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Freeland C, Adjei C, Wallace J, Wang S, Hicks J, Adda D, James C, Cohen C. Survey of lived experiences and challenges in hepatitis B management and treatment. BMC Public Health 2024; 24:944. [PMID: 38566070 PMCID: PMC10986103 DOI: 10.1186/s12889-024-18425-w] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Almost 300 million people are living with chronic hepatitis B infection worldwide and most remain undiagnosed and at risk for liver cancer. In 2015 the World Health Organization (WHO) developed guidelines for the prevention, care, and treatment of persons with chronic hepatitis B and in early 2023 began to work on updating these guidelines. In March 2023, a self-administered, anonymous online survey was launched, aiming to identify patient preferences related to the clinical management of hepatitis B including current management, treatment, and care experiences, preferences regarding engagement with providers, and preferences related to simplifying hepatitis B care access. A sample of 560 individuals living with hepatitis B (self-identified as HBsAg positive) from 76 countries completed the survey. Key findings demonstrated that less than half (49%, N = 268) of participants regularly visited a doctor to check the health of their liver (every 6-12 months), with 37% of participants prescribed antiviral medication by a specialist (82%, N = 167) or general practitioner (13%, N = 26). Participants reported not being actively involved in care decision making with their providers (42%, N = 217), with an overwhelming majority wanting to participate in hepatitis B management and treatment choices (85%, N = 435). Participants provided qualitative and quantitative details using open-ended responses within the survey about challenges with medication affordability and receiving care from a knowledgeable provider. Overall findings demonstrated key gaps in care, management, and treatment access related to hepatitis B: identifying these gaps can be used to identify areas for improvement along the care continuum for viral hepatitis. The survey found a need for the comprehensive simplification of clinical management and health care services related to hepatitis B. A thematic analysis of the open-ended survey responses highlighted major overarching themes including the cost and access burdens associated with hepatitis B management and treatment, and challenges in finding knowledgeable providers. Results from this mixed methods survey were used to inform the WHO hepatitis B guidelines update. Efforts should continue to explore public health approaches to address barriers and facilitators to testing, care, and treatment for people with hepatitis B to improve awareness of hepatitis B and access, care, and treatment among patients and providers.
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Affiliation(s)
| | | | - Jack Wallace
- Burnet Institute, Melbourne, Australia
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Su Wang
- Saint Barnabas Medical Center, Livingston, NJ, USA
| | | | - Danjuma Adda
- World Hepatitis Alliance, London, UK
- CFID Taraba, Taraba, Nigeria
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Vázquez Morejón AJ, Felipe González C, Muñoz Caracuel MA, Vázquez-Morejón R. Psychosocial factors associated with treatment preference in mental health. Int J Soc Psychiatry 2024:207640241236105. [PMID: 38439521 DOI: 10.1177/00207640241236105] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Studies examining the effects of incorporating patients' preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals' rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices. AIM This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences. METHODS A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied. RESULTS Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size. CONCLUSIONS There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.
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Affiliation(s)
- Antonio J Vázquez Morejón
- Hospital Universitario Virgen del Rocío, Seville, Andalucía, Spain
- University of Seville, Seville, Spain
| | | | | | - Raquel Vázquez-Morejón
- Grupo de Investigación Comportamientos Sociales y Salud, University of Seville, Seville, Spain
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Manglani HR, Lovette BC, Grunberg VA, Frieder J, Vranceanu AM, Greenberg J. "I Wish I Had That!": A Qualitative Analysis of Psychosocial Treatment Preferences Among Young Adults With Recent Concussion and Anxiety. Arch Phys Med Rehabil 2024:S0003-9993(24)00808-6. [PMID: 38369228 DOI: 10.1016/j.apmr.2024.01.024] [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: 08/31/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To assess psychosocial treatment preferences and factors that may affect treatment participation among young adults with a recent concussion and co-occurring anxiety. DESIGN In-depth, semi-structured individual qualitative interviews, followed by thematic analysis using a hybrid deductive-inductive approach. SETTING Academic medical center in the US Northeast. PARTICIPANTS Seventeen young adults (18-24y) who sustained a concussion within the past 3-10 weeks and reported at least mild anxiety (≥5 on the Generalized Anxiety Disorder-7 questionnaire). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Primary outcomes include preferences for program content (eg, topics and skills), delivery modality, format, and barriers and facilitators to participation. RESULTS We identified 4 domains characterizing participants' perceptions of and preferences for treatment. (1) Program content: Participants preferred a program early after injury that included psychoeducation and coping skills (eg, activity pacing, deep breathing, mindfulness). (2) Therapeutic processes: Participants preferred a person-centered approach in which clinicians normalized anxiety postconcussion and reassured them of recovery. (3) Program logistics: Participants endorsed that a brief, virtual program would be acceptable. They preferred access to program components through multiple modalities (eg, audio, video) and accommodations to manage concussion symptoms. (4) Barriers and facilitators to participation: Barriers included acute concussion symptoms (eg, screen sensitivity), time constraints, and forgetting sessions. Facilitators included a program that is flexible (format, scheduling), personalized (self-chosen mode for reminders, measure of accountability), and accessible (ie, advertising through health care professionals or social media). CONCLUSIONS Participants need psychosocial support that normalizes their experiences and provides education and coping tools. Treatments should be accessible, flexible, and person centered. Psychosocial treatments meeting these preferences may help optimize the recovery of young adults with recent concussion and anxiety.
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Affiliation(s)
- Heena R Manglani
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brenda C Lovette
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; MGH Institute of Health Professions, Boston, MA
| | - Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Newborn Medicine, Massachusetts General Hospital for Children, Boston, MA
| | | | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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Shanahan ML, Rand KL, Galloway A, Matthias MS. Treatment Goals and Preferences of Black Veterans with Chronic Musculoskeletal Pain. J Pain 2024:S1526-5900(24)00368-7. [PMID: 38336030 DOI: 10.1016/j.jpain.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Understanding patient goals and preferences is critical in the context of complex conditions such as chronic pain. This need may be especially pronounced for Black patients, who experience significant health and healthcare disparities. The primary aim of this study was to describe the treatment goals and preferences of Black veterans with chronic musculoskeletal pain who were enrolled in the intervention arm of a randomized controlled trial testing a coaching intervention. In the coaching sessions, participants (n = 106) identified their most important pain-related treatment goals and preferences. Participants' top treatment goals were to improve physical functioning (61%), increase engagement in valued activities (45%), and reduce pain intensity (37%). Most participants (73%) preferred non-pharmacological treatments (eg, physical therapy, exercise, acupuncture, yoga). The 17% of participants who identified medications as a preferred treatment demonstrated higher levels of depression and anxiety compared to those who did not. Approximately 42% and 21% of participants stated a preference to avoid pharmacological and surgical pain treatments, respectively. Black patients with chronic pain prioritize improving physical functioning and pain intensity in service of increasing their engagement in exercise, work, relationships, and leisure activities. Also, in the current study, patients expressed a clear preference for non-pharmacological pain treatments. Future research should investigate ways to improve communication of goals and preferences with providers and facilitate access to non-pharmacological treatments for Black patients with chronic pain. PERSPECTIVE: This article describes the treatment goals and preferences of Black veterans with chronic pain. Most patients prioritized goals to improve physical functioning, pain severity, and participation in valued activities. Patients primarily preferred non-pharmacological treatments. This emphasizes the need for clear communication with Black patients regarding pain-related goals and non-pharmacological treatment options.
