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Damman OC, van Strien-Knippenberg IS, Engelhardt EG, Determann D D, de Bruijne MC, Siesling S, Konings IR, Timmermans DR. Information and communication priorities of patients and healthcare professionals in shared decision making regarding adjuvant systemic breast cancer treatment: A survey study. Eur J Oncol Nurs 2024; 70:102574. [PMID: 38643680 DOI: 10.1016/j.ejon.2024.102574] [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: 10/31/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To assess information and communication priorities of patients and healthcare professionals in Shared Decision Making about adjuvant systemic treatment of primary breast cancer and identify key decision-relevant information accordingly. METHODS Patients (N = 122) and professionals working with breast cancer patients (N = 118), of whom 38 were nurse practitioners and 32 nurses, were recruited using convenience sampling, and surveyed about information/communication aspects key to decision-making, using ranking assignments. We further posed a simple open question, questions about receiving population-based statistics versus personalized statistics concerning treatment outcomes, and their attitude and experience concerning Shared Decision Making. Data were analyzed using descriptive analysis and a qualitative analysis. RESULTS Both patients and professionals prioritized information about treatment outcomes (i.e., survival, recurrence) as key decision-relevant information for patients. Patients prioritized information about relatively severe treatment side-effects and late effects (e.g., blood clot, stroke), whilst professionals prioritized information about effects that occur relatively often (e.g., hair loss, fatigue). Patients specifically wanted to know if the benefit of treatment is worth the negative impact. Both groups prioritized personalized statistics over population-based statistics. CONCLUSIONS Some differences between patients and professionals were found in information and communication priorities, specifically related to the different side-effects. It seems worthwhile to precisely address these side-effects in Shared Decision Making concerning adjuvant systemic treatment. Furthermore, it seems important to deliberate together on the question if expected benefit of treatment is worth the potential negative impact for the individual patient.
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Affiliation(s)
- Olga C Damman
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands.
| | - Inge S van Strien-Knippenberg
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Netherlands
| | | | - Martine C de Bruijne
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Netherlands; Department of Research and Development, Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands
| | - Inge R Konings
- Department of Medical Oncology and Cancer Center Amsterdam, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Netherlands
| | - Danielle R Timmermans
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
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Jenkins LC, Summers SJ, Nasser A, Verhagen A. Dry needling perceptions and experiences: A survey of Australian physiotherapists. Musculoskelet Sci Pract 2024; 69:102895. [PMID: 38081107 DOI: 10.1016/j.msksp.2023.102895] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND There is a lack of information on the use of dry needling in Australian physiotherapy practice. OBJECTIVES Our primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DESIGN Cross-sectional online survey. METHOD We developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. RESULTS/FINDINGS We invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). CONCLUSIONS We found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.
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Affiliation(s)
- Luke C Jenkins
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia.
| | - Simon J Summers
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Nasser
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
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Zohny H, Savulescu J, Malhi GS, Singh I. Flourishing, Mental Health Professionals and the Role of Normative Dialogue. Health Care Anal 2024:10.1007/s10728-023-00478-4. [PMID: 38214808 DOI: 10.1007/s10728-023-00478-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that 'liberal' approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust.
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Affiliation(s)
- Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore.
- Murdoch Children's Research Institute, Melbourne, Australia.
- University of Melbourne, Melbourne, Australia.
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Visiting Professor, Department of Psychiatry, University of Oxford, Oxford, Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, Australia
| | - Ilina Singh
- Department of Psychiatry, University of Oxford, Oxford, UK
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Müller F, Ngo J, Arnetz JE, Holman HT. Development and validation of the provider assessed quality of consultations with language interpretation scale (PQC-LI). BMC Res Notes 2024; 17:15. [PMID: 38178154 PMCID: PMC10768141 DOI: 10.1186/s13104-023-06675-7] [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: 08/29/2022] [Accepted: 12/16/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE With the growing immigrant communities in the western world, there is an urgent need to address language barriers to care, and health disparities as a whole. Studies on limited English proficiency patients (LEP) have focused on patient perspectives of office visits, however little is known about health care provider perspectives of medical visits using interpretive services. We aimed to develop a pragmatic brief questionnaire for assessing providers' views of the quality of communication in outpatient visits with patients with LEP. The questionnaire was validated in a cross-sectional study (n = 99) using principal component analyses (PCA) with oblimin rotation. Internal consistency was analyzed using Cronbach's alpha. RESULTS Based on theory and literature, a seven-item scale was developed that captures two relevant concepts: (1) Provider - patient interaction during the consultation and (2) perceived quality of translation. The questionnaire was used to assess 99 LEP consultations and demonstrated good feasibility in a clinical setting. PCA revealed the two theory-based components with good factor loadings and internal consistency of α = 0.77. These preliminary results indicate that the questionnaire provides medical professionals with a validated tool to evaluate LEP patient encounters. Further confirmatory validation of the Provider-assessed Quality of Consultations with Language Interpretation (PQC-LI) in larger samples is warranted.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA.
- Spectrum Health Family Medicine Residency Center, 25 Michigan St NE Suite 5100, Grand Rapids, MI, 49503, USA.
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Julie Ngo
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI, 49503, USA
- Spectrum Health Family Medicine Residency Center, 25 Michigan St NE Suite 5100, Grand Rapids, MI, 49503, USA
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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients. BMC Nephrol 2023; 24:383. [PMID: 38129771 PMCID: PMC10734071 DOI: 10.1186/s12882-023-03406-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Effective interpersonal communication is critical for shared decision-making (SDM). Previous SDM communication training in nephrology has lacked context-specific evidence from ethnographic analysis of SDM interactions with older patients considering treatment options of end stage kidney disease (ESKD). This study explores communication strategies in SDM discussions in nephrology, specifically focusing on older patients considering dialysis as kidney replacement therapy (KRT). METHODS We conducted a qualitative study analysing naturally-occurring audio-recorded clinical interactions (n = 12) between Australian kidney doctors, patients aged 60+, and carers. Linguistic ethnography and qualitative socially-oriented functional approaches were used for analysis. RESULTS Two types of communication strategies emerged: (1) Managing and advancing treatment decisions: involving active checking of knowledge, clear explanations of options, and local issue resolution. (2) Pulling back: Deferring or delaying decisions through mixed messaging. Specifically for non-English speaking patients, pulling back was further characterised by communication challenges deferring decision-making including ineffective issue management, and reliance on family as interpreters. Age was not an explicit topic of discussion among participants when it came to making decisions about KRT but was highly relevant to treatment decision-making. Doctors appeared reluctant to broach non-dialysis conservative management, even when it appears clinically appropriate. Conservative care, an alternative to KRT suitable for older patients with co-morbidities, was only explicitly discussed when prompted by patients or carers. CONCLUSIONS The findings highlight the impact of different communication strategies on SDM discussions in nephrology. This study calls for linguistic-informed contextualised communication training and provides foundational evidence for nephrology-specific communication skills training in SDM for KRT among older patients. There is urgent need for doctors to become confident and competent in discussing non-dialysis conservative management. Further international research should explore naturally-occurring SDM interactions in nephrology with other vulnerable groups to enhance evidence and training integration.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
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Grauman Å, Ancillotti M, Veldwijk J, Mascalzoni D. Precision cancer medicine and the doctor-patient relationship: a systematic review and narrative synthesis. BMC Med Inform Decis Mak 2023; 23:286. [PMID: 38098034 PMCID: PMC10722840 DOI: 10.1186/s12911-023-02395-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The implementation of precision medicine is likely to have a huge impact on clinical cancer care, while the doctor-patient relationship is a crucial aspect of cancer care that needs to be preserved. This systematic review aimed to map out perceptions and concerns regarding how the implementation of precision medicine will impact the doctor-patient relationship in cancer care so that threats against the doctor-patient relationship can be addressed. METHODS Electronic databases (Pubmed, Scopus, Web of Science, Social Science Premium Collection) were searched for articles published from January 2010 to December 2021, including qualitative, quantitative, and theoretical methods. Two reviewers completed title and abstract screening, full-text screening, and data extraction. Findings were summarized and explained using narrative synthesis. RESULTS Four themes were generated from the included articles (n = 35). Providing information addresses issues of information transmission and needs, and of complex concepts such as genetics and uncertainty. Making decisions in a trustful relationship addresses opacity issues, the role of trust, and and physicians' attitude towards the role of precision medicine tools in decision-making. Managing negative reactions of non-eligible patients addresses patients' unmet expectations of precision medicine. Conflicting roles in the blurry line between clinic and research addresses issues stemming from physicians' double role as doctors and researchers. CONCLUSIONS Many findings have previously been addressed in doctor-patient communication and clinical genetics. However, precision medicine adds complexity to these fields and further emphasizes the importance of clear communication on specific themes like the distinction between genomic and gene expression and patients' expectations about access, eligibility, effectiveness, and side effects of targeted therapies.
