé des Populations, Université de Toulouse, INSERM UMR1295, Université Toulouse, Toulouse, France
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | - Glyn Elwyn
- Dartmouth-Hitchcock Medical Center, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
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Habfast-Robertson I, Hempel-Bruder C, Durand MA, Morin D, Remillard S, Nanchen D, Daeppen JB, Berlin I, Selby K. [Three approaches to doctor-patient communication and prevention : Which model for which situation ?]. Rev Med Suisse 2021; 17:1934-1938. [PMID: 34755943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Doctors learn different communication approaches for use during prevention consultations to promote healthy habits, so as to set up a partnership and to promote patient autonomy. Three of these approaches are shared decision making, when there is more than one reasonable choice, motivational interviewing, principally for behaviour change and therapeutic education, a pedagogical approach helping patients develop skills so that they may have a better management of their chronic illness. This article presents an overview of the commonalities and the differences between these approaches, often considered separately, nevertheless they are complementary and in practice, using elements of all three during a consultation could improve preventative care.
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Affiliation(s)
| | | | - Marie-Anne Durand
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766, États-Unis
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III - Paul-Sabatier, 118 route de Narbonne, 31062 Toulouse, France
| | - Diane Morin
- Infirmières spécialisées en éducation thérapeutique du patient, CHUV, 1011 Lausanne
| | - Suzette Remillard
- Infirmières spécialisées en éducation thérapeutique du patient, CHUV, 1011 Lausanne
| | - David Nanchen
- Département promotion de la santé et préventions, Unisanté, 1010 Lausanne
| | | | - Ivan Berlin
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
- Département de pharmacologie, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Kevin Selby
- Département formation, recherche et innovation, Unisanté, 1010 Lausanne
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Schubbe D, Yen RW, Durand MA. How Does Patient Socioeconomic Position Affect Breast Cancer Surgical Treatment and Mortality?: A Rapid Review. Breast Cancer (Dove Med Press) 2021; 13:595-601. [PMID: 34737634 PMCID: PMC8558100 DOI: 10.2147/bctt.s293635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer is the second leading cause of death in women across the world. Despite significant improvements in overall breast cancer survival, disparities still exist. Research shows that socioeconomic position (SEP) plays a strong role in disparities in breast cancer care. Lower SEP can be a predictor of poorer breast cancer health outcomes and treatment received. No recent review has focused on SEP and breast cancer surgery outcomes. We conducted a rapid review assessing how patient SEP affects breast cancer surgical outcomes. Methods We developed and ran the search strategy in Ovid MEDLINE in January 2021. We assessed study eligibility using an adapted version of PICOS criteria. We included observational studies that assessed the relationship between SEP and breast cancer surgery treatment, including outcomes like surgery choice, survival, and wait time to surgery. We independently reviewed each article and independently extracted data using a pre-designed form. One reviewer narratively synthesized the data extracted from the included articles. Results We found twelve articles that met inclusion criteria. Eight out of 12 articles showed a difference in breast cancer surgery outcomes based on at least one measure of SEP. Six out of eight articles that collected surgery choice data found that women with lower SEP had lower rates of breast conserving surgery. One out of three articles that collected survival data found that higher SEP had a positive effect on survival. Additionally, one article that collected wait time to surgery data found a significant correlation between lower SEP and longer delays to surgical treatment. Conclusion In conclusion, our rapid review of SEP and breast cancer surgery outcomes found that there is a relationship between SEP and breast cancer surgery choice. This rapid review did not find enough evidence to see a relationship with overall survival and wait time to surgery.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.,UMR 1295, CERPOP, Université de Toulouse, INSERM, Université Toulouse II Paul Sabatier, Toulouse, France.,Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, CH-1011, Switzerland
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Yen RW, Smith J, Engel J, Muscat DM, Smith SK, Mancini J, Perestelo-Pérez L, Elwyn G, O'Malley AJ, Leyenaar JK, Mac O, Cadet T, Giguere A, Housten AJ, Langford A, McCaffery K, Durand MA. A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IDPAS). Med Decis Making 2021; 41:870-896. [PMID: 34151614 PMCID: PMC8763253 DOI: 10.1177/0272989x211020317] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effectiveness of patient decision aids (PtDAs) and other shared decision-making (SDM) interventions for socially disadvantaged populations has not been well studied. PURPOSE To assess whether PtDAs and other SDM interventions improve outcomes or decrease health inequalities among socially disadvantaged populations and determine the critical features of successful interventions. DATA SOURCES MEDLINE, CINAHL, Cochrane, PsycINFO, and Web of Science from inception to October 2019. Cochrane systematic reviews on PtDAs. STUDY SELECTION Randomized controlled trials of PtDAs and SDM interventions that included socially disadvantaged populations. DATA EXTRACTION Independent double data extraction using a standardized form and the Template for Intervention Description and Replication checklist. DATA SYNTHESIS Twenty-five PtDA and 13 other SDM intervention trials met our inclusion criteria. Compared with usual care, PtDAs improved knowledge (mean difference = 13.91, 95% confidence interval [CI] 9.01, 18.82 [I2 = 96%]) and patient-clinician communication (relative risk = 1.62, 95% CI 1.42, 1.84 [I2 = 0%]). PtDAs reduced decisional conflict (mean difference = -9.59; 95% CI -18.94, -0.24 [I2 = 84%]) and the proportion undecided (relative risk = 0.39; 95% CI 0.28, 0.53 [I2 = 75%]). PtDAs did not affect anxiety (standardized mean difference = 0.02, 95% CI -0.22, 0.26 [I2 = 70%]). Only 1 trial looked at clinical outcomes (hemoglobin A1C). Five of the 12 PtDA studies that compared outcomes by disadvantaged standing found that outcomes improved more for socially disadvantaged participants. No evidence indicated which intervention characteristics were most effective. Results were similar for SDM intervention trials. LIMITATIONS Sixteen PtDA studies had an overall unclear risk of bias. Heterogeneity was high for most outcomes. Most studies only had short-term follow-up. CONCLUSIONS PtDAs led to better outcomes among socially disadvantaged populations but did not reduce health inequalities. We could not determine which intervention features were most effective.[Box: see text].
