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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Humphries B, León-García M, Bates SM, Guyatt G, Eckman MH, D'Souza R, Shehata N, Jack SM, Alonso-Coello P, Xie F. Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study. BMJ Evid Based Med 2023; 28:309-319. [PMID: 36858800 DOI: 10.1136/bmjebm-2022-112098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES To gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients' experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin (LMWH) in the antenatal period. DESIGN Mixed-methods explanatory sequential pilot study. SETTING Hospitals in Canada (n=1) and Spain (n=4 sites). Due to the COVID-19 pandemic, we conducted part of the study virtually. PARTICIPANTS 15 individuals with a prior venous thromboembolism who were pregnant or planning pregnancy and had been referred for counselling regarding LMWH. INTERVENTION A shared decision-making intervention that included three components: (1) direct choice exercise; (2) preference elicitation exercises and (3) personalised decision analysis. MAIN OUTCOME MEASURES Participants completed a self-administered questionnaire to evaluate decision quality (decisional conflict, self-efficacy and satisfaction). Semistructured interviews were then conducted to explore their experience and perceptions of the decision-making process. RESULTS Participants in the study appreciated the opportunity to use an evidence-based decision support tool that considered their personal values and preferences and reported feeling more prepared for their consultation. However, there were mixed reactions to the standard gamble and personalised treatment recommendation. Some participants could not understand how to complete the standard gamble exercises, and others highlighted the need for more informative ways of presenting results of the decision analysis. CONCLUSION Our results highlight the challenges and opportunities for those who wish to incorporate decision analysis to support shared decision-making for clinical decisions.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Montserrat León-García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - M H Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rohan D'Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nadine Shehata
- Departments of Medicine, Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Susan M Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
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3
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Zhao J, Jull J, Finderup J, Smith M, Kienlin SM, Rahn AC, Dunn S, Aoki Y, Brown L, Harvey G, Stacey D. Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review. BMC Med Inform Decis Mak 2022; 22:265. [PMID: 36209086 PMCID: PMC9548102 DOI: 10.1186/s12911-022-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions. Methods We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions. Results We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches’, patients’, and clinicians’ commitments to patients’ involvement in decision making and decision coaches’ knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient’s values) (five CMOs). After decision coaching, the patient’s progress in making or implementing a values-based preferred decision can be facilitated by the decision coach’s advocacy for the patient, and the patient’s deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs). Discussion In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients’ participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients’ progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02007-0.
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Affiliation(s)
- Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Centre for Patient Involvement, Aarhus University & Central Region Denmark, Aarhus, Denmark
| | | | - Simone Maria Kienlin
- Department of Health and Caring Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, Norway.,Department of Medicine and Healthcare, The South-Eastern Norway Regional Health Authority, Hamar, Norway
| | - Anne Christin Rahn
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sandra Dunn
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,BORN Ontario, Ottawa, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yumi Aoki
- Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Leanne Brown
- School of Nursing, Queensland University of Technology, Brisban, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada.
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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5
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Humphries B, León-García M, Quispe ENDG, Canelo-Aybar C, Valli C, Pacheco-Barrios K, Agarwal A, Mirabi S, Eckman MH, Guyatt G, Bates SM, Xie F, Alonso-Coello P. More work needed on decision analysis for shared decision-making: A scoping review. J Clin Epidemiol 2021; 141:106-120. [PMID: 34628018 DOI: 10.1016/j.jclinepi.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making. STUDY DESIGN AND SETTING For this scoping review, we searched five bibliographic databases (from inception until February 2021), reference lists of included studies, trial registries, a thesis database and websites of relevant interest groups. Studies were eligible if they evaluated the application of decision analysis in a shared decision-making encounter. Pairs of reviewers independently screened and selected studies for inclusion, extracted study information using a data extraction form developed by the research team and assessed risk of bias for all studies with an experimental or quasi-experimental design. Data were narratively synthesized. RESULTS We identified 27 studies that varied greatly with regard to their patient population, design, content and delivery. A range of outcomes were evaluated to explore the effectiveness and acceptability of decision analytic interventions, with little information about the implementation process. Most studies found that decision analysis was broadly beneficial. CONCLUSION Despite the compelling rationale on the potential for decision analysis to support shared decision-making, rigorous randomized controlled trials are needed to confirm these interventions' effectiveness, while qualitative studies should seek to understand their potential implementation.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Montserrat León-García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ena Niño de Guzman Quispe
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Mirabi
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Mark H Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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6
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Edwards AL, Shaw PA, Halton CC, Bailey SC, Wolf MS, Andrews EN, Cartwright T. "It just makes me feel a little less alone": a qualitative exploration of the podcast Menopause: Unmuted on women's perceptions of menopause. Menopause 2021; 28:1374-1384. [PMID: 34469933 DOI: 10.1097/gme.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Menopause can negatively impact women's quality of life, with many women reporting inadequate information and support. Podcasts have grown in popularity in recent years and have been found to be accessible methods for increasing knowledge and challenging perceptions of stigmatized topics. The current research aimed to understand the impact of the podcast "menopause: unmuted" on women's menopause-related knowledge, understanding, and communication practices. METHODS A diverse sample of 30 women aged 40 to 60 years listened to the podcast series, which focused on menopause stories, before taking part in semistructured interviews to discuss the impact of the podcast on how they understood and communicated about menopause. The interviews were analyzed thematically. RESULTS Two overarching themes were identified in the data. A "journey of knowledge gain" explores participants' understanding of menopause before listening to the podcast and describes how this is deepened by hearing and connecting with women's stories. "Reframing menopause" describes the impact of the podcast, where women reflect on the value of communication amongst women, challenge and re-evaluate the stigmatization of menopause, and discuss ways to make positive behavioral changes in their lives. CONCLUSIONS The podcast "menopause: unmuted" helped women to learn about the menopause experience, have a greater sense of belonging to a community of women, and feel empowered to make changes in their own lives. Sharing stories via podcasts has potential as an accessible and impactful medium to educate women and reduce the widespread stigma associated with menopause.