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Affiliation(s)
- Å Grauman
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - M Ancillotti
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - J Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - D Mascalzoni
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Panton J, Beaulieu-Jones BR, Marwaha JS, Woods AP, Nakikj D, Gehlenborg N, Brat GA. How surgeons use risk calculators and non-clinical factors for informed consent and shared decision making: A qualitative study. Am J Surg 2023; 226:660-667. [PMID: 37468387 PMCID: PMC10592325 DOI: 10.1016/j.amjsurg.2023.07.017] [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: 03/15/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The discussion of risks, benefits, and alternatives to surgery with patients is a defining component of informed consent. As shared-decision making has become central to surgeon-patient communication, risk calculators have emerged as a tool to aid communication and decision-making. To optimize informed consent, it is necessary to understand how surgeons assess and communicate risk, and the role of risk calculators in this process. METHODS We conducted interviews with 13 surgeons from two institutions to understand how surgeons assess risk, the role of risk calculators in decision-making, and how surgeons approach risk communication during informed consent. We performed a qualitative analysis of interviews based on SRQR guidelines. RESULTS Our analysis yielded insights regarding (a) the landscape and approach to obtaining surgical consent; (b) detailed perceptions regarding the value and design of assessing and communicating risk; and (c) practical considerations regarding the future of personalized risk communication in decision-making. Above all, we found that non-clinical factors such as health and risk literacy are changing how surgeons assess and communicate risk, which diverges from traditional risk calculators. CONCLUSION Principally, we found that surgeons incorporate a range of clinical and non-clinical factors to risk stratify patients and determine how to optimally frame and discuss risk with individual patients. We observed that surgeons' perception of risk communication, and the importance of eliciting patient preferences to direct shared-decision making, did not consistently align with patient priorities. This study underscored criticisms of risk calculators and novel decision-aids - which must be addressed prior to greater adoption.
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Affiliation(s)
- Jasmine Panton
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Jayson S Marwaha
- Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Alison P Woods
- Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Drashko Nakikj
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Gabriel A Brat
- Department of Surgery, Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
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Flynn AN, McAllister A, Kete C, Koelper NC, Gallop RJ, Schreiber CA, Schapira MM, Sonalkar S. Evaluation of a decision aid for early pregnancy loss: A pilot randomized controlled trial in Philadelphia, Pennsylvania. Contraception 2023; 125:110077. [PMID: 37270163 DOI: 10.1016/j.contraception.2023.110077] [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: 12/22/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate the effect of a decision aid on decisional conflict scale in patients choosing management for early pregnancy loss. STUDY DESIGN We conducted a pilot randomized control trial to assess the effect of the Healthwise patient decision aid on decisional conflict scale in patients with early pregnancy loss as compared with a control website. Patients 18years and older were eligible if they had an early pregnancy loss between 5 and 12 completed weeks of gestation. Participants completed surveys at baseline, poststudy intervention, after consultation, and 1week postconsultation. Surveys assessed participant scores on the decisional conflict scale (scale 0-100), knowledge, assessment of shared decision-making, satisfaction, and decision regret. Our primary outcome was the poststudy-intervention decisional conflict scale score. RESULTS From July 2020 through March 2021 we randomized 60 participants. After the intervention, the median decisional conflict scale score for the control group was 10 [0-30] and 0 [0-20] for the intervention group (p = 0.17). When assessing the decisional conflict scale subscales postintervention, the informed subscale for the control group was 16.7 [0-33.3] as opposed to 0 [0] for the patient decision aid group (p = 0.003). Knowledge remained significantly higher in the experimental arm from the postintervention to the 1-week follow-up. We found no differences between groups when assessing our other metrics. CONCLUSIONS Use of a validated decision aid did not result in statistically significant differences in the total decisional conflict scale scores as compared with the control. Participants allocated to the intervention were more informed postintervention and had consistently higher knowledge scores. IMPLICATIONS Use of a validated decision aid prior to early pregnancy loss management consultation did not affect overall decisional conflict but resulted in improved knowledge.
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Affiliation(s)
- Anne N Flynn
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Arden McAllister
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Corinne Kete
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nathanael C Koelper
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert J Gallop
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M Schapira
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarita Sonalkar
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Milan L, Doucène S, Lenoir G, Farsi F, Moumjid N, Blot F. [Facilitators and barriers to shared decision-making in France in 2021: National survey in cancer]. Bull Cancer 2023; 110:893-902. [PMID: 37355394 DOI: 10.1016/j.bulcan.2023.04.019] [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: 01/03/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Shared-decision making (SDM) combines clinical expertise of the healthcare professional with patient's knowledge, values and preferences. This survey explores from a patient perspective, the implementation, facilitators and barriers of SDM in oncology in France in 2021. PATIENTS AND METHODS From August to October 2021, the digital platform Cancer contribution conducted an online survey relayed by 11 patient associations. RESULTS Out of 916 responses, 727 were analyzed: 394 from patients with hematological malignancies [HM], 185 with breast cancer [BC], 93 with other solid tumors [ST] and 55 with multiple cancers [MC]. Among the participants, 47.2 % reported that they participated in a decision about their health management, with a significant variation according to the pathology (BC 43.8 %, HM 41.1 %, ST 57 %, MC 60 %, P=0.01), and regardless of age and gender. Two-thirds felt comfortable with the shared decision-making process, in relation with the time allocated and the information provided, regardless of the pathology. In addition, emotions, uncertainty and lack of information are the main reasons quoted by patients to explain their lack of ease in making a decision related to their health. CONCLUSIONS In this survey, less than half of the patients declared that they have been enrolled in a SDM approach, this rate varying according to the type of solid tumor or hematological malignancy. This study shows that to improve the implementation of SDM in routine clinical practice in cancer, sufficient time and use of decision aids are needed.
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Affiliation(s)
- Léna Milan
- Université Paris Cité, laboratoire de Psychopathologie et Processus de Santé, F-92100 Boulogne-Billancourt, France
| | - Sandra Doucène
- Association Cancer Contribution (www.cancercontribution.fr), 39, rue Camille-Desmoulins, 94800 Villejuif, France.
| | - Gilbert Lenoir
- Association Cancer Contribution (www.cancercontribution.fr), 39, rue Camille-Desmoulins, 94800 Villejuif, France
| | - Fadila Farsi
- Association Cancer Contribution, Réseau Régional de Cancérologie ONCO-AURA, CRLCC Léon-Bérard, 69373 Lyon, France
| | - Nora Moumjid
- Université Claude-Bernard Lyon 1, Centre Léon-Bérard ; Collaboration FREeDOM ; Parcours Santé systémique, UR 4129, Lyon, France
| | - François Blot
- Université Paris-Saclay - Gustave-Roussy cancer campus, Département interdisciplinaire d'organisation du parcours patient, comité d'éthique, Collaboration FREeDOM, 94805 Villejuif, France
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10
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Blot F, Fasse L, Mateus C, Renard P, Verotte N, de Jesus A, Dumont SN. [Implementation of a multimodal strategy for information and collection of advance directives in a comprehensive cancer center]. Bull Cancer 2023:S0007-4551(23)00133-9. [PMID: 36963998 DOI: 10.1016/j.bulcan.2023.02.017] [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: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION In France, advance directives (AD) remain unknown and underused by healthcare users and professionals. This is particularly true in oncology. This work was carried out with patients and caregivers of a Comprehensive Cancer Center to improve their appropriation and information. METHODS The project, built by the Ethics Committee, the Patients Committee and the Palliative Care Team, made it possible to develop over 6 months a training program, an information procedure and several original documents. RESULTS A total of 34 one-hour training courses for all professionals were organized. A procedure for making information available, including the right to draft ADs, has been implemented. This procedure is personalized, gradual and multi-professional. When a patient wishes to write his AD, he is accompanied by a dedicated team and benefits from a specific form, which enlighten values and preferences before addressing the desired level of therapeutic commitment. Communication elements were diffused, and a specific training on "anticipated discussions" was created. A dedicated space in the computerized chart makes it possible to locate the existence of ADs and to display them instantaneously. DISCUSSION - CONCLUSION: Based on the observation of the obstacles to the use of ADs, the strategy we implemented aims to provide information that is both efficient and ethically respectful for both patients and caregivers. ADs are only one element facilitating autonomy and anticipation, and must be associated with a shared continuous definition of the project and of the goals of care.