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Affiliation(s)
- Mackenzie L Shanahan
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Kevin L Rand
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Amanda Galloway
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Karki C, Athavale A, Abilash V, Hantsbarger G, Geransar P, Lee K, Milicevic S, Perovic M, Raven L, Sajak-Szczerba M, Silber A, Yoon A, Tozer P. Multi-national observational study to assess quality of life and treatment preferences in patients with Crohn's perianal fistulas. World J Gastrointest Surg 2023; 15:2537-2552. [PMID: 38111766 PMCID: PMC10725550 DOI: 10.4240/wjgs.v15.i11.2537] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Patients with Crohn's disease (CD) are at risk of developing complications such as perianal fistulas. Patients with Crohn's perianal fistulas (CPF) are affected by fecal incontinence (FI), bleeding, pain, swelling, and purulent perianal discharge, and generally face a higher treatment burden than patients with CD without CPF. AIM To gain insights into the burden of illness/quality of life in patients with CPF and their treatment preferences and satisfaction. METHODS This cross-sectional observational study was conducted in patients with CD aged 21-90 years via a web-enabled questionnaire in seven countries (April-August 2021). Patients were recruited into three cohorts: Cohort 1 included patients without perianal fistulas; cohort 2 included patients with perianal fistulas without fistula-related surgery; and cohort 3 included patients with perianal fistulas and fistula-related surgery. Validated patient-reported outcome measures were used to assess quality of life. Drivers of treatment preferences were measured using a discrete choice experiment (DCE). RESULTS In total, 929 patients were recruited (cohort 1, n = 620; cohort 2, n = 174; cohort 3, n = 135). Short Inflammatory Bowel Disease Questionnaire scores were worse for patients with CPF (cohorts 2 and 3) than for those with CD without CPF (cohort 1): Mean score 3.8 and 3.7 vs 4.1, respectively, (P < 0.001). Similarly, mean Revised FI and FI Quality of Life scores were worse for patients with CPF than for those with CD without CPF. Quality of Life with Anal Fistula scores were similar in patients with CPF with or without CPF-related surgery (cohorts 2 and 3): Mean score 41 and 42, respectively. In the DCE, postoperative discomfort and fistula healing rate were the most important treatment attributes influencing treatment choice: Mean relative importance 35.7 and 24.7, respectively. CONCLUSION The burden of illness in CD is significantly higher for patients with CPF and patients rate lower postoperative discomfort and higher healing rates as the most desirable treatment attributes.
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Affiliation(s)
- Chitra Karki
- Global Evidence and Outcomes-Gastroenterology, Takeda Pharmaceuticals United States, Inc, Cambridge, MA 02139, United States
| | - Amod Athavale
- Trinity Partners, LLC, Waltham, MA 02451-7528, United States
| | - Vijay Abilash
- Trinity Partners, LLC, Waltham, MA 02451-7528, United States
| | - Gary Hantsbarger
- Observational Research, Takeda Pharmaceuticals United States, Inc, Cambridge, MA 02139, United States
| | - Parnia Geransar
- Medical Affairs, Takeda Pharmaceuticals International Co., Opfikon 8152, Zurich, Switzerland
| | - Kate Lee
- Research and Patient Programs, Crohn’s and Colitis Canada, 600-60 St. Clair Avenue East, Toronto M4T 1N5, Ontario, Canada
| | - Slobodan Milicevic
- Medical Affairs, Takeda Pharmaceuticals International Co., Opfikon 8152, Zurich, Switzerland
| | - Marko Perovic
- Treasurer, European Federation of Crohn’s & Ulcerative Colitis Associations, Brussels B 1000, Belgium
| | - Leanne Raven
- Crohn’s and Colitis Australia, Camberwell South, VIC 3124, Australia
| | | | - Abigail Silber
- Trinity Partners, LLC, Waltham, MA 02451-7528, United States
| | - Annabelle Yoon
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo 103-8668, Japan
| | - Phil Tozer
- Department of Colorectal Surgery, St Mark’s Hospital and Academic Institute, London HA1 3UJ, United Kingdom
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Saposnik G, Sánchez-Benavidez G, García-Arcelay E, Franco-Macías E, Bensi C, Carmelingo S, Allegri RF, Pérez-Martínez DA, Maurino J. Design of a Non-Interventional Study to Assess Neurologists' Perspectives and Pharmacological Treatment Decisions in Early Alzheimer's Disease. Neurol Ther 2023; 12:995-1006. [PMID: 36952172 DOI: 10.1007/s40120-023-00466-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION The current therapeutic landscape of Alzheimer's disease (AD) is evolving rapidly. Our treatment options include new anti-amyloid-β protein disease-modifying therapies (DMTs) that decrease cognitive decline in patients with early AD (prodromal and mild AD dementia). Despite these advances, we have limited information on how neurologists would apply the results of recent DMT trials to make treatment decisions. Our goal is to identify factors associated with the use of new AD DMTs among neurologists applying concepts from behavioral economics. METHODS This non-interventional, cross-sectional, web-based study will assess 400 neurologists with expertise in AD from across Spain. Participants will start by completing demographic information, practice settings, and a behavioral battery to address their tolerance to uncertainty and risk preferences. Participants will then be presented with 10 simulated case scenarios or vignettes of common encounters in patients with early AD to evaluate treatment initiation with anti-amyloid-β DMTs (e.g., aducanumab, lecanemab, etc.). The primary outcomes will be therapeutic inertia and suboptimal decisions. Discrete choice experiments will be used to determine the weight of factors influencing treatment choices. RESULTS The results of this study will provide new insights into a better understanding of the most relevant factors associated with therapeutic decisions on the use of DMTs, assessing how neurologists handle uncertainty when making treatment choices, and identifying the prevalence of therapeutic inertia in the management of early AD.
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Affiliation(s)
- Gustavo Saposnik
- Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada.
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, ON, M5C 1R6, Canada.
| | - Gonzalo Sánchez-Benavidez
- BarcelonaBeta Brain Research Center, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Emilio Franco-Macías
- Department of Neurology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Catalina Bensi
- Medical Department, Roche Farma, Buenos Aires, Argentina
| | | | - Ricardo F Allegri
- Department of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni, Buenos Aires, Argentina
| | - David A Pérez-Martínez
- Department of Neurology, Hospital Universitario Doce de Octubre, Hospital Universitario La Luz, Madrid, Spain
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Tauscher JS, DePue MK, Swank J, Salloum RG. Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment. J Subst Use Addict Treat 2023; 146:208938. [PMID: 36880898 DOI: 10.1016/j.josat.2022.208938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity. METHODS Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making. RESULTS Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use. CONCLUSIONS Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
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Affiliation(s)
- Justin S Tauscher
- BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - M Kristina DePue
- Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - Jacqueline Swank
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA; Department of Educational, School, and counseling Psychology, College of Education & Human Development, University of Missouri, Columbia, MO, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
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Saposnik G, Camacho A, Díaz-Abós P, Brañas-Pampillón M, Sánchez-Menéndez V, Cabello-Moruno R, Terzaghi M, Maurino J, Málaga I. Therapeutic Decision-Making Under Uncertainty in the Management of Spinal Muscular Atrophy: Results From DECISIONS-SMA Study. Neurol Ther 2022; 11:1209-1219. [PMID: 35657490 PMCID: PMC9338192 DOI: 10.1007/s40120-022-00366-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction There are many uncertainties about treatment selection and expectations regarding therapeutic goals and benefits in the new landscape of spinal muscular atrophy (SMA). Our aim was to assess treatment preferences and expectations of pediatric neurologists caring for patients with SMA. Methods DECISIONS-SMA is a non-interventional, cross-sectional pilot study that assessed pediatric neurologists with expertise in SMA from across Spain. Participants were presented with 11 simulated case scenarios of common encounters of patients with SMA type 1 and 2 to assess treatment initiation, escalation, or switches. We also asked for the expected benefit with new therapies for four simulated case scenarios. Participants completed a behavioral battery to address their tolerance to uncertainty and aversion to ambiguity. The primary outcome was therapeutic inertia (TI), defined as the number of simulated scenarios with lack of treatment initiation or escalation when warranted over the total (11) presented cases. Results A total of 35 participants completed the study. Participants’ mean (SD) expectation for achieving an improvement by starting a new therapy for SMA type 1 (case 1, a 5-month-old) and SMA type 2 (case 6, a 1-year-old) were both 59.6% (± 21.8), but declined to 20.2% (± 12.2) for a case scenario of a 16-year-old treatment-naïve patient with long-standing SMA type 2 with severe disability. The mean (SD) TI score was 4.2 (1.7), and 3.29 (1.5) for treatment initiation. Of a total 385 individual responses, TI was observed in 147 (38.2%) of treatment choices. The multivariable analysis showed that lower aversion to ambiguity (p = 0.019) and lower expectation of treatment response (p = 0.007) were associated with higher TI after adjustment for participants’ age and years of experience. Older age (p = 0.019), lower years of experience (p = 0.035), lower aversion to ambiguity (p = 0.015), and lower expectation of treatment benefits (p = 0.006) were associated with inertia for treatment initiation. Conclusions Pediatric neurologists managing patients with SMA were optimistic regarding treatment improvement in cases with early diagnosis, but had lower expectations when treatment delays and advanced patient age were present. Low aversion to ambiguity, low expectation of treatment benefits, and lower clinical experience were more likely to make suboptimal decisions, resulting in lack of treatment initiation, escalation, and TI. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-022-00366-4.