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sian K Smith
- University of Bath, School of Management, Bath, Somerset, UK
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Marseille, Provence-Alpes-Cote d'Azu, France
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Sciences, Dartmouth College, Lebanon, NH, USA
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston, MA, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha Langford
- New York University School of Medicine, Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Langone Medical Centre, New York, NY, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France
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Durand MA, Lamouroux A, Redmond NM, Rotily M, Bourmaud A, Schott AM, Auger-Aubin I, Frachon A, Exbrayat C, Balamou C, Gimenez L, Grosclaude P, Moumjid N, Haesebaert J, Massy HD, Bardes J, Touzani R, Diant LBEF, Casanova C, Seitz JF, Mancini J, Delpierre C. Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial. BMC Public Health 2021; 21:1684. [PMID: 34530800 PMCID: PMC8444501 DOI: 10.1186/s12889-021-11565-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. METHODS We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention's sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. DISCUSSION Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). TRIAL REGISTRATION Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER 2020-A01687-32 . Date of registration: 17th November 2020.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Aurore Lamouroux
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Comité Départemental d'Éducation pour la Santé de Vaucluse (CoDES 84), Avignon, France
| | - Niamh M Redmond
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.
| | - Michel Rotily
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,EA 3279: Aix-Marseille Université, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | | | | | | | - Adèle Frachon
- Département de Médecine Générale, Université de Paris, Paris, France
| | - Catherine Exbrayat
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Christian Balamou
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Laëtitia Gimenez
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Faculté de Médecine - Département Universitaire de Médecine Générale, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Institut Claudius Regaud, IUCT-O, Registre des cancers du Tarn, Toulouse, F-31059, France
| | - Nora Moumjid
- P2S EA4129, Centre Léon Bérard, Université Lyon 1, Lyon, France
| | | | - Helene Delattre Massy
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Julia Bardes
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Rajae Touzani
- Institut Paoli Calmettes, SESSTIM UMR1252, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | | | - Clémence Casanova
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Jean François Seitz
- Service d'Hépato-Gastroentérologie, Hôpital Timone, Assistance Publique Hôpitaux Marseille & Aix-Marseille-Université, Marseille, France.,Centre Régional de Coordination du Dépistage des Cancers Provence-Alpes-Côte d'Azur (CRCDC-PACA), Marseille, France
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France
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LaPlante A, Yen RW, Isaacs T, Crocker J, Demjen Z, Schubbe D, Kennedy AM, Engel J, O'Brien N, Richters C, Durand MA. Enrollment, retention, and strategies for including disadvantaged populations in randomized controlled trials: a systematic review protocol. Syst Rev 2021; 10:233. [PMID: 34407862 PMCID: PMC8372683 DOI: 10.1186/s13643-021-01790-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many randomized controlled trials fail to reach their target sample size. When coupled with the omission and underrepresentation of disadvantaged groups in randomized controlled trials, many trials fail to obtain data that accurately represents the true diversity of their target population. Policies and practices have been implemented to increase representation of disadvantaged groups in many randomized controlled trials, with some trials specifically targeting such groups. To our knowledge, no systematic review has quantified the enrollment metrics and effectiveness of inclusion and retention strategies in randomized controlled trials focused on disadvantaged populations specifically. METHODS We will conduct a systematic search across EMBASE, MEDLINE, Web of Science, and CINAHL as well as grey literature, conference proceedings, research monographs, and Google Scholar from inception onwards. We will include randomized controlled trials where at least 50% of enrolled participants are considered to be disadvantaged, as per the RCT authors' definition and in line with our inclusion criteria. Two independent researchers per article will conduct preliminary title and abstract screening, subsequent full text review, and data extraction for the selected trials, with a third reviewer available to resolve conflicts. We will assess the quality of all included studies using specific criteria regarding data reporting, external validity, and internal validity. We will combine all selected studies and conduct a narrative synthesis to assess enrollment metrics. If there is sufficient homogeneity and sufficient trials comparing recruitment strategies within disadvantaged populations, we will conduct a random effects meta-analysis to evaluate the effectiveness of strategies designed to maximize the inclusion of disadvantaged populations in randomized controlled trials. DISCUSSION The findings of this systematic review will establish baseline recruitment and enrollment metrics of trials targeting disadvantaged populations to elucidate the scope of the challenge of recruiting such populations. We hope that our findings will promote future research on the distinct barriers that may prevent disadvantaged populations from participating in health intervention research, will encourage more trials exploring effective, tailored recruitment strategies, and will establish a foundation to track future progress in the recruitment of disadvantaged populations. TRIAL REGISTRATIONS PROSPERO ID: CRD42020152814.