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Affiliation(s)
- François Blot
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Réanimation, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France.
| | - Léonor Fasse
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Unité de psycho-oncologie, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Christine Mateus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Perrine Renard
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Équipe mobile de soins palliatifs, département interdisciplinaire d'organisation du parcours patient, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Nelly Verotte
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction des affaires juridiques, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Anne de Jesus
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Direction de la qualité, relation avec les usagers, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
| | - Sarah N Dumont
- Comité d'éthique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France; Département de médecine oncologique, institut Gustave-Roussy, université Paris Saclay, Villejuif, France
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11
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Lanot A, Bechade C, Boyer A, Lobbedez T. Transitions between dialysis modalities. J Nephrol 2022; 35:2411-5. [PMID: 35849263 DOI: 10.1007/s40620-022-01397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
Thanks to the progress of dialysis, survival of patients with end-stage renal disease is increasing. For those patients who cannot benefit from a kidney transplantation, several dialysis alternatives exist, but the transition between dialysis techniques may be difficult. Home dialysis offers many advantages but requires personal commitment from the patients and the caregivers. How can we ensure smooth transitioning to the best dialysis technique at the right time for the right person? One of the main caveats of peritoneal dialysis is its limited technique survival, however, it combines the advantages of preserving residual kidney function, avoiding the need for a vascular access, or preserving it, when present, while providing good cost-effectiveness. On the other hand, home hemodialysis has excellent long-term technique survival. The home integrated model of peritoneal dialysis followed by home hemodialysis has been described as the ideal pathway of care. Eventually, in-center hemodialysis can be provided according to several schedules to adapt to the needs of the patients. The issue of technique survival and the possible need to switch to another technique should be part of the initial discussion, when the patient needs to choose the first dialysis modality. Unplanned transfers are associated with poor outcomes and unwanted shifts to in-center hemodialysis. Therefore, transfers from home-based techniques should be anticipated as much as possible in order to establish a shared decision modality process and to choose the desired new modality. Dialysis units dedicated to "transition care" should answer the needs of patients and smooth the transition process between dialysis modalities.
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12
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Daniels K, Rouppe van der Voort MBV, Biesma DH, van der Nat PB. Five years' experience with value-based quality improvement teams: the key factors to a successful implementation in hospital care. BMC Health Serv Res 2022; 22:1271. [PMID: 36266703 PMCID: PMC9585830 DOI: 10.1186/s12913-022-08563-5] [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] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background In recent years, value-based healthcare (VBHC) has become one of the most accepted concepts for fixing the ‘broken’ healthcare systems. Numerous hospitals have embraced VBHC and are trying to implement value-based quality improvement (VBQI) into their practice. However, there is a lack of knowledge on how to practically implement VBHC and organizations differ in their approach. The aim of this study was to explore the main factors that were experienced as hindering and/or supporting in the implementation of VBQI teams in hospital care. Methods A qualitative study was performed with semi-structured interviews with 43 members of eight VBQI teams in a large Dutch top-clinical teaching hospital. Participants included physicians, physician assistants, nurses, VBHC project leaders, managers, social workers, researchers and paramedics. Interview grids were structured according to the RE-AIM model (reach, effectiveness, adoption, implementation and maintenance). A thematic content analysis with open coding was used to identify emerging (sub)themes. Results We identified nine main factors divided over three domains (organization, culture and practice) that determined whether the implementation of VBQI teams was successful or not: 1). Practical organization of value-based quality improvement teams, 2). Organizational structure 3). Integration of VBHC with existing quality improvement approaches and research 4). Adoption and knowledge of the VBHC concept in the hospital 5). Multidisciplinary engagement 6). Medical leadership 7). Goal setting and selecting quality improvement initiatives 8). Long-cycle benchmarking and short-cycle feedback 9). Availability of outcome data. Conclusions Overall, this study goes beyond the general VBHC theory and provides healthcare providers with more detailed knowledge on how to practically implement value-based quality improvement in a hospital care setting. Factors in the ‘organization’ and ‘practice’ domain were mentioned in the strategic value agenda of Porter and Lee. Though, this study provides more practical insight in these two domains. Factors in the ‘culture’ domain were not mentioned in the strategic value agenda and have not yet been thoroughly researched before. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08563-5.
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Affiliation(s)
- Kirsten Daniels
- Department of Value-Based Healthcare, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein/Utrecht, the Netherlands. .,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.
| | - Marc B V Rouppe van der Voort
- Department of Value-Based Healthcare, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein/Utrecht, the Netherlands.,Department of Health Organisation, Policy and Economics, Faculty of Health Sciences, Maastricht University, Maastricht, the Netherlands
| | - Douwe H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Paul B van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein/Utrecht, the Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
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13
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Antel R, Abbasgholizadeh-Rahimi S, Guadagno E, Harley JM, Poenaru D. The use of artificial intelligence and virtual reality in doctor-patient risk communication: A scoping review. Patient Educ Couns 2022; 105:3038-3050. [PMID: 35725526 DOI: 10.1016/j.pec.2022.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/18/2021] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 05/14/2023]
Abstract
OBJECTIVES While the development of artificial intelligence (AI) and virtual reality (VR) technologies in medicine has been significant, their application to doctor-patient communication is limited. As communicating risk is a challenging, yet essential, component of shared decision-making (SDM) in surgery, this review aims to explore the current use of AI and VR in doctor-patient surgical risk communication. METHODS The search strategy was prepared by a medical librarian and run in 7 electronic databases. Articles were screened by a single reviewer. Included articles described the use of AI or VR applicable to surgical risk communication between patients, their families, and the surgical team. RESULTS From 4576 collected articles, 64 were included in this review. Identified applications included decision support tools (15, 23.4%), tailored patient information resources (13, 20.3%), treatment visualization tools (17, 26.6%) and communication training platforms (19, 29.7%). Overall, these technologies enhance risk communication and SDM, despite heterogeneity in evaluation methods. However, improvements in the usability and versatility of these interventions are needed. CONCLUSIONS There is emerging literature regarding applications of AI and VR to facilitate doctor-patient surgical risk communication. PRACTICE IMPLICATIONS AI and VR hold the potential to personalize doctor-patient surgical risk communication to individual patients and healthcare contexts.
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Affiliation(s)
- Ryan Antel
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
| | - Samira Abbasgholizadeh-Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Electrical and Computer Engineering Department, McGill University, Montreal, Canada.
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center and McGill University, Montreal, Canada.
| | - Jason M Harley
- Department of Experimental Surgery, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada; Institute for Health Sciences Education, McGill University, Montreal, Canada.
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center and McGill University, Montreal, Canada.
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14
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Vengalasetti YV, Narayan AK, Brown CA, Boakye-Ansa N, Strigel RM, Elezaby MA, Martin MD, Woods RW, Flores EJ, Miles RC. Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey. Acad Radiol 2022; 30:1101-1106. [PMID: 35965156 DOI: 10.1016/j.acra.2022.07.014] [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: 05/11/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. METHODS Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. RESULTS 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). CONCLUSION Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.
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Affiliation(s)
- Y V Vengalasetti
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - A K Narayan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - C A Brown
- School of Medicine, Meharry Medical College, Nashville, TN
| | - N Boakye-Ansa
- School of Medicine, Meharry Medical College, Nashville, TN
| | - R M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M A Elezaby
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M D Martin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - R W Woods
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - E J Flores
- Department of Radiology, Harvard Medical School, Harvard University, Boston, MA
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15
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Kongsakon R. The Road to Recovery for Patients with Depression: From Treatment Initiation to Treatment Continuity. Adv Ther 2022; 39:1-4. [PMID: 35247183 DOI: 10.1007/s12325-021-02027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/17/2021] [Indexed: 11/01/2022]
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16
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Behrens LL, Morgan B, Summerhayes E, Talwar S, Burshnic-Neal VL, Ersek M, Hodgson N. Feasibility and acceptability of a web-based advance care plan for dementia. Geriatr Nurs 2022; 44:251-8. [PMID: 35259603 DOI: 10.1016/j.gerinurse.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
While advance care planning (ACP) can help elicit preferences and is associated with improved end-of-life outcomes, persons living with dementia (PLWD) in nursing homes are rarely included in ACP. Web-based decision aids are a readily available tool to engage PLWD in ACP, but none are designed for the unique needs of PLWD, particularly those residing in nursing homes. Our Memory Care Wishes (OMCW) was adapted from a publicly available web-based ACP tool in collaboration with dementia care experts. This study aimed to explore the acceptability of OMCW. We used a convergent, mixed methods design to describe PLWD and surrogates' experiences using the OMCW website. Participants described ease of use, comfort with viewing, helpfulness for planning, and likelihood to recommend. Overall, OMCW is acceptable, however, PLWD continue to have difficulties understanding and engaging with some website content. Modifications were incorporated based on these findings, setting the stage for implementation and effectiveness testing.