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Affiliation(s)
- Gustavo Saposnik
- Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada. .,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Ana Camacho
- Division of Child Neurology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | | | | | - María Terzaghi
- Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada
| | | | - Ignacio Málaga
- Child Neurology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
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Simons G, Caplan J, DiSantostefano RL, Veldwijk J, Englbrecht M, Bywall KS, Kihlbom U, Raza K, Falahee M. Systematic review of quantitative preference studies of treatments for rheumatoid arthritis among patients and at-risk populations. Arthritis Res Ther 2022; 24:55. [PMID: 35193653 PMCID: PMC8862509 DOI: 10.1186/s13075-021-02707-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
Treatments used for rheumatoid arthritis (RA) are under investigation for their efficacy to prevent RA in at risk groups. It is therefore important to understand treatment preferences of those at risk. We systematically reviewed quantitative preference studies of drugs to treat, or prevent RA, to inform the design of further studies and trials of RA prevention. Stated preference studies for RA treatment or prevention were identified through a search of five databases. Study characteristics and results were extracted, and the relative importance of different types of treatment attributes was compared across populations. Twenty three studies were included 20 of RA treatments (18 of patients; 2 of the general public) and 3 prevention studies with first-degree relatives (FDRs). Benefits, risks, administration method and cost (when included) were important determinants of treatment choice. A benefit was more important than a risk attribute in half of the studies of RA treatment that included a benefit attribute and 2/3 studies of RA prevention. There was variability in the relative importance of attributes across the few prevention studies. In studies with non-patient participants, attributes describing confidence in treatment effectiveness/safety were more important determinants of choice than in studies with patients. Most preference studies relating to RA are of treatments for established RA. Few studies examine preferences for treatments to prevent RA. Given intense research focus on RA prevention, additional preference studies in this context are needed. Variation in treatment preferences across different populations is not well understood and direct comparisons are needed.
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Affiliation(s)
- Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.
| | - Joshua Caplan
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK
| | | | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Julius Center for Health and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Karin Schölin Bywall
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrik Kihlbom
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK.,Research into Inflammatory Arthritis Centre Versus Arthritis and MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Queen Elizabeth Hospital, University of Birmingham, Birmingham, B15 2WB, UK
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Mor S, Botella C, Campos D, Carlbring P, Tur C, Quero S. An internet-based treatment for flying phobia using 360° images: A feasibility pilot study. Internet Interv 2022; 28:100510. [PMID: 35242593 PMCID: PMC8866141 DOI: 10.1016/j.invent.2022.100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND More research is needed in the field of Internet-delivered Cognitive Behavioral Treatments (ICBTs) for specific phobia in order to understand which characteristics are important in online exposure scenarios. The aim of the present work was to conduct a feasibility pilot study to explore participants' opinions, preferences, and acceptability ratings of two types of images (still images vs 360° navigable images) in an ICBT for Flying Phobia (FP). A secondary aim was to test the potential effectiveness of the two active treatment arms compared to a waiting list control group. An exploratory aim was to compare the role of navigable images vs. still images in the level of sense of presence and reality judgment and explore their possible mediation in treatment effectiveness. METHODS Participants were randomly allocated to three conditions: NO-FEAR Airlines with still images (n = 26), NO-FEAR Airlines with still and navigable images (n = 26), and a waiting list group (n = 26). Primary outcome measures were participants' opinions, preferences, satisfaction, and acceptance regarding the images used in the exposure scenarios. Secondary outcome measures included FP symptomatology outcomes and measures of sense of presence and reality judgment. RESULTS Participants in the study preferred navigable images over still images before and after treatment (over 84%), and they considered them more effective and logical for the treatment of their problem. However, adherence in the experimental conditions was low (42.3% dropout rate), and more participants withdrew from the group that included navigable images compared to the group that only included still images (14 vs. 8), with no statistical differences in attrition between the two conditions. NO-FEAR Airlines proved to be effective in reducing FP symptomatology compared to the control group, with large between-group effect sizes on all FP measures (ranging from 0.76 to 2.79). No significant mediation effect was found for sense of presence or reality judgment in treatment effectiveness. DISCUSSION The results of the current study suggest that participants prefer more immersive images in exposure scenarios, providing data that can help to design useful exposure scenarios to treat specific phobias in the future. They also provide evidence supporting the effectiveness of an ICBT for FP. TRIAL REGISTRATION Registered at Clinicaltrials.gov (NCT03900559) on April 9, 2019. Retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain,Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain.
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11
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Spalding RL, Edelstein B. Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic. Patient Educ Couns 2022; 105:311-321. [PMID: 34144854 PMCID: PMC8805830 DOI: 10.1016/j.pec.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/01/2020] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Surrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates' characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates' accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient. METHODS 154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer. RESULTS When taken all together in a predictive model, the variables significantly predicted surrogates' accuracy, F (6) = 3.03, R2 = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R2 = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions. CONCLUSIONS Consistent with prior research, this study found that surrogates' characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions. PRACTICE IMPLICATIONS These findings can inform development of decision-making interventions to improve surrogates' accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.
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Affiliation(s)
- Rachael L Spalding
- Department of Psychology, West Virginia University, Morgantown, WV, USA.
| | - Barry Edelstein
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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12
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [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: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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13
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Kravitz RL, Marois M, Sim I, Ward D, Kanekar SS, Yu A, Dounias P, Yang J, Wang Y, Schmid CH. Chronic pain treatment preferences change following participation in N-of-1 trials, but not always in the expected direction. J Clin Epidemiol 2021; 139:167-176. [PMID: 34400254 DOI: 10.1016/j.jclinepi.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine pain treatment preferences before and after participation in an N-of-1 trial. STUDY DESIGN AND SETTING In this observational study nested within a randomized trial, we examined chronic pain patients' preferences before and after treatment in relation to N-of-1 trial results; assessed the influence of different schemes for defining comparative "superiority" on potential conclusions; and generated classification trees illustrating the relationship between pre-treatment preferences, N-of-1 trial results, and post-treatment preferences. RESULTS Treatment preferences differed pre- and post-trial for 40% of participants. The proportion of patients whose N-of-1 trials demonstrated "superiority" of one treatment regimen over the other varied depending on how superiority was defined and ranged from 24% (using criteria that required statistically significant differences between regimens) to 62% (when relying only on differences in point estimates). Regardless of criteria for declaring treatment superiority, nearly three-fourths of patients with equivocal N-of-1 trial results nevertheless expressed definite preferences post-trial. CONCLUSION A large segment of patients undergoing N-of-1 trials for chronic pain altered their treatment preferences. However, the direction of preference change did not necessarily correspond to the N-of-1 results. More research is needed to understand how patients use N-of-1 trial results, why preferences are "sticky" even in the face of personalized data, and how patients and clinicians might be educated to use N-of-1 trial results more informatively.
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Affiliation(s)
- Richard L Kravitz
- UC Davis Division of General Medicine, 4150 V Street, Suite 2400 PSSB, Sacramento, CA 95817, USA.
| | - Maria Marois
- UC Davis Center for Healthcare Research and Policy, Sacramento, CA
| | - Ida Sim
- UC San Francisco Department of Medicine, San Francisco, CA
| | | | | | | | - Peach Dounias
- UC Davis Center for Healthcare Research and Policy, Sacramento, CA
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Hayes JF, Tate DF, Espeland MA, LaRose JG, Gorin AA, Lewis CE, Jelalian E, Bahnson J, Dunsiger SI, Wing RR. Making large changes or small changes to prevent weight gain in young adulthood: which is preferred and by whom? Transl Behav Med 2021; 11:2081-2090. [PMID: 34293164 DOI: 10.1093/tbm/ibab099] [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] [Indexed: 11/14/2022] Open
Abstract
Knowledge of participant treatment preferences can inform decision-making regarding treatment dissemination and future participant adoption. To compare participant perceptions of two evidence-based approaches for weight gain prevention in young adults to identify the intervention with the greatest likelihood of adoption. As part of a randomized trial (Study of Novel Approaches to Weight Gain Prevention [SNAP]; n = 599) testing weight gain prevention interventions in young adults (18-35 years), individuals assigned to self-regulation interventions using either large changes or small changes reported on perceived personal effectiveness and difficulty of treatment over 3 years. Treatment satisfaction at 2-year follow-up was also reported. Pre-randomization, participants believed the large change intervention would be more personally effective than the small change intervention, although they also considered it more complex. Older age, lower body mass index (p = 0.056), and desire to maintain versus lose weight predicted greater perceived effectiveness of the small change relative to large change intervention. Over follow-up, the large change intervention was no longer perceived as more effective, but perceived effectiveness aligned with assigned treatment. The small change intervention was rated as less complex than the large change intervention at 4 months, but not at other follow-ups. At study conclusion, participants were largely satisfied with both treatments; however, in the small change intervention, individuals who were not successful at preventing weight gain were less satisfied than individuals who were successful. The large and small change interventions are both appropriate for dissemination with no clear advantages based on the participant perceptions.