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Affiliation(s)
- Abigail LaPlante
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA.,Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Talia Isaacs
- UCL Centre for Applied Linguistics, UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK.
| | - Joanna Crocker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Zsofia Demjen
- UCL Centre for Applied Linguistics, UCL Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, UK
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Alice M Kennedy
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Nancy O'Brien
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Carla Richters
- Patient and Family Advocate, Dartmouth Hitchcock Medical Center Office of Patient Experience, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA.,UMR 1027, équipe EQUITY, Faculté de Médecine, 37 Allées Jules Guesde, 31000, Toulouse, France
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Hollanda De Sa Neto H, Habfast-Robertson I, Hempel-Bruder C, Durand MA, Jacot-Sadowski I, Khazaal Y, Berlin I, Selby K. Formative provider testing of a New Encounter Decision Aid for Smoking Cessation (Preprint). JMIR Form Res 2021; 6:e32960. [PMID: 35442200 PMCID: PMC9069282 DOI: 10.2196/32960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.
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Affiliation(s)
| | | | | | - Marie-Anne Durand
- Lausanne University Hospital, Lausanne, Switzerland
- Centre d'Epidémiologie et de Recherche en Santé des Populations, University of Toulouse, Institut National de la Santé et de la Recherche Médicale, Toulouse, France
- Dartmouth Institute for Health Policy and Clinical Practice, University of Dartmouth, Lebanon, NH, United States
| | | | - Yasser Khazaal
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Ivan Berlin
- Hôpital Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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Scalia P, Schubbe DC, Lu ES, Durand MA, Frascara J, Noel G, O’Malley AJ, Elwyn G. Comparing the impact of an icon array versus a bar graph on preference and understanding of risk information: Results from an online, randomized study. PLoS One 2021; 16:e0253644. [PMID: 34297713 PMCID: PMC8301663 DOI: 10.1371/journal.pone.0253644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Few studies have examined the best way to convey the probability of serious events occurring in the future (i.e., risk of stroke or death) to persons with low numeracy or graph literacy proficiency. To address this gap, we developed and user-tested a bar graph and compared it to icon arrays to assess its impact on understanding and preference for viewing risk information. OBJECTIVES To determine the: (i) formats' impact on participants' understanding of risk information; (ii) formats' impact on understanding and format preference across numeracy and graph literacy subgroups; (iii) rationale supporting participants' preference for each graphical display format. METHODS An online sample (evenly made up of participants with high and low objective numeracy and graph literacy) was randomized to view either the icon array or the bar graph. Each format conveyed the risk of major stroke and death five years after choosing surgery, a stent, or medication to treat carotid artery stenosis. Participants answered questions to assess their understanding of the risk information. Lastly, both formats were presented in parallel, and participants were asked to identify their preferred format to view risk information and explain their preference. RESULTS Of the 407 participants, 197 were assigned the icon array and 210 the bar graph. Understanding of risk information and format preference did not differ significantly between the two trial arms, irrespective of numeracy and graph literacy proficiency. High numeracy and graph literacy proficiency was associated with high understanding (p<0.01) and a preference for the bar graph (p = 0.01). CONCLUSION We found no evidence to demonstrate the superiority of one format over another on understanding. The majority of participants preferred viewing the risk information using the bar graph format.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Danielle C. Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Emily S. Lu
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- UMR 1095, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Jorge Frascara
- Department of Art and Design, University of Alberta, Edmonton, Alberta, Canada
| | - Guillermina Noel
- Lucerne School of Arts and Design, Lucerne University of Applied Sciences and Arts, Luzern-Emmenbrucke, Switzerland
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
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Calderwood AH, Carter C, Durand MA, O’Connor S, Boardman M. Impact of Knowledge and Risk Perceptions on Older Adults' Intention for Surveillance Colonoscopy. J Clin Gastroenterol 2021; 55:528-533. [PMID: 32740100 PMCID: PMC10851922 DOI: 10.1097/mcg.0000000000001401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/27/2020] [Indexed: 12/10/2022]
Abstract
GOALS The authors aimed to characterize older adults' intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans. BACKGROUND Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be "individualized." Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown. STUDY In collaboration with a rural family medicine practice, the authors invited adults aged 65 years and older with a history of colon adenomas to complete a 14-item survey regarding intention for colonoscopy and knowledge of colon polyps. RESULTS Sixty-seven of 105 (63%) patients completed the survey. The mean age was 72 years. Regarding future surveillance, 53% planned to return, 25% were unsure, and 22% did not plan to return. There were no significant differences in baseline characteristics on the basis of the intention for future colonoscopy. Regarding polyp knowledge, 73% had correct knowledge around how common polyps are; 50% thought that more than half of untreated polyps would become cancerous-an inaccurately elevated perception by 10 folds. Respondents who perceived polyps to have a high malignant potential were more likely to report plans for surveillance colonoscopy (68% vs. 39%; P=0.03). CONCLUSIONS In this survey of older adults with a history of polyps, many had a falsely elevated perception of polyps' potential for cancer that was associated with a higher intention for future colonoscopy. Ensuring older adults have an understanding of the risks of polyps is an essential step toward improving decision making around surveillance colonoscopy.