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17
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Boucherie AS, Girault A, Berlingo L, Goffinet F, Le Ray C. Cesarean delivery on maternal request: How do French obstetricians feel about it? Eur J Obstet Gynecol Reprod Biol 2021; 269:84-9. [PMID: 34974210 DOI: 10.1016/j.ejogrb.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The number of cesarean deliveries on maternal request (CDMR) is unknown in France. We aimed to evaluate the rate of obstetricians willing to perform a CDMR in 2020 in Paris and to compare OB/GYN seniors' and residents' points of view about CDMR using six hypothetical clinical scenarios. STUDY DESIGN A survey was conducted between January to March 2020 with an anonymous self-administrated questionnaire sent by email to OB/GYN seniors working in 16 public and private maternity units and residents of Paris. Questionnaire was based on previous peer-reviewed literature. Socio professional characteristics were collected. OB/GYN seniors were asked if they agree to perform a CDMR and have already done one. OB/GYN seniors' and residents' points of view on six hypothetical clinical scenarios (CDMR, scarred uterus, breech presentation, multiple pregnancy, history of perineal tears or stillbirth) were compared. RESULTS Eighty-three OB/GYN seniors and one hundred and fifteen residents answered to our questionnaire. Twenty-three (27,7%) OB/GYN seniors were ready to perform a CDMR, mostly because they think that mode of delivery is a woman's choice. Physicians working in a private maternity unit or having an exclusive private practice were significantly more willing to perform a cesarean delivery on maternal request. No differences were found between the OB/GYN seniors' and residents' point of view on the six hypothetical clinical scenarios. A third of OB/GYN seniors and residents reported having done at least one CDMR during their career or during their residency. CONCLUSION One out of four OB/GYN senior interviewed is ready to perform a CDMR in Paris in 2020. OB/GYN seniors and residents share the same point of view concerning CDMR.
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18
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Abstract
PURPOSE OF REVIEW Present the value of a person-centered approach in diabetes management and review current evidence supporting its practice. RECENT FINDINGS Early evidence from glycemic control trials in diabetes resulted in most practice guidelines adopting a glucose-centric intensive approach for management of the disease, consistently relying on HbA1c as a marker of metabolic control and success. This paradigm has been recently dispelled by new evidence that shows that intensive glycemic control does not provide a significant benefit regarding patient-important microvascular and macrovascular hard outcomes when compared to moderate glycemic targets. The goals of diabetes therapy are to reduce the risks of acute and chronic complications and increase quality of life while incurring least burden of treatment and disruption to the patient's life. A person-centered approach to diabetes management is achieved through shared decision making, integration of evidence-based care and patient´s needs, values and preferences, and minimally disruptive approaches to diabetes care and at the same time offer practical guidance to clinicians and patients on achieving this type of care.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico.
- Endocrinology Division, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Av. Gonzalitos s/n, Mitras Centro, Monterrey, 64460, México.
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
| | - Juan Manuel Millan-Alanis
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Francisco J Barrera
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rozalina G McCoy
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN, 55905, USA
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19
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Manners D, Pettigrew S, Lake FR, Piccolo F, McWilliams AM, Brims FJH. Development and evaluation of a consumer information resource, including Patient Decision Aid, for lung cancer screening: a quasi-experimental study. Transl Behav Med 2021; 10:404-412. [PMID: 30855087 DOI: 10.1093/tbm/ibz029] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lung cancer screening of high-risk individuals with computed tomography is a promising intervention to reduce lung cancer mortality. Patient Decision Aids (PtDAs) may assist eligible individuals assess the risks and benefits associated with screening. Screening preference is high among lower-risk, screening-ineligible individuals and strategies are needed to reduce screening demand among this group. We developed and evaluated a resource comprising a recruitment pamphlet combined with either a PtDA for screening-eligible individuals or an education pamphlet for screening-ineligible individuals. Quasi-experimental pre-post pamphlet exposure design. Ever-smokers aged 55-80 years attending hospital outpatient clinics were invited. Among screening-eligible participants, the assessed outcome was change in score on the Decisional Conflict Scale (DCS). Among screening-ineligible participants, the assessed outcomes were change in screening preference. In the study 51% (55/107) of invited individuals participated, with mean ± standard deviation age 66.9 ± 6.4 years, 53% (29/55) male, and 65% (36/55) eligible for screening. Median (interquartile range) DCS among screening-eligible participants reduced from 28.9 (22.7-45.3) pre-PtDA to 25 (1.6-29.7) post-PtDA (p < .001), but there was no significant change in the proportion that reached the accepted threshold for decisional certainty (DCS < 25, 10/36 [28%] pre-exposure vs. 14/36 [39%] post-exposure, p = .1). Screening preference among screening-ineligible individuals reduced after viewing the screening-ineligible brochure (pre-exposure median of "Prefer" to post-exposure median of "Unsure," p = .001). Our consumer information pamphlets about lung cancer screening may reduce decisional conflict and improve alignment of screening preference with eligibility.
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Affiliation(s)
- David Manners
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.,Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Bentley, Western Australia, Australia
| | - Fiona R Lake
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Francesco Piccolo
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
| | - Annette M McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fraser J H Brims
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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20
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Lindig A, Hahlweg P, Christalle E, Giguere A, Härter M, von dem Knesebeck O, Scholl I. Translation and psychometric evaluation of the German version of the IcanSDM measure - a cross-sectional study among healthcare professionals. BMC Health Serv Res 2021; 21:541. [PMID: 34078373 DOI: 10.1186/s12913-021-06430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Shared decision-making (SDM) between patients and healthcare professionals (HCPs) is a key component of patient-centred care. To implement SDM in clinical practice and to evaluate its effects, it is helpful to know about HCPs’ perception of SDM barriers. The measure IcanSDM was developed in Canada and assesses the perception of SDM barriers. To our knowledge, no equivalent measure exists in German. Therefore, the aim of this study was to translate and adapt the IcanSDM measure to be used by a German speaking population and evaluate its psychometric properties. Methods This is a cross-sectional psychometric study based on a secondary analysis of baseline data from a SDM implementation study. The original 8-item IcanSDM was translated into German using a team translation protocol. We assessed comprehensibility via cognitive interviews with n = 11 HCPs. Based on results of cognitive interviews, the translated IcanSDM version was revised. Two hundred forty-two HCPs filled out the measure. Psychometric analysis included acceptance (completion rate), item characteristics (response distribution, skewness, item difficulties, corrected item-total correlations, inter-item correlations), factorial structure (confirmatory factor analysis (CFA), model fit), and internal consistency (Cronbach’s α). Results We translated and adapted the German IcanSDM successfully except for item 8, which had to be revised after the cognitive interviews. Completion rate was 98%. Skewness of the items ranged between −.797 and 1.25, item difficulties ranged between 21.63 and 70.85, corrected item-total-correlations ranged between .200 and .475, inter-item correlations ranged between .005 and .412. Different models based on CFA results did not provide a valid factorial structure. Cronbach’s α ranged between .563 and .651 for different factor models. Conclusion We provide the first German measure for assessing perception of SDM barriers by HCPs. The German IcanSDM is a brief measure with good acceptance. However, we found unsatisfying psychometric properties, which were comparable to results of the original scale. In a next step, the IcanSDM should be further developed and modified and predictive validity should be evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06430-3.