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Affiliation(s)
- Jacqueline F Hayes
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
| | - Deborah F Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond, Richmond, VA 23219, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
| | - Judy Bahnson
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02912, USA
| | - Rena R Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
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15
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Chang JW, Rubenstein JH, Mellinger JL, Kodroff E, Strobel MJ, Scott M, Mack D, Book W, Sable K, Kyle S, Paliana A, Dellon ES. Motivations, Barriers, and Outcomes of Patient-Reported Shared Decision Making in Eosinophilic Esophagitis. Dig Dis Sci 2021; 66:1808-1817. [PMID: 32621259 PMCID: PMC9110111 DOI: 10.1007/s10620-020-06438-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about patient choice in treatment of eosinophilic esophagitis (EoE). AIM Determine motivators and barriers to using common EoE therapies and describe patient-reported shared decision making (SDM) and satisfaction with treatment. METHODS We developed and administered a Web-based survey on factors influencing EoE treatment choice, SDM, and satisfaction. Adults with EoE and adult caregivers of pediatric EoE patients were recruited via patient advocacy groups and at two centers. Descriptive statistics of multiple response questions and multivariable logistic regression were performed to identify predictors of SDM and satisfaction with treatment. RESULTS A total of 243 adults (mean age 38.7 years) and 270 adult caregivers of children (mean age 9.5 years) completed the survey. Preventing worsening disease was the most common motivator to treat EoE. Barriers to topical steroids were potential side effects, cost, and preferring a medication-free approach. Inconvenience and quality of life were barriers to diet. Potential adverse events, discomfort, and cost were barriers to dilation. Nearly half (42%) of patients experienced low SDM, but those followed by gastroenterologists were more likely to experience greater SDM compared to non-specialists (OR 1.81; 95% CI 1.03-3.15). Patients receiving more SDM were more satisfied with treatment, regardless of provider or treatment type (OR 2.62, 95% CI 1.76-3.92). CONCLUSIONS Patients with EoE pursue treatment mostly to prevent worsening disease. Common barriers to treatment are inconvenience and financial costs. SDM is practiced most by gastroenterologists, but nearly half of patients do not experience SDM, indicating a substantial area of need in EoE.
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Affiliation(s)
- Joy W. Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA
| | - Joel H. Rubenstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA,Veterans Affairs Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Jessica L. Mellinger
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Mary J. Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | | | - Denise Mack
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Wendy Book
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Kathleen Sable
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Scholeigh Kyle
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Allisa Paliana
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Evan S. Dellon
- Division of Gastroenterology, Center for Esophageal and Swallowing Disorders, University of North Carolina, Chapel‑Hill, NC, USA
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Mor S, Botella C, Campos D, Tur C, Castilla D, Soler C, Quero S. An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study. Internet Interv 2021; 24:100387. [PMID: 33936953 PMCID: PMC8076687 DOI: 10.1016/j.invent.2021.100387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Flying Phobia (FP) is a prevalent disorder that can cause serious interference in a person's life. ICBT interventions have already shown their efficacy in several studies, but studies in the field of specific phobias are still scarce. Moreover, few studies have investigated the feasibility of using different types of images in exposure scenarios in ICBTs and no studies have been carried out on the role of sense of presence and reality judgement. The aim of the present study is to explore the feasibility of an ICBT for FP (NO-FEAR Airlines) using two types of images with different levels of immersion (still and navigable images). A secondary aim is to explore the potential effectiveness of the two experimental conditions using two types of images compared to a waiting list control group. Finally, the role of navigable images compared to the still images in the level of anxiety, sense of presence, and reality judgement will also be explored. This paper presents the study protocol. METHODS This study is a three-armed feasibility pilot study with the following conditions: NO-FEAR Airlines with navigable images, NO-FEAR Airlines with still images, and a waiting list group. A minimum of 60 participants will be recruited. The intervention will have a maximum duration of 6 weeks. Measurements will be taken at four different moments: baseline, post-intervention, and two follow-ups (3- and 12-month). Participants' opinions, preference, satisfaction and acceptance regarding the images used in the exposure scenarios will be assessed. FP symptomatology outcomes will also be considered for secondary analyses. The anxiety, sense of presence, and reality judgement in the exposure scenarios will also be analysed. DISCUSSION This study will conduct a pilot study on the feasibility of an ICBT for FP and it is the first one to explore the evaluation of patients of the two type of images (still and navigable) and the role of presence and reality judgement in exposure scenarios delivered through the Internet. Research in this field can have an impact on the way these scenarios are designed and developed, as well as helping to explore whether they have any effect on adherence. TRIAL REGISTRATION NCT03900559. Trial Registration date 3 April 2019, retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | | | | | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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17
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Rocque G, Wheeler S, Williams GR. The missing voice in multidisciplinary tumor boards. J Geriatr Oncol 2021; 12:1157-1158. [PMID: 33722503 DOI: 10.1016/j.jgo.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grant R Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, USA.
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18
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Seligman LD, Hovey JD, Ibarra M, Hurtado G, Marin CE, Silverman WK. Latino and Non-Latino Parental Treatment Preferences for Child and Adolescent Anxiety Disorders. Child Psychiatry Hum Dev 2020; 51:617-24. [PMID: 31807934 DOI: 10.1007/s10578-019-00945-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is frequently a presumption that Latino parents have a greater preference for involvement in their child's treatment for anxiety compared to non-Latino white parents. However, parent involvement may increase burdens associated with treatment and research suggests that Latino individuals already face significantly greater barriers to obtaining mental health treatment. In the current study, we compared Latino and non-Latino parents' preferences for parental involvement and perceptions of burdens in cognitive behavioral therapy (CBT) for youth anxiety. 117 parents (57 Latino) completed measures to assess child anxiety, perceptions of treatment involvement, and burdens associated with treatment. There were no significant differences between Latino and non-Latino parents except for a trend toward Latino parents reporting more concerns about the feasibility of obtaining CBT for their child's anxiety. Because Latino parents expressed concern about potential treatment barriers, cultural adaptations for treatment should focus on decreasing burdens associated with treatment rather than increasing parental involvement.
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Spalding R, Strough J, Edelstein B. What would people think? Perceived social norms, willingness to serve as a surrogate, and end-of-life treatment decisions. Palliat Support Care 2021; 19:46-54. [PMID: 32665048 DOI: 10.1017/S1478951520000401] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals' willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. METHOD An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments. RESULTS Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients' physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. SIGNIFICANCE OF RESULTS The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making - the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates' confidence in their decisions.