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Affiliation(s)
- Audrey H. Calderwood
- Dartmouth-Hitchcock Medical Center, Lebanon
- The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon
- Dartmouth’s Geisel School of Medicine, Hanover, NH
| | | | - Marie-Anne Durand
- The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sharon O’Connor
- Center for Program Design and Evaluation, Dartmouth College, Hanover, NH
| | - Maureen Boardman
- Dartmouth’s Geisel School of Medicine, Hanover, NH
- Dartmouth Primary Care Cooperative Research Network, Dartmouth’s Geisel School of Medicine, Hanover, NH
- Little Rivers Health Care, Bradford, VT
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Politi MC, Forcino RC, Parrish K, Durand MA, O'Malley AJ, Elwyn G. Cost talk: protocol for a stepped-wedge cluster randomized trial of an intervention helping patients and urologic surgeons discuss costs of care for slow-growing prostate cancer during shared decision-making. Trials 2021; 22:422. [PMID: 34187547 PMCID: PMC8240421 DOI: 10.1186/s13063-021-05369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Costs of care are important to patients making cancer treatment decisions, but clinicians often do not feel prepared to discuss treatment costs. We aim to (1) assess the impact of a conversation-based decision aid (Option Grid) containing cost information about slow-growing prostate cancer management options, combined with urologic surgeon training, on the frequency and quality of patient-urologic surgeon cost conversations, and (2) examine the impact of the decision aid and surgeon training on decision quality. METHODS We will conduct a stepped-wedge cluster randomized trial in outpatient urology practices affiliated with a large academic medical center in the USA. We will randomize five urologic surgeons to four intervention sequences and enroll their patients with a first-time diagnosis of slow-growing prostate cancer independently at each period. Primary outcomes include frequency of cost conversations, initiator of cost conversations, and whether or not a referral is made to address costs. These outcomes will be collected by patient report (post-visit survey) and by observation (audio-recorded clinic visits) with consent. Other outcomes include the following: patient-reported decisional conflict post-visit and at 3-month follow-up, decision regret at 3-month follow-up, shared decision-making post-visit, communication post-visit, and financial toxicity post-visit and at 3-month follow-up; clinician-reported attitudes about shared decision-making before and after the study, and feasibility of sustained intervention use. We will use hierarchical regression analysis to assess patient-level outcomes, including urologic surgeon as a random effect to account for clustering of patient participants. DISCUSSION This study evaluates a two-part intervention to improve cost discussions between urologic surgeons and patients when deciding how to manage slow-growing prostate cancer. Establishing the effectiveness of the strategy under study will allow for its replication in other clinical decision contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT04397016 . Registered on 21 May 2020.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Katelyn Parrish
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA.,Université Toulouse III Paul Sabatier, Toulouse, France
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
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Selby K, Cardinaux R, Metry B, de Rougemont S, Chabloz J, Meier-Herrmann V, Stoller J, Durand MA, Auer R. Citizen advisory groups for the creation and improvement of decision aids: experience from two Swiss centers for primary care. Res Involv Engagem 2021; 7:37. [PMID: 34090511 PMCID: PMC8179076 DOI: 10.1186/s40900-021-00283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users. METHODS Between 2017 and 2020, two Swiss centers for primary care (Lausanne and Bern) created citizen advisory groups to contribute to multiple improvement cycles for colorectal, prostate and lung cancer screening DAs. Following Community Based Participatory Research principles, we collaborated with local organizations to recruit citizens aged 50 to 75 without previous cancer diagnoses. We remunerated incidental costs and participant time. One center supplemented in-person meetings by mailed paper questionnaires, while the other supplemented meetings using small-group workshops and analyses of meeting transcripts. RESULTS In Lausanne, we received input from 49 participants for three DAs between 2017 and 2020. For each topic, participants gave feedback on the initial draft and 2 subsequent versions during in-person meetings with ~ 8 participants and one round of mailed questionnaires. In Bern, 10 participants were recruited among standardized patients from the university, all of whom attended in-person meetings every three months between 2017 and 2020. At both sites, numerous changes were made to the content, appearance, language, and tone of DAs and outreach materials. Participants reported high levels of satisfaction with the participative process. CONCLUSIONS Citizen advisory groups are a feasible means of repeatedly incorporating end-user feedback during the creation of multiple DAs. Methodological differences between the two centers underline the need for a flexible model adapted to local needs.
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Affiliation(s)
- Kevin Selby
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland.