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21
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Nuis RJ, Jadoon A, van Dalen BM, Dulfer K, Snelder SM, Yazdi MT, Masdjedi K, den Dekker WK, Diletti R, Wilschut J, Daemen J, Lenzen MJ, Zijlstra F, Smits PC, Van Mieghem NM. Patient perspectives on left main stem revascularization strategies, the OPINION-2 study. J Cardiol 2020; 77:271-278. [PMID: 33041162 DOI: 10.1016/j.jjcc.2020.09.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Treatment preferences in patients with left main (LM) stem disease and no prior revascularization are unknown. The objectives of this study were to determine (i) patient-reported importance ratings of particular features related to percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery, (ii) how these features determine treatment preference, and (iii) how educational and psychosocial background influence this preference. METHODS In this prospective, multicenter study a total of 500 patients without previous revascularization who underwent diagnostic angiography for suspected coronary disease were asked to complete a case-vignette on a (hypothetical) LM stenosis qualifying for both PCI and CABG, in addition to 6 validated questionnaires to assess the influence of psychosocial factors on treatment preference. RESULTS Overall, 90% favored PCI over CABG because of the lower bleeding and stroke risk despite a higher likelihood for repeat revascularization. By multivariable regression, the only independent determinant of treatment preference for CABG was lower educational level (14% in low vs. 8% in higher educated patients, OR: 3.22, CI: 1.16-8.95, p=0.025) while psychosocial variables were not associated. Compared to higher educated patients, those with lower educational level suffered more from depression, anxiety, loneliness, and uncertainty. CONCLUSIONS Overall, patients who are informed about risk and benefits of each treatment modality clearly favor PCI over CABG and particularly value lower short-term morbidity while being aware of higher risk of repeat revascularization. Lower educational level was associated with a higher prevalence of psychosomatic phenotypes and a 14% preference for CABG. Educational and psychosocial background matter in the revascularization strategy decision-making process.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Adeel Jadoon
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Department of Paediatrics and Paediatric Surgery, Intensive Care Unit, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Mehrdad Talebian Yazdi
- Department of Cardiology, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wijnand K den Dekker
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract
Bilateral gonadectomy was the historical recommendation for patients diagnosed with complete androgen insensitivity syndrome (CAIS) due to the perceived risk of malignancy in the gonads. However, new shared-decision making approaches are allowing patients to explore the option to defer surgery. Here we report two patients who presented with primary amenorrhea to their primary care provider (PCP). After imaging and karyotyping, these patients were diagnosed with CAIS. They underwent exams under anesthesia and diagnostic laparoscopies in which the gonads did not present any immediate concerns or indications for removal. After discussing their options using the shared-decision making approach with the differences in sex development (DSD) team, they opted to defer gonadectomy and follow up annually with imaging to monitor the gonads.
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Affiliation(s)
| | | | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
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23
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Giardina JC, Cha T, Atlas SJ, Barry MJ, Freiberg AA, Leavitt L, Marques F, Sepucha K. Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data. BMC Med Inform Decis Mak 2020; 20:187. [PMID: 32787849 PMCID: PMC7425151 DOI: 10.1186/s12911-020-01175-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/14/2019] [Accepted: 07/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background Determining the primary indication of a surgical procedure can be useful in identifying patients undergoing elective surgery where shared decision-making is recommended. The purpose of this study was to develop and validate an algorithm to identify patients receiving the following combinations of surgical procedure and primary indication as part of a study to promote shared decision-making: (1) knee arthroplasty to treat knee osteoarthritis (KOA); (2) hip arthroplasty to treat hip osteoarthritis (HOA); (3) spinal surgery to treat lumbar spinal stenosis (SpS); and (4) spinal surgery to treat lumbar herniated disc (HD). Methods Consecutive surgical procedures performed by participating spine, hip, and knee surgeons at four sites within an integrated care network were included. Study staff reviewed electronic medical records to ascertain a “gold standard” determination of the procedure and primary indication status. Electronic algorithms consisting of ICD-10 and CPT codes for each combination of procedure and indication were then applied to records for each case. The primary measures of validity for the algorithms were the sensitivity and specificity relative to the gold standard review. Results Participating surgeons performed 790 procedures included in this study. The sensitivity of the algorithms in determining whether a surgical case represented one of the combinations of procedure and primary indication ranged from 0.70 (HD) to 0.92 (KOA). The specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA). Conclusion The electronic algorithm was able to identify all four procedure/primary indication combinations of interest with high specificity. Additionally, the sensitivity for the KOA cases was reasonably high. For HOA and the spine conditions, additional work is needed to improve the sensitivity of the algorithm to identify the primary indication for each case.
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Affiliation(s)
- John C Giardina
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
| | - Thomas Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Barry
- Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew A Freiberg
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Felisha Marques
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Sepucha
- Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Martin FE, Kalsi T, Baker H, Bharathan R, Sbai M, Partridge JSL, Dhesi JK. Functional recovery in older women undergoing surgery for gynaecological malignancies: A systematic review and narrative synthesis. J Geriatr Oncol 2020; 11:1087-1095. [PMID: 32601003 DOI: 10.1016/j.jgo.2020.06.006] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. This systematic review and narrative synthesis describes functional recovery after gynaeoncology surgery with respect to baseline characteristics. MATERIALS AND METHODS Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974 to 2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria: Results analysed and presented using narrative synthesis. RESULTS Fifteen studies identified (8 Endometrial, 2 Ovarian, 2 Vulval, 3 mixed cancer types). 1/15 used a standalone functional assessment tool, 14/15 used Health-Related Quality of Life tools (EORTC QLQ C30 (8), FACT-G (3), SF-36 (3)) comprising items describing function. More studies showed full recovery to baseline (n = 13) than incomplete recovery (n = 2). Four studies reported a negative association between older age and functional trajectory. Recovery was more likely and occurred faster in minimally-invasive surgery. Few studies reported baseline characteristics including cognition, frailty or comorbidities and none examined associations with functional recovery. CONCLUSION There is inadequate data on functional recovery of older women following gynaeoncology surgery. Future studies are needed to identify factors associated with poorer/better outcomes. This may enable identification of opportunities for risk reduction, improve equity of access and better shared-decision making.
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Affiliation(s)
- Fionna E Martin
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - Tania Kalsi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Primary Care and Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Holly Baker
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Rasiah Bharathan
- Department of Gynaecological Oncology, Leicester University Hospitals NHS Trust, Leicester, UK
| | - Magda Sbai
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Judith S L Partridge
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Primary Care and Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Jugdeep K Dhesi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's & St Thomas' NHS Foundation Trust, London, UK; Division of Primary Care and Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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25
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van Egdom LSE, de Kock MA, Apon I, Mureau MAM, Verhoef C, Hazelzet JA, Koppert LB. Patient-Reported Outcome Measures may optimize shared decision-making for cancer risk management in BRCA mutation carriers. Breast Cancer 2019; 27:426-434. [PMID: 31832891 PMCID: PMC7196093 DOI: 10.1007/s12282-019-01033-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/12/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022]
Abstract
Purpose The aim of this study was to compare patient-reported outcomes (PROs) of BRCA1/2 mutation carriers, either after bilateral prophylactic mastectomy (BPM) or during breast surveillance, to improve shared decision-making in their cancer risk management. Methods Unaffected BRCA1/2 mutation carriers at least one year after BPM followed by immediate breast reconstruction (BPM-IBR) or one year under surveillance were eligible. After informed consent, the Hospital Anxiety and Depression Scale (HADS) and BREAST-Q were administered and compared between the different strategies. PROs were also compared to available normative data. Results Ninety-six participants were analyzed in this study and showed significant differences between strategies in age, age at genetic testing, and time since BPM or starting breast surveillance. All HADS scores were below 8 suggesting no signs of anxiety or depression in both groups. Higher mean ‘Q-physical well-being’ scores were reported by the surveillance group (81.78 [CI 76.99–86.57]) than the BPM group (76.96 [CI 73.16 – 80.75]; p = 0.011). Overall, for both questionnaires better scores were seen when compared to age-matched normative data. Conclusions No signs of anxiety or depression were seen in the surveillance or BPM-IBR group. Slightly better mean BREAST-Q scores were seen for the surveillance group in comparison to BPM-IBR, except for ‘Q-psychological well-being’. The difference in ‘Q-physical well-being’ was significantly worse for BPM-IBR. Approaches to obtain longitudinal PROs and reference values should be explored in the future, which could add value to shared decision-making in regards to breast cancer risk management in this specific patient population.
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Affiliation(s)
- L S E van Egdom
- Department of Surgical Oncology, RG-228, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, P.O. 2040, 3000 CA, Rotterdam, The Netherlands
| | - M A de Kock
- Department of Surgical Oncology, RG-228, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, P.O. 2040, 3000 CA, Rotterdam, The Netherlands
| | - I Apon
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgical Oncology, RG-228, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, P.O. 2040, 3000 CA, Rotterdam, The Netherlands
| | - J A Hazelzet
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, RG-228, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, P.O. 2040, 3000 CA, Rotterdam, The Netherlands.