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Sonik RA, Creedon TB, Progovac AM, Carson N, Delman J, Delman D, Lê Cook B. Depression treatment preferences by race/ethnicity and gender and associations between past healthcare discrimination experiences and present preferences in a nationally representative sample. Soc Sci Med 2020; 253:112939. [PMID: 32276182 DOI: 10.1016/j.socscimed.2020.112939] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression treatment disparities are well documented. Differing treatment preferences across social groups have been suggested as a cause of these disparities. However, existing studies of treatment preferences have been limited to individuals currently receiving clinical care, and existing measures of depression treatment preferences have not accounted for factors that may be disproportionately relevant to the preferences of disparities populations. This study therefore aimed to assess depression treatment preferences by race/ethnicity and gender in a representative community sample, while accounting for access to healthcare, provider characteristics, and past experiences of discrimination in healthcare settings. METHODS We conducted a nationally representative study of individuals with depression in and out of clinical care. Treatment preferences (medication versus talk therapy) were elicited through a discrete choice experiment that accounted for tradeoffs with factors related to access and provider characteristics deemed relevant by community stakeholders. Past discrimination was assessed through questions about unfair treatment from medical providers and front desk staff due to personal characteristics (e.g., race, gender). We used conditional logit models to assess treatment preferences by race/ethnicity and gender and examined whether preferences were associated with past experiences of healthcare discrimination. RESULTS Non-Hispanic white respondents (OR-here, the odds of a talk therapy preference over the odds of a medication preference: 0.80, 95% CI: 0.64, 0.99) and men (OR 0.76, 95% CI: 0.60, 0.96) preferred medication over talk therapy, while non-Hispanic black respondents, Hispanic respondents, and women did not prefer one over the other. Past discrimination in healthcare settings was associated with lower preferences for talk therapy and greater preferences for medication, particularly among non-Hispanic black respondents and women respondents. CONCLUSIONS Addressing previous methodological limitations yielded estimates for depression treatment preferences by race/ethnicity and gender that differed from past studies. Also, past discrimination in healthcare settings was associated with current treatment preferences.
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Affiliation(s)
| | - Timothy B Creedon
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | - Ana Maria Progovac
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | - Nicholas Carson
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
| | | | | | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, United States
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- AltaMed Institute for Health Equity, United States
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Simhi M, Sarid O, Cwikel J. Preferences for mental health treatment for post-partum depression among new mothers. Isr J Health Policy Res 2019; 8:84. [PMID: 31806009 PMCID: PMC6894496 DOI: 10.1186/s13584-019-0354-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022] Open
Abstract
Background The prevalence rate of postpartum depression (PPD) is 9 to 17% among mothers, with higher rates among low income and immigrant populations. Due to the negative effects of PPD symptoms on both the mother and baby, treating mothers with depression symptoms is of great importance. This study examined treatment preferences for PPD among Israeli mothers with and without PPD symptoms, specifically focusing on treatment centers, type of professional and mode of treatment, to help develop relevant policies to promote the health of mothers by reaching a deeper understanding of their preferences. Methods 1000 mothers who attended Maternal Child Health Clinics (MCHCs) in Israel for their infant’s first medical exam participated in a cross-sectional survey. Results In this sample, 8.4% of the participants suffered from PPD. Mothers with PPD compared to those without symptoms had lower economic status, were more likely to be single, to be first-time mothers, have an unemployed partner and to have immigrated to Israel. Mothers with PPD preferred private mental health practice and community treatment centers by mental healthcare professionals. They also preferred group interventions and personal psychotherapy rather than technology-based interventions. Conclusions The study findings support the formulation of mother-sensitive health policies based on understanding mothers’ preferences, and thus, help prepare treatment alternatives that will suit different groups of mothers with PPD, for the benefit of mothers, newborns, and families. Disseminating the results of this study among professionals as part of professional training, can promote appropriate treatment facilities and modes of care for mothers with PPD.
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Affiliation(s)
- Meital Simhi
- Spitzer Department of Social Work and the Center for Women's Health Studies and Promotion, Ben Gurion University of the Negev, POB 653, 84105, Beer Sheva, Israel.
| | - Orly Sarid
- Spitzer Department of Social Work and the Center for Women's Health Studies and Promotion, Ben Gurion University of the Negev, POB 653, 84105, Beer Sheva, Israel
| | - Julie Cwikel
- Spitzer Department of Social Work and the Center for Women's Health Studies and Promotion, Ben Gurion University of the Negev, POB 653, 84105, Beer Sheva, Israel
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Nolan A, O'Connor C. The effect of causal attributions for depression on help-seeking and treatment preferences. J Affect Disord 2019; 257:477-85. [PMID: 31319339 DOI: 10.1016/j.jad.2019.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/28/2019] [Accepted: 07/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Depression is a leading cause of ill-health and disability globally and encouraging help-seeking and treatment engagement is a key priority of health authorities worldwide. Causal attributions for mental illness have numerous attitudinal and behavioural consequences; however, limited research has explored their implications for attitudes to treatment. This study experimentally investigates the impact of causal attributions for depression on attitudes to specific help-seeking and treatment options. METHODS In an online study, 196 participants read a vignette that emphasised either biological, social or biopsychosocial causes of a character's depression. Participants rated several help-seeking and treatment options on how helpful or harmful they would be for the individual described in the vignette and for themselves personally. RESULTS The causal attribution manipulation significantly affected treatment attitudes. Relative to social attributions, emphasising biological causes of depression significantly decreased the perceived helpfulness of lifestyle-based treatments, but did not affect attitudes to psychotherapeutic or medical treatment options. Participants rated most help-seeking and treatment options as less helpful for themselves compared to the vignette character. Participants with personal experience of depression had lower confidence in informal sources of help-seeking and greater confidence in medical treatment. LIMITATIONS Limitations include reliance on self-report measures and low reliability of certain sub-scales. CONCLUSIONS These findings suggest emphasising the biological underpinnings of depression could deter people from engaging with lifestyle-based treatment options. Promoting biopsychosocial theories of depression could increase awareness about the multifactorial causes of depression without negatively impacting the perceived efficacy of any help-seeking or intervention options.
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Grover S, Sahoo S, Bn S, Malhotra N, Dua D, Avasthi A. Attitude and perceptions of patients towards long acting depot injections (LAIs). Asian J Psychiatr 2019; 44:200-208. [PMID: 31419737 DOI: 10.1016/j.ajp.2019.07.052] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the well-established efficacy of the long acting depot injectable (LAIs) antipsychotics, these are significantly underused and underutilized by the mental health professionals, with a belief that patients will not accept the same. AIMS & OBJECTIVES To explore the acceptability and perception of patients towards various psychiatric treatments, with specific focus on LAIs. Additionally the study aimed to compare the acceptability of various types of treatments including LAIs between patients with severe mental disorders (Psychotic disorders and Bipolar disorder) and those with Common mental disorders (Anxiety, neurotic and depressive disorders). METHODOLOGY A self-designed semi-structured questionnaire was used to evaluate the preferred treatment options of all the new patients attending the psychiatry outpatient clinic of a tertiary care hospital. Depending on the response, they were further probed for the reasons for accepting or rejecting the LAIs. RESULTS 2659 patients were interviewed who were divided into two groups (Group I - 321 subjects with psychotic disorders and 120 subjects with bipolar affective disorder (BPAD) and Group II - 2218 subjects with neurotic, stress-related and unipolar depressive disorders). More than three-fourth (78.8%) of the participants in the whole study sample opted for tablets only as their first preferred choice and injectables were opted by about 5% of the participants only, with no significant difference between the 2 groups. After being explained about LAIs, one fourth of the participants (24.9%) reported that they may consider LAIs, without any significant difference between the 2 groups. Among those who refused to take LAIs even after explanation, the commonly reported reasons were difficulty in visiting hospital frequently for the injectables (41.69%), injectables being painful (19.41%), fear of injections (13.96%), no need to take LAIs (12.45%) and preference to take some other types of medicines (8.52%). CONCLUSIONS Considering the fact that LAIs are highly underused in patients with severe mental disorders and there is lack of awareness about LAIs among patients with severe mental disorders, the present study findings suggest that there is reasonable level of acceptance of LAIs among patients with severe mental disorders when explained about the same.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Subodh Bn
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Nidhi Malhotra
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, Sector-32, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Keikes L, de Vos-Geelen J, de Groot JWB, Punt CJA, Simkens LHJ, Trajkovic-Vidakovic M, Portielje JEA, Vos AH, Beerepoot LV, Hunting CB, Koopman M, van Oijen MGH. Implementation, participation and satisfaction rates of a web-based decision support tool for patients with metastatic colorectal cancer. Patient Educ Couns 2019; 102:1331-1335. [PMID: 30852117 DOI: 10.1016/j.pec.2019.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/10/2018] [Revised: 02/03/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine implementation and patients' and providers' participation and satisfaction of a newly developed decision support tool (DST) for patients with metastatic colorectal cancer (mCRC) in palliative setting. METHODS Our DST consisted of a consultation sheet and web-based tailored information for mCRC treatment options. We conducted an implementation trajectory in 11 Dutch hospitals and evaluated implementation, participation and satisfaction rates. RESULTS Implementation rates fluctuated between 3 and 72 handed out (median:23) consultation sheets per hospital with patients' login rates between 36% and 83% (median:57%). The majority of patients (68%) had (intermediate)-high participation scores. The median time spent using the DST was 38 min (IQR:18-56) and was highest for questions concerning patients' perspective (5 min). Seventy-six% of patients were (very) satisfied. The provider DST rating was 7.8 (scale 1-10) and participation ranged between 25 and 100%. Remaining implementation thresholds included providers' treatment preferences, resistance against shared decision-making and (over)confidence in shared decision-making concepts already in use. CONCLUSION We implemented a DST with sufficient patient and oncologist satisfaction and high patient participation, but participation differed considerably between hospitals suggesting unequal adoption of our tool. PRACTICE IMPLICATIONS Requirements for structural implementation are to overcome remaining thresholds and increase awareness for additional decision support.