| | - Regula Cardinaux
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
| | - Beatrice Metry
- Institute of primary health care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | | | | | - Marie-Anne Durand
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
- University of Toulouse, Toulouse, France
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Reto Auer
- Center for primary care and public health (Unisanté), University of Lausanne, Rue de Bugnon 44, 1010, Lausanne, Switzerland
- Institute of primary health care (BIHAM), University of Bern, Bern, Switzerland
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Muscat DM, Smith J, Mac O, Cadet T, Giguere A, Housten AJ, Langford AT, Smith S, Durand MA, McCaffery K. Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:848-869. [PMID: 34053361 DOI: 10.1177/0272989x211011101] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. PURPOSE An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. DATA SOURCES Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). STUDY SELECTION RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). DATA EXTRACTION Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. DATA SYNTHESIS Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%). LIMITATIONS We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Cadet
- School of Social Work, Simmons University, Boston MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | | | - Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health. New York, NY, USA
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia
| | - Marie-Anne Durand
- Université Toulouse III Paul Sabatier, Toulouse, France.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Suisse.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Bath Centre for Healthcare Innovation and Improvement, Information Decisions and Operations, School of Management, University of Bath, Somerset, UK
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Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. 'Because Everybody is so Different': a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11:e043245. [PMID: 34011586 PMCID: PMC8137244 DOI: 10.1136/bmjopen-2020-043245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/08/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To (1) characterise (A) the lived experiences and (B) information needs of patients with rectal cancer; and (2) compare to the perceived lived experiences and information needs of colorectal surgeons. DESIGN We conducted 1-hour semistructured qualitative interviews, dual independent transcript coding and thematic analysis. SETTING/PARTICIPANTS Interviews included rectal cancer survivors (stages I-III), some accompanied by caregivers, at Dartmouth-Hitchcock Medical Center and experienced colorectal surgeons. RESULTS We performed 25 interviews involving 30 participants, including 15 patients with 5 caregivers, plus 10 physicians. Two major themes emerged. First, patients reported major impacts on their lives following rectal cancer, including on their everyday lives and leisure activities; identity, self-confidence and intimacy; mental health, especially anxiety. These impacts were mediated by their medical experiences, lifestyle and attitudes. Second, the diversity of effects on patients' lives means that care, counselling and information needs should be personalised for a better medical experience and outcomes. Surgeons did not report knowledge of the full range of patient experiences and reported limited counselling in key areas, particularly concerning intimacy and mental health. CONCLUSION Rectal cancer diagnosis, treatment and survivorship dramatically affect all people, regardless of which surgical treatment they undergo. Effects are varied and necessitate customised care, counselling and information, which surgeons are not currently providing. Because rectal cancer affects every part of patients' lives, they need holistic support and information. Patients would benefit from substantial support after treatment as they establish a new normal.
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Affiliation(s)
- Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jackson T Read
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- Dartmouth College, Hanover, New Hampshire, USA
| | - Srinivas J Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Scalia P, Saunders CH, Dannenberg M, Mc Giguere A, Alper BS, Hoffmann T, Perestelo-Perez L, Durand MA, Elwyn G. Processes for evidence summarization for patient decision aids: A Delphi consensus study. Health Expect 2021; 24:1178-1186. [PMID: 33991160 PMCID: PMC8369090 DOI: 10.1111/hex.13244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patient decision aids (PDAs) should provide evidence-based information so patients can make informed decisions. Yet, PDA developers do not have an agreed-upon process to select, synthesize and present evidence in PDAs. OBJECTIVE To reach the consensus on an evidence summarization process for PDAs. DESIGN A two-round modified Delphi survey. SETTING AND PARTICIPANTS A group of international experts in PDA development invited developers, scientific networks, patient groups and listservs to complete Delphi surveys. DATA COLLECTION We emailed participants the study description and a link to the online survey. Participants were asked to rate each potential criterion (omit, possible, desirable, essential) and provide qualitative feedback. ANALYSIS Criteria in each round were retained if rated by >80% of participants as desirable or essential. If two or more participants suggested rewording, reordering or merging, the steering group considered the suggestion. RESULTS Following two Delphi survey rounds, the evidence summarization process included defining the decision, reporting the processes and policies of the evidence summarization process, assembling the editorial team and managing (collect, manage, report) their conflicts of interest, conducting a systematic search, selecting and appraising the evidence, presenting the harms and benefits in plain language, and describing the method of seeking external review and the plan for updating the evidence (search, selection and appraisal of new evidence). CONCLUSION A multidisciplinary stakeholder group reached consensus on an evidence summarization process to guide the creation of high-quality PDAs. PATIENT CONTRIBUTION A patient partner was part of the steering group and involved in the development of the Delphi survey.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Michelle Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Anik Mc Giguere
- Faculte de medicine, Universite Laval, Quebec City, Quebec, Canada
| | | | - Tammy Hoffmann
- Institute of Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia
| | | | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
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Schubbe D, Yen RW, Saunders CH, Elwyn G, Forcino RC, O'Malley AJ, Politi MC, Margenthaler J, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bradley A, Goodwin C, van den Muijsenbergh M, Aarts JWM, Scalia P, Durand MA. Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices. Implement Sci 2021; 16:51. [PMID: 33971913 PMCID: PMC8108365 DOI: 10.1186/s13012-021-01115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. METHODS We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. RESULTS We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. CONCLUSIONS Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136367 , registered on May 2, 2017.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert J Volk
- Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sanja Percac-Lima
- Massachusetts General Hospital's Chelsea Healthcare Center, Chelsea, MA, USA
| | - Ann Bradley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- UMR 1295, CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
- Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
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Scalia P, Ahmad F, Schubbe D, Forcino R, Durand MA, Barr PJ, Elwyn G. Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems. J Med Internet Res 2021; 23:e22766. [PMID: 33938806 PMCID: PMC8129884 DOI: 10.2196/22766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and time-consuming task; yet, the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems. Objective This study aims to identify the steps and time required to integrate a PDA into the Epic EHR system and examine facilitators and barriers to the integration effort. Methods We conducted a case study at 5 academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate the integration of the uterine fibroid Option Grid PDAs into clinician-facing menus. We scheduled regular meetings with the Epic software analysts and an expert Epic technologist to discuss how best to integrate the tools into Epic for use by clinicians with patients. The meetings were then recorded and transcribed. Two researchers independently coded the transcripts and field notes before categorizing the codes and conducting a thematic analysis to identify the facilitators and barriers to EHR integration. The steps were reviewed and edited by an Epic technologist to ensure their accuracy. Results Integrating the uterine fibroid Option Grid PDA into clinician-facing menus required an 18-month timeline and a 6-step process, as follows: task priority negotiation with Epic software teams, security risk assessment, technical review, Epic configuration; troubleshooting, and launch. The key facilitators of the process were the clinical champions who advocated for integration at the institutional level and the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard app platform (Health Level 7 Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources) as a means of integrating the Option Grid into existing systems. This standard platform enabled clinicians to access the tools by using single sign-on credentials and prevented protected health information from leaving the EHR. Key barriers were the lack of control over the Option Grid product developed by EBSCO (Elton B Stephens Company) Health; the periodic Epic upgrades that can result in a pause on new software configurations; and the unforeseen software problems with Option Grid (ie, inability to print the PDA), which delayed the launch of the PDA. Conclusions The integration of PDAs into the Epic EHR system requires a 6-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance from an experienced technologist, and a willing EHR software developer team.