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26
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De Kleermaeker FGCM, Uitdehaag BMJ, van Oosten BW. Patients' expectations of autologous hematopoietic stem cell transplantation as a treatment for MS. Mult Scler Relat Disord 2019; 37:101467. [PMID: 31678857 DOI: 10.1016/j.msard.2019.101467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/05/2018] [Revised: 08/13/2019] [Accepted: 10/22/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (aHSCT) receives increasing attention as a treatment option for MS. However, as there are no randomized controlled trials comparing aHSCT to best medical treatment as yet, aHSCT is not generally advised and implemented as a treatment option for MS. Neurologists are increasingly faced with patients asking questions regarding aHSCT and seeking commercially offered aHSCT abroad. The aim of this study is to evaluate MS patients' knowledge and expectations of aHSCT and their actual and desired sources of information. METHODS 137 MS patients visiting the Amsterdam University Medical Center MS clinic, completed a self-developed questionnaire with items on disease history, knowledge about aHSCT, expectations of aHSCT, information sources and the role they assign to their neurologists. RESULTS Fifty-four percent is considering aHSCT either now or in the future, especially those who are dissatisfied with current treatment, have a shorter disease duration (≤ 10 years) or are more disabled (EDSS > 3.5). Only 25% report to have sufficient knowledge about aHSCT. Patients mainly use potentially unreliable information sources such as the internet and television, although they prefer information from their neurologist. Half of the patients think aHSCT to be superior to highly effective DMT. Expectations of efficacy in patients interested in aHSCT are significantly higher than in patients not wanting to undergo aHSCT. Only about one third of patients are able to mention at least one side effect. CONCLUSION Many MS patients are considering aHSCT as a treatment option, although they think that they are not well-informed regarding aHSCT. They prefer their neurologist as a source of information. Therefore, neurologists should pro-actively inform their patients about the potential benefits and risks of aHSCT to enable them to choose the best treatment option.
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Affiliation(s)
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Amsterdam UMC, location VUmc, Department of Neurology, Amsterdam, The Netherlands.
| | - Bob W van Oosten
- MS Center Amsterdam, Amsterdam UMC, location VUmc, Department of Neurology, Amsterdam, The Netherlands.
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27
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Semple CJ, Rutherford H, Killough S, Moore C, McKenna G. Long-term impact of living with an obturator following a maxillectomy: A qualitative study. J Dent 2019; 90:103212. [PMID: 31618671 DOI: 10.1016/j.jdent.2019.103212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore the long-term impact for patients living with an obturator prosthesis, following a maxillectomy for a head and neck neoplasm. METHODS A qualitative approach was employed, using semi-structured interviews. A purposive sample of eight men and four women, living with an obturator prosthesis for at least five years, were recruited. Interviews were digitally recorded and transcribed. Using thematic analysis, two researchers analysed the data. RESULTS The data were categorised into four themes: 1. Preparedness for living with an obturator, 2. Impact of living with an obturator - what changes to expect, 3. Stability and retention of the obturator, and 4. Coping strategies to aid adjustment. Long-term effects of living with an obturator spanned many aspects of life to include: chewing and eating, speaking, dealing with nasal leakage and altered body image, employment and intimacy issues, along with embarrassment during social encounters. Optimal retention and stability of the obturator, as perceived by the patient, lead to improved social confidence and engagement. The emotional impact varied greatly on peoples' lives. CONCLUSIONS Patients experiencing the greatest long-term challenges had larger defects, were of employment age and had not returned to work. Gaining an improved understanding of the psychology of coping overtime is clearly important, as this can inform interventions to facilitate adjustment for those who are emotionally struggling. Furthermore, the findings of this study could inform the design of a communication tool to facilitate shared-decision making and aid preparedness for living with an obturator following a maxillectomy. CLINICAL SIGNIFICANCE The multidisciplinary head and neck team should provide patients with detailed pre-operative information, including potential effects on social, work and personal relationships. The restorative dentistry team has a pivotal role in the long-term management of these patients, as obturators have a finite lifespan with ongoing maintenance necessary to promote optimal retention and stability.
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Affiliation(s)
- Cherith J Semple
- Institute of Nursing and Health Research, School of Nursing, Ulster University/SEHSCT, Belfast, United Kingdom.
| | | | | | | | - Gerry McKenna
- Centre for Public Health, Queen's University Belfast, United Kingdom; College of Medicine and Health, University College Cork, Ireland
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28
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Huang RC, Song XT, Zhang DF, Xu JY, Boehmer KR, Leppin AA, Gionfriddo MR, Ting HH, Montori VM. Preferences and attitudes of young Chinese clinicians about using a shared decision making tools for communicating cardiovascular risk. Chronic Dis Transl Med 2019; 5:105-112. [PMID: 31367699 PMCID: PMC6656904 DOI: 10.1016/j.cdtm.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM). METHODS From May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann-Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario. RESULTS Of the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM. CONCLUSIONS Most young Chinese clinicians want to participate in SDM. However, they state the main barriers to perform SDM are lack of experience and time. The educational intervention about SDM that exposes clinicians to DAs was found to increase their receptivity.
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Affiliation(s)
- Rong-Chong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Dong-Feng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jia-Ying Xu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Kasey R. Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55902, USA
| | - Aaron A. Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55902, USA
| | - Michael R. Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55902, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN 55902, USA
| | - Henry H. Ting
- Division of Cardiology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55902, USA
- Division of Endocrinology, Mayo Clinic, Rochester, MN 55902, USA
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29
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Hurley EA, Bradley-Ewing A, Bickford C, Lee BR, Myers AL, Newland JG, Goggin K. Measuring shared decision-making in the pediatric outpatient setting: Psychometric performance of the SDM-Q-9 and CollaboRATE among English and Spanish speaking parents in the US Midwest. Patient Educ Couns 2019; 102:742-748. [PMID: 30448047 DOI: 10.1016/j.pec.2018.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/12/2018] [Revised: 09/21/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) measures have never been assessed for validity and feasibility in pediatric outpatient settings. We compared psychometric performance of parent adaptations of a well-established measure (SDM-Q-9) to a newer measure focusing on provider effort in facilitating SDM (CollaboRATE) in two clinics. METHODS English (n = 955) and Spanish (n = 58) speaking parents of children ages 1-5 years with symptoms of acute respiratory tract infections (ARTI) completed post-visit SDM-Q-9, CollaboRATE, satisfaction items (visit, provider communication, and study participation), and qualitative feedback. RESULTS Parents felt CollaboRATE was more comprehensible and relevant than SDM-Q-9, which refers to decision-making actions difficult to define in ARTI visits. Among English-speakers, both measures showed high internal consistency (α = 0.91, α = 0.97). SDM-Q-9 reliability was strong (split-half, r = 0.83) and CollaboRATE weak-to-moderate (two-week test-retest, ρ = 0.41-0.66). Convergent validity with communication and visit satisfaction was poor for SDM-Q-9 (r=0.38, r=0.34) but higher for CollaboRATE (r=0.59, r = 0.52). Both showed divergent validity with study participation satisfaction (r=0.08, r=0.13). Spanish versions demonstrated similar results. CONCLUSIONS Parent preference and correlations with satisfaction support CollaboRATE over SDM-Q-9, however psychometrics were borderline acceptable. PRACTICE IMPLICATIONS Tools like CollaboRATE that focus on provider effort appear more appropriate for routine pediatric visits where SDM outcomes may be difficult to identify, yet additional validation research is needed.
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Affiliation(s)
- Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, USA.
| | - Andrea Bradley-Ewing
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, USA
| | - Carey Bickford
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, USA
| | - Brian R Lee
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, USA; University of Missouri - Kansas City School of Medicine, Kansas City, USA
| | - Angela L Myers
- University of Missouri - Kansas City School of Medicine, Kansas City, USA; Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, USA
| | - Jason G Newland
- Pediatric Infectious Disease, St. Louis Children's Hospital, St. Louis, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, USA; University of Missouri - Kansas City School of Medicine, Kansas City, USA; University of Missouri - Kansas City School of Pharmacy, Kansas City, USA
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30
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Dams OC, van den Akker-Scheek I, Diercks RL, Wendt KW, Bosma E, van Raaij TM, Munzebrock AV, Zijlstra WP, Zwerver J, Reininga IHF. The recovery after Achilles tendon rupture: a protocol for a multicenter prospective cohort study. BMC Musculoskelet Disord 2019; 20:69. [PMID: 30744626 PMCID: PMC6371453 DOI: 10.1186/s12891-019-2437-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs. The primary aim of this study is to give a broad insight into the recovery after ATR. Secondarily this study aims to explore factors contributing to recovery and gain insight into the cost-effectiveness of ATR management. METHODS This multicenter prospective cohort study will include all adult (≥ 18 years) patients with an ATR treated at the three main hospitals in the Northern Netherlands: University Medical Center Groningen, Martini Hospital Groningen and Medical Center Leeuwarden. All subjects will be invited for three visits at 3, 6 and 12 months post-injury. The following data will be collected: patient-reported outcome measures (PROMs), physical tests, imaging and economic questionnaires. At 3 months post-injury personal, injury, and treatment data will be collected through a baseline questionnaire and assessment of the medical file. The PROMs concern the Dutch version of the Achilles Tendon Total Rupture Score, EQ-5D-5 L, Oslo Sport Trauma Research Center Overuse Injury Questionnaire, Injury Psychological Readiness Return to Sport Scale, Tampa Scale of Kinesiophobia, Expectations, Motivation and Satisfaction questionnaire and a ranking of reasons for not returning to sport. The administered physical tests are the heel-rise test, standing dorsiflexion range of motion, resting tendon length and single leg hop for distance. Ultrasound Tissue Characterization will be used for imaging. Finally, economic data will be collected using the Productivity Cost Questionnaire and Medical Consumption Questionnaire. DISCUSSION This prospective cohort study will contribute to optimal decision making in the primary treatment and rehabilitation of ATRs by providing insight into (1) ATR recovery (2) novel imaging for monitoring recovery (3) (barriers to) return to sport and (4) cost-effectiveness of management. The analysis of these data strives to give a broad insight into the recovery after ATR as well as provide data on novel imaging and costs, contributing to individualized ATR management. TRIAL REGISTRATION Trialregister.nl. NTR6484 . 20/06/2017. 20/07/2017.