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Affiliation(s)
- Lotte Keikes
- Department of Medical Oncology, Amsterdam University Medical Centers, Location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the Netherlands.
| | | | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam University Medical Centers, Location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Lieke H J Simkens
- Department of Medical Oncology, Maxima Medical Center, Veldhoven, the Netherlands.
| | | | | | - Allert H Vos
- Department of Medical Oncology, Hospital Bernhoven, Uden, the Netherlands.
| | - Laurens V Beerepoot
- Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
| | - Cornelis B Hunting
- Department of Medical Oncology, Antonius Hospital, Nieuwegein, the Netherlands.
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center, Utrecht, the Netherlands.
| | - Martijn G H van Oijen
- Department of Medical Oncology, Amsterdam University Medical Centers, Location AMC, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Falahee M, Finckh A, Raza K, Harrison M. Preferences of Patients and At-risk Individuals for Preventive Approaches to Rheumatoid Arthritis. Clin Ther 2019; 41:1346-1354. [PMID: 31196645 DOI: 10.1016/j.clinthera.2019.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/08/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
Effective treatments for rheumatoid arthritis (RA) are available and can lead to remission for some patients, but most patients remain on potentially toxic and expensive medications in the long term. Interest is increasingly turning to the disease phases preceding the development of RA that represent opportunities for preventive interventions. At-risk target populations include individuals with genetic and environmental risk factors, those who have developed systemic autoimmunity, and those who have developed clinically suspect symptoms (eg, arthralgias without synovitis, or an early arthritis). Ongoing prospective studies will inform the development of increasingly accurate predictive tools to identify individuals at risk of developing RA. Furthermore, a range of preventive approaches has been suggested, including lifestyle modification (eg, smoking cessation) and pharmacologic interventions (eg, hydroxychloroquine, methotrexate, abatacept, rituximab) that are currently the subject of randomized controlled trials. As prediction and prevention of RA evolve, it is increasingly likely that individuals at risk (including asymptomatic individuals) may be faced with complex decisions about whether to accept assessment of their risk status or to take a preventive intervention associated with risk of serious adverse events and uncertain benefit. Acceptance of preventive medication in other contexts can be low. For example, <25% of women at high risk of breast cancer are willing to take preventive hormonal treatments. Actual uptake is lower still. Patients' beliefs and preferences predict treatment uptake and adherence. Before the dream of preventing RA can become reality, health care providers need to understand the perspectives of individuals in the target population and to identify barriers and facilitators for this approach. This commentary reviews what is currently known about the perspectives of patients and individuals at risk about predictive and preventive approaches for RA and identifies gaps to be addressed to inform the development of efficient preventive strategies.
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Affiliation(s)
- Marie Falahee
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Axel Finckh
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Ozdemir S, Jafar TH, Choong LHL, Finkelstein EA. Family dynamics in a multi-ethnic Asian society: comparison of elderly CKD patients and their family caregivers experience with medical decision making for managing end stage kidney disease. BMC Nephrol 2019; 20:73. [PMID: 30823872 PMCID: PMC6397496 DOI: 10.1186/s12882-019-1259-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/21/2018] [Accepted: 02/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Elderly end stage kidney patients face a decision concerning whether or not to initiate dialysis. In Asia, this decision is highly influenced by family caregivers. The objective of this paper was to understand patients’ experience with and preferences for family involvement in treatment decisions, and via a series of hypothetical vignettes, to identify whether there was discordance in treatment preferences between patients and their caregivers, and how any potential conflicts were reconciled. Methods We conducted a survey with 151 elderly (aged ≥65) chronic kidney disease patients and their caregivers at outpatient renal clinics. The survey asked, when making treatment decisions, whom they wish makes the final decisions (i.e., preference) and who usually makes the final decisions (i.e., experience). The survey also presented a series of choice vignettes for managing patient’s condition and asked respondents to choose between two hypothetical treatment profiles in each vignette. Patients and caregivers were first interviewed separately in tandem, and then were brought together to choose a treatment jointly for vignettes where the initial treatment choice differed within the dyad. We used multivariate regressions to investigate the predictors of discordance and reconciliation. Results We found that most (51%) patients preferred and experienced (64%) significant involvement from caregivers. However, 38% of patients preferred to make final decisions alone but only 27% of patients did. In the hypothetical vignettes, caregivers chose the more intensive option (i.e., dialysis) more than patients did (26% vs 19%; p < 0.01). Overall, 44% of the dyads had discordance in at least 3 vignettes, and the odds of discordance within patient-caregiver dyads was higher when caregivers chose dialysis or treatment with the higher cost (p < 0.01). In half the cases, discordance resolved in the patients’ favor, and this was more likely to be the case if the patient was employed and wanted to be in charge of final decisions (p < 0.01). Conclusions Our results highlight the important role of caregivers in decision-making but also the potential for them to overstep. Clinicians should be aware of this challenge and identify strategies that minimize the chances that patients may receive treatments not consistent with their preferences. Electronic supplementary material The online version of this article (10.1186/s12882-019-1259-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Programme in Health Services and Systems Research Programme, Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Tazeen H Jafar
- Programme in Health Services and Systems Research Programme, Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Lina Hui Lin Choong
- Department of Renal Medicine, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,Programme in Health Services and Systems Research Programme, Duke-NUS Medical School Singapore, 8 College Road, Singapore, 169857, Singapore.
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Avey JP, Dirks LG, Dillard DA, Manson SM, Merrick M, Smith JJ, Prickette GC, Tetpon S, Galbreath D, Triplett B, Robinson RF. Depression management interests among Alaska Native and American Indian adults in primary care. J Affect Disord 2018; 239:214-219. [PMID: 30025310 DOI: 10.1016/j.jad.2018.05.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 07/01/2017] [Revised: 05/05/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Depression remains the second leading cause of disability worldwide. Symptoms of depression are expressed and experienced differently across cultural groups, impacting treatment decisions. Patient preferences predict service utilization, treatment selection and persistence, as well as health outcomes for medical and behavioral health conditions, including depression. We identified depression management preferences of Alaska Native and American Indian (AN/AI) people who receive care within a comprehensive, integrated, tribally owned and operated healthcare facility in Anchorage, Alaska. METHODS Adult AN/AI patients who screened positive for depression (10 or greater on the Patient Health Questionnaire - 9 (PHQ-9)) completed a culturally-tailored decision-support tool to assess their depression management interests. RESULTS The 125 eligible patients, who screened positive for depression, preferred counseling and medications to peer support groups, herbal remedies, and spiritual support. Those 18-39 years of age were more likely to prefer medications and less likely to prefer spirituality and peer support than those 40 years of age and older. Patients with moderate and severe depression were more likely to prefer exercise, healthy eating, and stress reduction than individuals with mild depression. LIMITATIONS Women comprised 78% of the sample. Responses may not adequately represent the views of men. CONCLUSIONS Counseling and medications should consistently be made available earlier in the course of depression management. Patient interest in exercise, stress reduction, and healthy eating to manage depression, especially among those with moderate and severe depression, offers opportunity for additional collaboration in an integrated care setting.