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Affiliation(s)
| | | | | | | | | | | | - Glyn Elwyn
- Dartmouth College, Lebanon, NH, United States
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Hoffmann TC, Bakhit M, Durand MA, Perestelo-Pérez L, Saunders C, Brito JP. Basing Information on Comprehensive, Critically Appraised, and Up-to-Date Syntheses of the Scientific Evidence: An Update from the International Patient Decision Aid Standards. Med Decis Making 2021; 41:755-767. [PMID: 33660539 DOI: 10.1177/0272989x21996622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients and clinicians expect the information in patient decision aids to be based on the best available research evidence. The objectives of this International Patient Decision Aid Standards (IPDAS) review were to 1) check the currency of, and where needed, update evidence for the domain of "basing the information in decision aids on comprehensive, critically appraised, and up-to-date syntheses of the evidence"; 2) analyze the evidence characteristics of decision aids; and 3) propose updates to relevant IPDAS criteria. METHODS We searched MEDLINE and PubMed to inform updates of this domain's definitions, justifications, and components. We also searched 5 sources to identify all publicly available decision aids (N = 471). Two assessors independently extracted each aid's evidence characteristics. RESULTS Minor updates to the definitions and theoretical justifications of this IPDAS domain are provided and changes to relevant IPDAS criteria proposed. Nearly all aids (97%) provided a year of creation/update, but most (81%) did not report an explicit update or expiration policy. No scientific references were cited in 33% of aids. Of the 314 that cited at least 1 reference, 39% cited at least 1 guideline, 44% cited at least 1 systematic review, and 23% cited at least 1 randomized trial. In 35%, it was unclear what statement in the aid the citations referred to. Only 14% reported any of the processes used to find and decide on evidence inclusion. Only 14% reported the evidence quality. Many emerging issues and future research areas were identified. CONCLUSIONS Although many emerging issues need to be addressed, this IPDAS domain is validated and criteria refined. High-quality patient decision aids should be based on comprehensive and up-to-date syntheses of critically appraised evidence.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Marie-Anne Durand
- Universite Toulouse III Paul Sabatier, Toulouse, France.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | | | - Catherine Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Centre, Lebanon NH, USA
| | - Juan P Brito
- Knowledge Evaluation and Research Unit, Mayo Clinic, Minnesota, Rochester, MN, USA
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Saunders CH, Durand MA, Scalia P, Kirkland KB, MacMartin MA, Barnato AE, Milne DW, Collison J, Jaggars A, Butt T, Wasp G, Nelson E, Elwyn G. User-Centered Design of the consideRATE Questions, a Measure of People's Experiences When They Are Seriously Ill. J Pain Symptom Manage 2021; 61:555-565.e5. [PMID: 32814165 PMCID: PMC9162500 DOI: 10.1016/j.jpainsymman.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/22/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT No brief patient-reported experience measure focuses on the most significant concerns of seriously ill individuals. OBJECTIVES The objective of the study was to develop the consideRATE questions. METHODS This user-centered design study had three phases. We reviewed the literature and consulted stakeholders, including caregivers, clinicians, and researchers, to identify the elements of care most important to patients (Phase 1). We refined items based on cognitive interviews with patients, families, and clinicians (Phase 2). We piloted the measure with patients and families (Phase 3). RESULTS Phase 1 resulted in seven questions addressing the following elements: 1) care team attention to patients' physical symptoms, 2) emotional symptoms, 3) environment of care, 4) respect for patients' priorities, 5) communication about future plans, 6) communication about financial and similar affairs, and 7) communication about illness trajectory. Phase 2 participants included eight patients, eight family members, and seven clinicians. We added an open-text comment option. We did not identify any other issues that were important enough to participants to include. Response choices ranged from one (very bad) to four (very good), with a not applicable option (does not apply). Phase 3 involved 15 patients and 16 family members and demonstrated the acceptability of the consideRATE questions. Most reported that the questions were not distressing, disruptive, or confusing. Completion time averaged 2.4 minutes (range 1-5). CONCLUSION Our brief patient-reported serious illness experience measure is based on what matters most to patients, families, and clinicians. It was acceptable to patients and families in a regional sample. It has promise for use in clinical settings.