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Affiliation(s)
- Olivier C Dams
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaus W Wendt
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelke Bosma
- Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Tom M van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Arvid V Munzebrock
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johannes Zwerver
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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31
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Rawson TM, Moore LSP, Castro-Sanchez E, Charani E, Hernandez B, Alividza V, Husson F, Toumazou C, Ahmad R, Georgiou P, Holmes AH. Development of a patient-centred intervention to improve knowledge and understanding of antibiotic therapy in secondary care. Antimicrob Resist Infect Control 2018; 7:43. [PMID: 29568516 PMCID: PMC5859655 DOI: 10.1186/s13756-018-0333-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/17/2018] [Accepted: 03/07/2018] [Indexed: 11/25/2022] Open
Abstract
Background We developed a personalised antimicrobial information module co-designed with patients. This study aimed to evaluate the potential impact of this patient-centred intervention on short-term knowledge and understanding of antimicrobial therapy in secondary care. Methods Thirty previous patients who had received antibiotics in hospital within 12 months were recruited to co-design an intervention to promote patient engagement with infection management. Two workshops, containing five focus-groups were held. These were audio-recorded. Data were analysed using a thematic framework developed deductively based on previous work. Line-by-line coding was performed with new themes added to the framework by two researchers. This was used to inform the development of a patient information module, embedded within an electronic decision support tool (CDSS). The intervention was piloted over a four-week period at Imperial College Healthcare NHS Trust on 30 in-patients. Pre- and post-intervention questionnaires were developed and implemented to assess short term changes in patient knowledge and understanding and provide feedback on the intervention. Data were analysed using SPSS and NVIVO software. Results Within the workshops, there was consistency in identified themes. The participants agreed upon and co-designed a personalised PDF document that could be integrated into an electronic CDSS to be used by healthcare professionals at the point-of-care. Their aim for the tool was to provide individualised practical information, signpost to reputable information sources, and enhance communication between patients and healthcare professionals. Eighteen out of thirty in-patients consented to participant in the pilot evaluation with 15/18(83%) completing the study. Median (range) age was 66(22–85) years. The majority were male (10/15;66%). Pre-intervention, patients reported desiring further information regarding their infections and antibiotic therapy, including side effects of treatment. Deployment of the intervention improved short term knowledge and understanding of individuals infections and antibiotic management with median (IQR) scores improving from 3(2–5)/13 to 10(6–11)/13. 13/15(87%) reported that they would use the intervention again. Conclusion A personalised, patient-centred intervention improved understanding and short-term knowledge of infections and antibiotic therapy in participating patients’. Long term impact on attitudes and behaviours post discharge will be further investigated. Electronic supplementary material The online version of this article (10.1186/s13756-018-0333-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy M Rawson
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK.,2Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS UK
| | - Luke S P Moore
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK.,2Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS UK.,3Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
| | - Enrique Castro-Sanchez
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Esmita Charani
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Bernard Hernandez
- 4Centre for Bio-Inspired Technology, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ UK
| | - Vivian Alividza
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Fran Husson
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Christofer Toumazou
- 4Centre for Bio-Inspired Technology, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ UK
| | - Raheelah Ahmad
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK
| | - Pantelis Georgiou
- 4Centre for Bio-Inspired Technology, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ UK
| | - Alison H Holmes
- 1National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN UK.,3Chelsea & Westminster Hospital, 369 Fulham Rd, Chelsea, London, SW10 9NH UK
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Brandi K, Woodhams E, White KO, Mehta PK. An exploration of perceived contraceptive coercion at the time of abortion. Contraception 2017; 97:329-334. [PMID: 29253582 DOI: 10.1016/j.contraception.2017.12.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore patient experiences of contraceptive coercion by healthcare providers at time of abortion. STUDY DESIGN We conducted a qualitative study of English-speaking women seeking abortion services at a hospital-based clinic. We used the Integrated Behavioral Model and the Reproductive Autonomy Scale to inform our semi-structured interview guide; the Scale provides a framework of reproductive coercion as a lack of autonomy or power to decide about and control decisions relating to reproduction. We enrolled participants until thematic saturation was achieved. Two coders used modified grounded theory to analyze transcribed interviews with Nvivo 11.0 (Κ=0.81). RESULTS The 31 women we interviewed from June 2016 to March 2017 were all in the first trimester, and predominantly young (mean age 27±5 years), non-Hispanic Black (52%) and Medicaid-insured (68%). Some participants (42%) reported feeling "pressured" into choosing some form of contraception. A subset of participants (26%) voiced that providers seemed to prefer LARC methods or were "pushing" a specific method. Several participants perceived pressure to choose any method due to providers' preference to prevent repeat abortions. Conversely, participants who were offered a range of methods through the use of decision aids and who were given time to deliberate demonstrated more reproductive autonomy. CONCLUSIONS Almost half of participants perceived a form of coercion around their contraceptive counseling. Coercion manifested in perceived provider preference for specific methods or immediate initiation of a method. Participant narratives involving decision aids to offer a range of methods and time for deliberation demonstrated greater reproductive autonomy and less coercion. Abortion stigma may mediate potentially coercive interactions between patients and providers. IMPLICATIONS This qualitative study explored contraceptive coercion at the time of abortion. Findings highlighted provider pressure to initiate contraception, LARC preference, and abortion stigma. Offering many methods and opportunity for deliberation supported autonomy and satisfaction. Findings inform ongoing efforts to improve contraceptive counseling and promote reproductive autonomy, while addressing unintended pregnancies.
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Affiliation(s)
- Kristyn Brandi
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, 850 Harrison Avenue YACC-5, Boston, MA, USA 02118.
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, 850 Harrison Avenue YACC-5, Boston, MA, USA 02118.
| | - Katharine O White
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, 850 Harrison Avenue YACC-5, Boston, MA, USA 02118.
| | - Pooja K Mehta
- Department of Obstetrics and Gynecology, Boston Medical Center/Boston University School of Medicine, 850 Harrison Avenue YACC-5, Boston, MA, USA 02118.
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Raval MV, Taylor N, Piper K, Thakore M, Hoff K, Owens S, Durham MM. Pediatric Patient and Caregiver Preferences in the Development of a Mobile Health Application for Management of Surgical Colorectal Conditions. J Med Syst 2017; 41:105. [PMID: 28540617 DOI: 10.1007/s10916-017-0750-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
Patient-centered frameworks are an effective way to engage patients in treatment plans, strengthen adherence behaviors, and improve disease outcomes. These frameworks can also be applied in the design of mobile technology disease management applications. However, the utilization of these frameworks is rare and frequently overlooked in existing colorectal mobile health (mHealth) applications. The purpose of this study was to utilize a patient-centered framework to facilitate the development of a valid, appropriate, and feasible mHealth tool for pediatric patients and their caregivers. To inform application design and production, in-depth interviews were conducted with pediatric patients and their caregivers to capture management experiences, application preferences, and barriers and facilitators to application use. Patient ages ranged from 3 to 16. Six caregivers and 2 adolescent patients participated in the interviews. Patients and caregivers reported various management styles and desired an application that is not only user-friendly and customizable, but also able to facilitate communication and information sharing with other patients, caregivers, and providers. Older patients also wanted the application to give them more independence in managing their disease. Employing patient-centered frameworks is context-specific, but holds much promise at the intersection of mobile technology and healthcare. By incorporating pediatric patient experiences and viewpoints, we identified important components for inclusion in a mHealth surgical colorectal disease management application. Patients and caregivers wanted a mHealth application that was unique to their needs and easy to use. They suggested that the application include treatment tracking, note taking, and provider communication features.