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Affiliation(s)
- Jaedon P Avey
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA.
| | - Lisa G Dirks
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Denise A Dillard
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Spero M Manson
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa Merrick
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Julia J Smith
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Guilford C Prickette
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Sonda Tetpon
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Donna Galbreath
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Brianna Triplett
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
| | - Renee F Robinson
- Southcentral Foundation, 4085 Tudor Center Drive, Suite 238, Anchorage, AK 99508, USA
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Schöffski P, Requilé A, van Cann T. Assessment of Physician's Systemic Treatment Preferences for Patients with Advanced Desmoid-Type Fibromatosis: Experience-Based Medicine in the Absence of High-Level Evidence. Oncol Res Treat 2018; 41:214-219. [PMID: 29562221 DOI: 10.1159/000486514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/27/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of advanced desmoid-type fibromatosis (DF) is poorly standardized and primarily based on physician's choice. We assessed systemic treatment preferences for advanced DF among European experts, with the aim to define a control treatment for prospective randomized trials. MATERIAL AND METHODS A structured questionnaire was sent to a group of physicians involved in DF treatment. RESULTS 54 experts from 14 countries (Europe, Israel) responded. Disease progression and failure of local therapy were typical indications for systemic therapy. Treatment preferences for patients with sporadic DF versus DF associated with Gardner's syndrome were similar. Physicians use at least 5 different classes of drugs (27 agents). The most frequently used compounds were anti-estrogens and non-steroidal anti-inflammatory agents (NSAIDs), in combination or as single agents. The second and third most common systemic approach was chemotherapy based on methotrexate or an anthracycline. Trial activity was limited to 1 country/1 multicentric study. CONCLUSIONS There is an unmet medical need for evidence-based treatments and well-designed studies. Clinical trials with systemic agents should ideally select a homogeneous DF population with advanced, progressive, ideally symptomatic disease and/or functional impairment after failure of wait-and-see and/or local treatments, and should be randomized, with placebo, anti-estrogens, NSAIDs, or physician's choice as comparator.
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Nickel B, Brito JP, Moynihan R, Barratt A, Jordan S, McCaffery K. Patients' experiences of diagnosis and management of papillary thyroid microcarcinoma: a qualitative study. BMC Cancer 2018; 18:242. [PMID: 29499654 PMCID: PMC5833084 DOI: 10.1186/s12885-018-4152-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 02/20/2018] [Indexed: 12/12/2022] Open
Abstract
Background In recent years management practices in relation to low-risk papillary microcarcinoma (PMC) have been evolving with increased awareness of the potential overdiagnosis and overtreatment of PMCs, and guidelines recommendations for non-surgical management options such as active surveillance. This study aimed to develop an in-depth understanding of patients’ experiences of the communication of their PMC diagnosis, their treatment preferences and decision making. Methods Semi-structured qualitative interviews with 25 patients diagnosed pre-operatively with PMC < 1 year since their diagnosis and treatment. Interviews were conducted between September 2015 and July 2016 and were audio-recorded and transcribed verbatim. Framework analysis method was used to analyse the data. Results The diagnosis and treatment experience of PMC patients varied widely. The majority of patients were asymptomatic, and their PMC was initially detected via an imaging test requested for a reason unrelated to a thyroid disorder or symptom. Clinicians generally described PMC to patients as being a “small” or “slow-growing” cancer, and there was little evidence that clinicians had discussions about the possibility of overdiagnosis or overtreatment. Overall, surgery was the only option discussed and offered to patients. Patients preference for treatment was largely based on eliminating the possibility of the cancer spreading (thyroidectomy) or not wanting to be on thyroid replacement medication for the rest of their life (hemi-thyroidectomy). Many patients reported emotional and physical side-effects associated with their diagnosis and treatment, however patients generally indicated that active surveillance is not something they would have been interested in if it was offered to them. Conclusions Evidence continues to emerge that many patients with PMCs may be overdiagnosed, and management guidelines are recommending more conservative management options for these patients. As a result, shared decision making around treatment options is vital so that patients are fully aware of the meaning of their diagnosis and their management options including active surveillance. Importantly, interventions to reduce unnecessary diagnoses of PMC are critically needed. Electronic supplementary material The online version of this article (10.1186/s12885-018-4152-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, 2006, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, 2006, NSW, Australia
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ray Moynihan
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, 2006, NSW, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Robina, 4226, QLD, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, 2006, NSW, Australia
| | - Susan Jordan
- QIMR Berghofer Medical Research Institute, Brisbane City, QLD, 4006, Australia.,School of Public Health, The University of Queensland, St Lucia, 4072, QLD, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, 2006, NSW, Australia. .,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, 2006, NSW, Australia.
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Muris P, Roodenrijs D, Kelgtermans L, Sliwinski S, Berlage U, Baillieux H, Deckers A, Gunther M, Paanakker B, Holterman I. No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD. Child Psychiatry Hum Dev 2018; 49:974-992. [PMID: 29767387 PMCID: PMC6208996 DOI: 10.1007/s10578-018-0812-x] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step, or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands. .,Stellenbosch University, Stellenbosch, South Africa.
| | | | - Lut Kelgtermans
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Sonja Sliwinski
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Ulrike Berlage
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Hanna Baillieux
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Anne Deckers
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | - Marieke Gunther
- Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
| | | | - Ida Holterman
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands ,Lucertis (Virenze-RIAGG) Maastricht, Maastricht, The Netherlands
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Campbell DG, Bonner LM, Bolkan CR, Lanto AB, Zivin K, Waltz TJ, Klap R, Rubenstein LV, Chaney EF. Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression. Ann Behav Med 2017; 50:533-44. [PMID: 26935310 DOI: 10.1007/s12160-016-9780-1] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. PURPOSE This study tests whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. METHODS We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. RESULTS Relative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. CONCLUSIONS High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement.
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Affiliation(s)
| | - Laura M Bonner
- Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA.,Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Cory R Bolkan
- Department of Human Development, Washington State University Vancouver, Vancouver, WA, USA
| | - Andrew B Lanto
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kara Zivin
- Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J Waltz
- Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Ruth Klap
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,UCLA School of Medicine, Los Angeles, CA, USA.,RAND Health Program, Santa Monica, CA, USA
| | - Edmund F Chaney
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Moritz S, Berna F, Jaeger S, Westermann S, Nagel M. The customer is always right? Subjective target symptoms and treatment preferences in patients with psychosis. Eur Arch Psychiatry Clin Neurosci 2017; 267:335-9. [PMID: 27194554 DOI: 10.1007/s00406-016-0694-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
Clinicians and patients differ concerning the goals of treatment. Eighty individuals with schizophrenia were assessed online about which symptoms they consider the most important for treatment, as well as their experience with different interventions. Treatment of affective and neuropsychological problems was judged as more important than treatment of positive symptoms (p < 0.005). While most individuals had experience with Occupational and Sports Therapy, only a minority had received Cognitive-Behavioral Therapy, Family Therapy, and Psychoeducation with family members before. Patients appraised Talk, Psychoanalytic, and Art Therapy as well as Metacognitive Training as the most helpful treatments. Clinicians should carefully take into consideration patients' preferences, as neglect of consumers' views may compromise outcome and adherence to treatment.
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Sidani S, Fox M, Epstein DR, Miranda J. Challenges in Using the Randomized Trial Design to Examine the Influence of Treatment Preferences. Can J Nurs Res 2016; 48:7-13. [PMID: 28841070 DOI: 10.1177/0844562116665274] [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] [Indexed: 11/16/2022] Open
Abstract
The overall purpose of this methodological study was to investigate the strengths and limitations of the randomized clinical trial design in examining the influence of treatment preferences on outcomes. The study was a secondary analysis of data obtained in two randomized clinical trials that evaluated behavioral therapies for insomnia. In both trials, the same design and methods were used to assess participants' treatment preferences and outcomes, however, the treatments differed. The results illustrated the challenges encountered in using the randomized clinical trial design. The challenges were related to the unbalanced distribution of participants with preferences for the study treatments, non-comparability of the subgroups with treatments matched or mismatched to their preferences, differential attrition, which compromised the sample size and composition of the subgroups and limited the use of the planned statistical analyses. Whether these challenges occur in trials of other types of treatments and target populations should be explored in future research. Some strategies were proposed and should be evaluated for their utility in addressing these challenges.