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Affiliation(s)
- Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Kathryn B Kirkland
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - David W Milne
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joan Collison
- Patient and Family Advisors, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ashleigh Jaggars
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Tanya Butt
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Garrett Wasp
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eugene Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
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Beaubrun en Famille Diant L, Durand MA, Witkowski V, Dordonne Honore M, Clastres N, Linon C, Journet P, Netens B, Lamouroux A. Les défis de l’inclusion des patients et du public dans la recherche interventionnelle pour lutter contre les inégalités sociales de santé. Glob Health Promot 2021. [DOI: 10.1177/1757975921991080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
L’implication des patients et du public (IPP) dans la recherche interventionnelle est incontournable mais présente des défis à relever. L’IPP requiert une réflexion éthique et collégiale en amont de la conception de l’étude, des moyens et une gouvernance adaptée afin de tenir compte des enjeux collectifs et individuels qui sous-tendent ce nouveau partenariat.
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Affiliation(s)
- Laury Beaubrun en Famille Diant
- Docteure en psychologie, psychologue clinicienne, Laboratoire Centre d’études et de recherche en psychopathologie et santé (CERPPS) (EA741), Université Toulouse II Jean Jaurès, Toulouse, France
| | - Marie-Anne Durand
- Chercheure, UMR 1295, Centre d’épidémiologie et de recherche en santé des Populations (CERPOP), équipe EQUITY, Université Toulouse III - Paul Sabatier, France. Professeure associée adjointe, Dartmouth College, Lebanon, USA. Adjointe scientifique, Unisanté, Lausanne, Suisse
| | - Veronique Witkowski
- Patient-expert, Aix-Marseille Université, Marseille, Provence-Alpes-Côte d’Azur, France
| | | | | | - Carole Linon
- Patient-expert, Aix-Marseille Université, Marseille, Provence-Alpes-Côte d’Azur, France
| | - Pascale Journet
- Patient-expert, Aix-Marseille Université, Marseille, Provence-Alpes-Côte d’Azur, France
| | - Béatrice Netens
- Patient-expert, Aix-Marseille Université, Marseille, Provence-Alpes-Côte d’Azur, France
| | - Aurore Lamouroux
- Assistance Publique des Hôpitaux de Marseille, Marseille, France. CoDES 84, Avignon, France
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Selby K, Durand MA, Gouveia A, Bosisio F, Barazzetti G, Hostettler M, D'Acremont V, Kaufmann A, von Plessen C. Citizen Responses to Government Restrictions in Switzerland During the COVID-19 Pandemic: Cross-Sectional Survey. JMIR Form Res 2020; 4:e20871. [PMID: 33156809 PMCID: PMC7717891 DOI: 10.2196/20871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 01/15/2023] Open
Abstract
Background The success of government-recommended mitigation measures during the COVID-19 pandemic depends largely on information uptake and implementation by individual citizens. Objective Our aim was to assess citizens’ knowledge and perceptions about COVID-19 recommendations in the Canton of Vaud, Switzerland. Methods A cross-sectional electronic survey with open and closed questions was disseminated by community-based partners prior to the relaxation of government restrictions. Outcomes included citizen knowledge (9-question measure) and worry about the virus, perception of government measures, and recommendations for improvements. Comparisons used linear regression, controlling for age, sex, education, and health literacy. Free-text answers were analyzed thematically. Results Of 807 people who accessed the survey, 684 (85%) completed all questions and 479 (60%) gave free-text recommendations. Overall, 75% were female, the mean age was 48 years, and 93% had high health literacy. Knowledge scores were high, with a median score of 8 out of 9. Mean levels of worry about the COVID-19 pandemic were higher in women than men (55/100 versus 44/100, P<.001), and in respondents with lower health literacy (57/100 versus 52/100, P=.03). Self-reported adherence to recommendations was high (85%) and increased with age and worry (both P<.001). Respondents rated their own adherence higher than others (85% versus 61%, P<.001). Moreover, 34% of respondents reported having self-quarantined; this rose to 52% for those aged ≥75 years. Those who had self-quarantined reported higher levels of fear. Nearly half (49%) of respondents felt the government response had been adequate, though younger age and higher levels of worry were associated with considering the response to be insufficient (both P<.001). Analysis of open-text answers revealed 4 major themes: access to and use of masks, gloves, and hand sanitizer; government messaging; lockdown and lockdown exit plan communication; and testing for COVID-19. Conclusions Knowledge, adherence, and satisfaction regarding government recommendations and response were high in this sample, but many desired greater access to personal protective equipment. Those with lower health literacy and those who have been in self-isolation reported greater concerns about the pandemic.