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Main BG, McNair AGK, Huxtable R, Donovan JL, Thomas SJ, Kinnersley P, Blazeby JM. Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians. BMC Med Ethics 2017; 18:29. [PMID: 28446164 PMCID: PMC5406972 DOI: 10.1186/s12910-017-0188-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/09/2016] [Accepted: 04/14/2017] [Indexed: 11/17/2022] Open
Abstract
Background Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. Main body The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. Conclusion The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice.
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Affiliation(s)
- Barry G Main
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. .,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK.
| | - Angus G K McNair
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Richard Huxtable
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jenny L Donovan
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Steven J Thomas
- School of Oral and Dental Sciences, University of Bristol, Bristol, BS1 2LY, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
| | - Paul Kinnersley
- Centre for Medical Education, University of Cardiff, Cardiff, CF14 4YU, UK
| | - Jane M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW, UK
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Lederer S, Fischer MJ, Gordon HS, Wadhwa A, Popli S, Gordon EJ. A question prompt sheet for adult patients with chronic kidney disease. BMC Nephrol 2016; 17:155. [PMID: 27760524 PMCID: PMC5070305 DOI: 10.1186/s12882-016-0362-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 01/08/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023] Open
Abstract
Background Patients with chronic kidney disease (CKD) commonly have unmet information needs. Greater patient participation in healthcare discussions can address these needs and improve health outcomes. We developed a patient-centered question prompt sheet (QPS) to engage CKD patients in healthcare conversations. Methods We conducted a two phase, mixed-methods, cross-sectional study involving semi-structured telephone interviews. Patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, on dialysis, or with a kidney transplant were recruited from one Veterans Affairs (VA) nephrology clinic. Phase 1 interviews included open-ended questions assessing patients’ CKD-related information needs and generated a preliminary 67-item QPS. Phase 2 interview participants rated the importance of asking each question on a 5-point Likert scale and provided open-ended feedback. All participants rated their willingness to use a CKD-QPS. Input from patient ratings, a multidisciplinary team, and from members of the National Kidney Disease Education Program (NKDEP) Coordinating Panel helped to shorten and refine the QPS. A qualitative thematic approach was used to analyze open-ended responses. Quantitative data were analyzed for means and proportions. Results Eighty-five patients participated. Most were male (97 %), non-Hispanic white (71 %), and mean age was 67 years. Patients desired more information about CKD, particularly dialysis/transplant, and the relationship between CKD and comorbid medical conditions. The final QPS included 31-questions divided into 7 CKD subtopics. Most patients (88 %) reported being ‘completely’ or ‘very’ willing to use a CKD-QPS in future doctor visits. Conclusions CKD patients have unmet information needs. We developed a QPS to engage CKD patients in healthcare discussions and to facilitate patient-centered care. Future research should assess whether the CKD-QPS addresses patients’ information needs, enhances doctor-patient communication, and improves health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0362-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Swati Lederer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA.,Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Michael J Fischer
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA.,Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Howard S Gordon
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA.,Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Anuradha Wadhwa
- Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Loyola University Medical Center, Maywood, IL, USA
| | - Subhash Popli
- Department of Medicine, Edward Hines Jr. VA Hospital, Hines, IL, USA.,Loyola University Medical Center, Maywood, IL, USA
| | - Elisa J Gordon
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA. .,Center for Healthcare Studies, and Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.
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Silverstein W, Lass E, Born K, Morinville A, Levinson W, Tannenbaum C. A survey of primary care patients' readiness to engage in the de-adoption practices recommended by Choosing Wisely Canada. BMC Res Notes 2016; 9:301. [PMID: 27286651 PMCID: PMC4902938 DOI: 10.1186/s13104-016-2103-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 01/24/2016] [Accepted: 05/26/2016] [Indexed: 12/01/2022] Open
Abstract
Background Strategies such as Choosing Wisely have been established to identify the overuse of interventions considered as low-value. Reduction of low-value practices will require patients to understand why certain interventions are no longer recommended. The objective of this study was to determine whether older adults accept the rationale for and perceive themselves ready to de-adopt annual electrocardiogram testing, imaging for low back pain, the use of antibiotics for sinusitis, the use of sedative-hypnotics for insomnia, and the use of antipsychotics to treat behavioural symptoms of dementia. Methods A self-administered iPad survey was distributed to consecutive patients aged 50 years and older, presenting to three primary care outpatient practices in Ontario, Canada. Data from patients who were able and willing to complete the survey while waiting to see their physician were included. The survey queried knowledge, attitudes and behaviours around the targeted low-value interventions, before and after exposure to a Choosing Wisely Canada patient educational brochure on one of these five topics. A subset of patients agreed to participate in a semi-structured interview after their clinic visit. Results Three-hundred and forty-four patients (mean age 63, range 50–88, 59 % female) read the materials and completed the survey. Forty-eight percent (95 % CI 43–53 %) intended to discuss the information with a healthcare provider. Forty-five percent (95 % CI 40–51 %) expressed a desire to change current low-value practices. Approximately two-thirds of those who indicated they would not change future behaviours explained that it was because they were already espousing the Choosing Wisely values. After reading the Choosing Wisely brochures, knowledge improved independent of age, sex and education in 48 % (95 % CI 38–57 %) of participants about electrocardiogram testing, in 74 % (95 % CI 65–82 %) about use of antipsychotics, in 66 % (95 % CI 52–78 %) about use of antibiotics for sinusitis, in 60 % (95 % CI 46–72 %) about imaging for low back pain, and in 40 % (95 % CI 26–55 %) about sedative-hypnotic use in the elderly. Conclusions The majority of primary care patients seem ready to de-adopt low-value practices. Provision of education in clinic waiting rooms can help improve knowledge around unnecessary care.
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Affiliation(s)
- William Silverstein
- Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Elliot Lass
- Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Karen Born
- Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Anne Morinville
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Wendy Levinson
- Faculty of Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Cara Tannenbaum
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Faculties of Medicine and Pharmacy, Université de Montréal, Montréal, QC, Canada
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Abstract
Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider-patient relationship to blossom and helps in clearing patients' doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient's in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass.
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Affiliation(s)
- Rangeel Singh Raina
- Associate Professor, Department of Pharmacology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Vijay Thawani
- Professor, Department of Pharmacology, People’s College of Medical Sciences & Research Centre, Bhopal, Madhya Pradesh, India
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Tong A, Brown MA, Winkelmayer WC, Craig JC, Jesudason S. Perspectives on Pregnancy in Women With CKD: A Semistructured Interview Study. Am J Kidney Dis 2015; 66:951-61. [PMID: 26452499 DOI: 10.1053/j.ajkd.2015.08.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [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: 04/14/2015] [Accepted: 08/06/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Women with chronic kidney disease (CKD) often have difficulty achieving pregnancy and are at increased risk for adverse pregnancy outcomes. Given the medical, ethical, and emotional complexities of pregnancy in CKD, the clinical approach should involve explicit consideration of women's values, for which there are sparse data. This study aims to describe the beliefs, values, and experiences of pregnancy in women with CKD to inform prepregnancy counseling and pregnancy care. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 41 women (95% response rate) aged 22 to 56 years with CKD stages 3 to 5 (n=5), receiving dialysis (n=5), or received a kidney transplant (n=31) from 2 renal units in Australia. METHODOLOGY Semistructured interviews. ANALYTICAL APPROACH Transcripts were analyzed thematically. RESULTS 6 themes were identified: bodily failure (conscious of fragility, noxious self, critical timing, and suspended in limbo), devastating loss (denied motherhood, disempowered by medical catastrophizing, resolving grief, barriers to parenthood alternatives, and social jealousy), intransigent guilt (disappointing partners, fear of genetic transmission, respecting donor sacrifice, and medical judgment), rationalizing consequential risks (choosing survival, avoiding fetal harm, responding to family protectiveness, compromising health, decisional ownership, and unjustifiable gamble), strengthening resolve (hope and opportunity, medical assurance, resolute determination, and reticent hope), and reorientating focus (valuing life and gratitude in hindsight). LIMITATIONS Only English-speaking women were recruited, which may limit transferability of the findings. CONCLUSIONS Decisions surrounding pregnancy in the context of CKD require women to confront uncertainties about their own survival, disease progression, guilt toward their family and kidney donor, the outcomes of their offspring, and genetic transmission. Communicating the medical risks of pregnancy to women with CKD must be carefully balanced with their values of autonomy, hope, security, and family. Informed and shared decision making that addresses women's priorities as identified in this study may help contribute to improved pregnancy, health, and psychosocial outcomes in this vulnerable population.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Mark A Brown
- Department of Renal Medicine, St. George Hospital and University of NSW, Kogarah, Sydney, NSW, Australia
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Shilpanjali Jesudason
- Centre for Clinical and Experimental Transplantation, Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
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