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Affiliation(s)
- Souraya Sidani
- 1 School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Mary Fox
- 2 School of Nursing, York University, Toronto, ON, Canada
| | - Dana R Epstein
- 3 Phoenix VA Health Care System, Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - Joyal Miranda
- 1 School of Nursing, Ryerson University, Toronto, ON, Canada
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Nickel B, Barratt A, Hersch J, Moynihan R, Irwig L, McCaffery K. How different terminology for ductal carcinoma in situ (DCIS) impacts women's concern and management preferences: A qualitative study. Breast 2015; 24:673-9. [PMID: 26376460 DOI: 10.1016/j.breast.2015.08.004] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE There are increasing rates of mastectomy and bi-lateral mastectomy in women diagnosed with ductal carcinoma in situ (DCIS). To help women avoid decisions that lead to unnecessary aggressive treatments, there have been recent calls to remove the cancer terminology from descriptions of DCIS. We investigated how different proposed terminologies for DCIS affect women's perceived concern and management preferences. MATERIALS AND METHODS Qualitative study using semi-structured interviews with a community sample of 26 Australian women varying by education and cancer screening experience. Women responded to a hypothetical scenario using terminology with and without the cancer term to describe DCIS. RESULTS Among a sample of women with no experience of a DCIS diagnosis, a hypothetical scenario involving a diagnosis of DCIS elicited high concern regardless of the terminology used to describe it. Women generally exhibited stronger negative reactions when a cancer term was used to describe DCIS compared to a non-cancer term, and most preferred the diagnosis be given as a description of abnormal cells. Overall women expressed interest in watchful waiting for DCIS but displayed preferences for very frequent monitoring with this management approach. CONCLUSION Communicating a diagnosis of DCIS using terminology that does not include the cancer term was preferred by many women and may enable discussions about more conservative management options. However, women's preference for frequent monitoring during watchful waiting suggests women need more education and reassurance about this management approach.
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Affiliation(s)
- Brooke Nickel
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW 2006, Australia
| | - Alexandra Barratt
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW 2006, Australia
| | - Jolyn Hersch
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW 2006, Australia
| | - Ray Moynihan
- Faculty of Health Sciences and Medicine, Bond University, QLD 4229, Australia
| | - Les Irwig
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW 2006, Australia
| | - Kirsten McCaffery
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW 2006, Australia.
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Puts MT, Tapscott B, Fitch M, Howell D, Monette J, Wan-Chow-Wah D, Krzyzanowska M, Leighl NB, Springall E, Alibhai SM. A systematic review of factors influencing older adults' decision to accept or decline cancer treatment. Cancer Treat Rev. 2015;41:197-215. [PMID: 25579752 DOI: 10.1016/j.ctrv.2014.12.010] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/12/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cancer is a disease that affects mostly older adults. Older adults often have other chronic health conditions in addition to cancer and may have different health priorities, both of which can impact cancer treatment decision-making. However, no systematic review of factors that influence an older cancer patient's decision to accept or decline cancer treatment has been conducted. MATERIALS AND METHODS Systematic review of the literature published between inception of the databases and February 2013. Dutch, English, French or German articles reporting on qualitative studies, cross-sectional, longitudinal observational or intervention studies describing factors why older adults accepted or declined cancer treatment examining actual treatment decisions were included. Ten databases were used. Two independent reviewers reviewed manuscripts and performed data abstraction using a standardized form and the quality of studies was assessed with the Mixed Methods Appraisal Tool. RESULTS Of 17,343 abstracts reviewed, a total of 38 studies were included. The majority focused on breast and prostate cancer treatment decisions and most studies used a qualitative design. Important factors for accepting treatment were convenience and success rate of treatment, seeing necessity of treatment, trust in the physician and following the physician's recommendation. Factors important for declining cancer treatment included concerns about the discomfort of the treatments, fear of side effects and transportation difficulties. CONCLUSION Although the reasons why older adults with cancer accepted or declined treatment varied considerably, the most consistent determinant was physician recommendation. Further studies using large, representative samples and exploring decision-making incorporating health literacy and comorbidity are needed.
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Liao LM, Baker E, Boyle ME, Woodhouse CR, Creighton SM. Experiences of surgical continence management approaches for cloacal anomalies: a qualitative analysis based on 6 women. J Pediatr Adolesc Gynecol 2014; 27:266-70. [PMID: 24841521 DOI: 10.1016/j.jpag.2013.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE The aim of this qualitative study was to gain insight into health care experiences of young women diagnosed with cloacal anomalies, with a special focus on continence management. DESIGN Qualitative analysis of one-to-one interviews. SETTING A tertiary center for congenital anomalies of the urogenital tract in London. PARTICIPANTS Six women aged 16 to 24 with cloacal anomalies. INTERVENTIONS Tape-recorded one-to-one semi-stuctured interviews with a skilled interviewer. MAIN OUTCOME MEASURE(S) The taped interviews were transcribed and analyzed verbatim using interpretative phenomenological analysis according to the research question. Organizing themes across all of the accounts were identified. RESULTS Two organizing themes concerning our research interests are summarized. The first theme Personal Agency in the Hands of Experts focuses on the interviewees' appreciation of their life-saving surgical care and their involvement in treatment decisions. The second theme Compromises and Trade-Offs focuses on what it was like to live with the more traditional versus the more advanced continence methods. Reliability emerged as a key priority in terms of continence treatment outcome. Gratitude may have interfered with the women's honest communications during treatment decision and evaluation consultations. CONCLUSIONS A more developed approach to communication about the complex interventions proposed, founded on a nuanced understanding of users perspectives, can enhance informed decision making about continence management approaches. Despite these specific gaps, the interviewees were appreciative of their care and optimistic about life.
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Barry VB, Raiff BR. Weight management preferences in a non-treatment seeking sample. Health Promot Perspect 2013; 3:147-53. [PMID: 24688964 DOI: 10.5681/hpp.2013.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/20/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity is a serious public health issue in the United States, with the CDC reporting that most adult Americans are now either overweight or obese. Little is known about the comparative acceptability of available weight management approaches in non-treatment seeking samples. METHOD This report presents preliminary survey data collected from an online sample on weight management preferences for 8 different weight management strategies including a proposed incentive-based program. Participants were 72 individuals (15 men, 55 women and 2 transgendered individuals) who self-re-ported being overweight or obese, or who currently self-reported a normal weight but had attempted to lose weight in the past. RESULTS ANOVA and Pair-wise comparison indicated clear preferences for cer-tain treatments over others in the full sample; most notably, the most popular option in our sample for managing weight was to diet and exercise without pro-fessional assistance. Several differences in preference between the three weight groups were also observed. CONCLUSIONS Dieting and exercising without any professional assistance is the most highly endorsed weight management option among all groups. Overweight and obese individuals may find self-management strategies for weight loss less attractive than normal weight individuals, but still prefer it to other alternatives. This has implications for the development and dissemination of empirically based self-management strategies for weight.
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Affiliation(s)
- Victoria B Barry
- National Development and Research Institute, New York, New York10010, USA
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Downey L, Au DH, Curtis JR, Engelberg RA. Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions. J Pain Symptom Manage 2013; 46:9-19. [PMID: 23017611 PMCID: PMC3534846 DOI: 10.1016/j.jpainsymman.2012.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/04/2012] [Accepted: 07/11/2012] [Indexed: 12/23/2022]
Abstract
CONTEXT Better clinician understanding of patients' end-of-life treatment preferences has the potential for reducing unwanted treatment, decreasing health care costs, and improving end-of-life care. OBJECTIVES To investigate patient preferences for life-sustaining therapies, clinicians' accuracy in understanding those preferences, and predictors of patient preference and clinician error. METHODS This was an observational study of 196 male veterans with chronic obstructive pulmonary disease who participated in a randomized trial. Measures included patients' preferences for mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) if needed in their current state of health, and outpatient clinicians' beliefs about those preferences. RESULTS Analyses were based on 54% of participants in the trial who had complete patient/clinician data on treatment preferences. Patients were more receptive to CPR than MV (76% vs. 61%; P<0.001). Preferences for both treatments were significantly associated with the importance patients assigned to avoiding life-sustaining therapies during the final week of life (MV: b=-0.11, P<0.001; CPR: b=-0.09, P=0.001). When responses were dichotomized (would/would not want treatment), clinicians' perceptions matched patient preferences in 75% of CPR cases and 61% of MV cases. Clinician errors increased as patients preferred less aggressive treatment (MV: b=-0.28, P<0.001; CPR: b=-0.32, P<0.001). CONCLUSION Clinicians erred more often about patients' wishes when patients did not want treatment than when they wanted it. Treatment decisions based on clinicians' perceptions could result in costly and unwanted treatments. End-of-life care could benefit from increased clinician-patient discussion about end-of-life care, particularly if discussions included patient education about risks of treatment and allowed clinicians to form and maintain accurate impressions of patients' preferences.
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Affiliation(s)
- Lois Downey
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
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