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Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Alexandre Gouveia
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Francesca Bosisio
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Gaia Barazzetti
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Maxime Hostettler
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Alain Kaufmann
- The ColLaboratory - Participatory, Collaboratory and Action-Research Unit, University of Lausanne, Lausanne, Switzerland
| | - Christian von Plessen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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Durand MA, Yen RW, O’Malley J, Elwyn G, Mancini J. Graph literacy matters: Examining the association between graph literacy, health literacy, and numeracy in a Medicaid eligible population. PLoS One 2020; 15:e0241844. [PMID: 33175891 PMCID: PMC7657552 DOI: 10.1371/journal.pone.0241844] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Graphic display formats are often used to enhance health information. Yet limited attention has been paid to graph literacy in people of lower education and lower socioeconomic status (SES). This study aimed to: 1) examine the relationship between graph literacy, numeracy, health literacy and sociodemographic characteristics in a Medicaid-eligible population 2) determine the impact of graph literacy on comprehension and preference for different visual formats. METHODS We conducted a cross-sectional online survey among people in the US on Medicaid, and of presumed lower education and SES. RESULTS The mean graph literacy score among 436 participants was 1.47 (SD 1.05, range: 0 to 4). Only graph literacy was significantly associated with overall comprehension (p < .001). Mean comprehension scores were highest for the table format (1.91), closely followed by bar graph (1.85) and icon array (1.80). Information comprehension was aligned with preference scores. CONCLUSIONS Graph literacy in a Medicaid-eligible population was lower than previous estimates in the US. Tables were better understood, with icon arrays yielding the lowest score. Preferences aligned with comprehension. PRACTICE IMPLICATIONS It may be necessary to reconsider the use of graphic display formats when designing information for people with lower educational levels. Further research is needed.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
- UMR 1027, Université Toulouse III Paul Sabatier, Toulouse, France
- * E-mail:
| | - Renata W. Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, SESSTIM, “Cancer, Biomedicine & Society” Group, Hop Timone, Marseille, France
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Durand MA, Yen RW, O'Malley AJ, Schubbe D, Politi MC, Saunders CH, Dhage S, Rosenkranz K, Margenthaler J, Tosteson ANA, Crayton E, Jackson S, Bradley A, Walling L, Marx CM, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bergin E, Goodwin C, Miller C, Harris C, Barth RJ, Aft R, Feldman S, Cyr AE, Angeles CV, Jiang S, Elwyn G. What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata. Cancer 2020; 127:422-436. [PMID: 33170506 PMCID: PMC7983934 DOI: 10.1002/cncr.33248] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
Abstract
Background Women of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women across socioeconomic strata in making breast cancer surgery choices. Methods We conducted a 3‐arm (Option Grid, Picture Option Grid, and usual care), multisite, randomized controlled superiority trial with surgeon‐level randomization. The Option Grid (text only) and Picture Option Grid (pictures plus text) conversation aids were evidence‐based summaries of available breast cancer surgery options on paper. Decision quality (primary outcome), treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care were measured from T0 (pre‐consultation) to T5 (1‐year after surgery. Results Sixteen surgeons saw 571 of 622 consented patients. Patients in the Picture Option Grid arm (n = 248) had higher knowledge (immediately after the visit [T2] and 1 week after surgery or within 2 weeks of the first postoperative visit [T3]), an improved decision process (T2 and T3), lower decision regret (T3), and more SDM (observed and self‐reported) compared to usual care (n = 257). Patients in the Option Grid arm (n = 66) had higher decision process scores (T2 and T3), better coordination of care (12 weeks after surgery or within 2 weeks of the second postoperative visit [T4]), and more observed SDM (during the surgical visit [T1]) compared to usual care arm. Subgroup analyses suggested that the Picture Option Grid had more impact among women of lower SES and health literacy. Neither intervention affected concordance, treatment choice, or anxiety. Conclusions Paper‐based conversation aids improved key outcomes over usual care. The Picture Option Grid had more impact among disadvantaged patients. Lay Summary The objective of this study was to understand how to help women with lower incomes or less formal education to make breast cancer surgery choices. Compared with usual care, a conversation aid with pictures and text led to higher knowledge. It improved the decision process and shared decision making (SDM) and lowered decision regret. A text‐only conversation aid led to an improved decision process, more coordinated care, and higher SDM compared to usual care. The conversation aid with pictures was more helpful for women with lower income or less formal education. Conversation aids with pictures and text helped women make better breast cancer surgery choices.
A paper‐based pictorial conversation aid (pictures plus text) is beneficial to all patients with early‐stage breast cancer and particularly to disadvantaged patients. Between‐surgeon variation suggests that the maximal impact of such interventions requires standardized physician training combined with these interventions.
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Affiliation(s)
- Marie-Anne Durand
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,UMR 1027 Team EQUITY, Paul Sabatier University, Toulouse, France
| | - Renata W Yen
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - A James O'Malley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Danielle Schubbe
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine H Saunders
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Shubhada Dhage
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | | | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Eloise Crayton
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sherrill Jackson
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ann Bradley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Linda Walling
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Christine M Marx
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elissa Ozanne
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sanja Percac-Lima
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts
| | | | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Camille Harris
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | | | - Rebecca Aft
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Amy E Cyr
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Shuai Jiang
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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Durand MA, Selby K, Bodenmann P, Zaman K, Ducros C, Cornuz J. [Risk communication in healthcare: literature review and recommendations for clinical practice]. Rev Med Suisse 2020; 16:2092-2098. [PMID: 33146957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Consistent with the principles of evidence-based medicine, communicating clinical risks to patients and their families is an essential part of informed consent and decision-making. Communication of clinical risks can take place during and after consultations, orally or in writing, based on the latest available scientific data, when available. Numerous studies show that there are different degrees of innumeracy in the general population, meaning more or less significant difficulties mastering numbers in everyday situations. It is therefore imperative to communicate risks in a way that is adapted to the patients' variable numeracy and health literacy levels. This article presents a synthesis of international research on risk communication, as well as recommendations for clinical practice.
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Affiliation(s)
- Marie-Anne Durand
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
- Université Toulouse-III-Paul-Sabatier, Route de Narbonne, 31330 Toulouse, France
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH 03766, États-Unis
| | - Kevin Selby
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Patrick Bodenmann
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | | | - Cyril Ducros
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
| | - Jacques Cornuz
- Centre universitaire de médecine générale et santé publique, Unisanté, 1011 Lausanne
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