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Affiliation(s)
- Amy L Edwards
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Philippa A Shaw
- School of Social Sciences, University of Westminster, London, UK
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, UK
- Studio Health, London, UK
| | - Stacy C Bailey
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL
| | | | - Tina Cartwright
- School of Social Sciences, University of Westminster, London, UK
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7
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Rahn AC, Jull J, Boland L, Finderup J, Loiselle MC, Smith M, Köpke S, Stacey D. Guidance and/or Decision Coaching with Patient Decision Aids: Scoping Reviews to Inform the International Patient Decision Aid Standards (IPDAS). Med Decis Making 2021; 41:938-953. [PMID: 33759626 DOI: 10.1177/0272989x21997330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In 2005, the International Patient Decision Aid Standards (IPDAS) collaboration identified guidance and decision coaching as important dimensions of patient decision aids (PtDAs) and developed a set of quality criteria. We sought to update definitions, theoretical rationale, and evidence for guidance and/or decision coaching used within or alongside PtDAs for the IPDAS update 2.0. METHODS We conducted 2 scoping reviews on guidance and decision coaching, including systematic searches and a hand search of the Cochrane Review on PtDAs. Eligible studies were randomized controlled trials (RCTs) on guidance or decision coaching used with/alongside PtDAs. Data, including conceptual models, were summarized narratively and with meta-analyses when appropriate. RESULTS Of 1022 citations, we found no RCTs that evaluated guidance in PtDAs. The 2013 definition for guidance was endorsed, and we made minimal changes to the description of guidance. Of 3039 citations, we identified 21 RCTs on decision coaching informed by 5 conceptual models stating that people exposed to decision coaching are more likely to progress in making informed decisions consistent with their values. Compared to usual care, decision coaching with PtDAs led to improved knowledge mean difference [MD], 19.5/100; 95% confidence interval [CI], 10.0-29.0; 5 RCTs). Compared to decision coaching alone, PtDAs led to a small improvement in knowledge (MD, 3.6/100; 95% CI, 1.0-6.3; 3 RCTs). There were variable effects on other outcomes. We simplified the decision coaching definition slightly and defined minimal decision coaching elements. CONCLUSION We found no evidence on which to propose changes in guidance in IPDAS. Decision coaching is continuing to be used alongside PtDAs, but there is inadequate evidence on the added effectiveness compared to PtDAs alone. The decision coaching definition was updated with minimal elements.
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Affiliation(s)
- Anne Christin Rahn
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Janet Jull
- Queen's University, Kingston, ON, Canada
| | - Laura Boland
- Western University, London, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeanette Finderup
- Aarhus University Hospital & Aarhus University, Aarhus, Denmark and ResCenPI - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Denmark
| | | | | | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dawn Stacey
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Still CH, Tahir S, Yarandi HN, Hassan M, Gary FA. Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women. West J Nurs Res 2020; 42:784-794. [PMID: 32590927 DOI: 10.1177/0193945919898477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Sadia Tahir
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Hossein N Yarandi
- College of Nursing, Office of Health Research, Wayne State University, Detroit, MI, USA
| | - Mona Hassan
- College of Nursing, Prairie View A&M University, Houston, TX, USA
| | - Faye A Gary
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Vandenberg AE, Bowling CB, Adisa O, Sahlie A, Nadel L, Lea J, Plantinga LC. Shared patient and provider values in end-stage renal disease decision making: Identifying the tensions. PATIENT EDUCATION AND COUNSELING 2019; 102:1280-1287. [PMID: 30803904 DOI: 10.1016/j.pec.2019.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine concordance and tensions in values among stakeholder groups across the shared decision making process for end-stage renal disease patients treated with hemodialysis. METHODS A thematic analysis of transcripts from three stakeholder groups: hemodialysis patients (2 groups, n = 17), nephrologists (1 group, n = 9), and non-physician providers (dietitians, social workers, and registered nurses) (1 group, n = 8). A framework of decision-making components (communication, information, decision, behavior, and outcome) guided analysis of values within and across groups. RESULTS Shared values included communication that informed patients and involved family; information about function, trajectory, life context, and patient experience; behavior to manage diet; and outcomes of function, safety, and survival. Identified thematic tensions in patient-provider values were: personalized vs. routinized communication; shared vs. separate information; managed vs. adherent behavior; and participating vs. protected outcome. Patient behavior emerged as a contested area of control. CONCLUSION Emphasizing shared values and bridging values conflicts may ease tensions surrounding self-care behavior by facilitating discussions about diet, medications, and consistent dialyzing. PRACTICE IMPLICATIONS More individualized information needs to be delivered to patients in a personalized communication approach that can still be achieved within a busy dialysis clinic setting.
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Affiliation(s)
- Ann E Vandenberg
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - C Barrett Bowling
- Durham Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Olufunmilola Adisa
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abyalew Sahlie
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Leigh Nadel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Janice Lea
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura C Plantinga
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Leinweber KA, Columbo JA, Kang R, Trooboff SW, Goodney PP. A Review of Decision Aids for Patients Considering More Than One Type of Invasive Treatment. J Surg Res 2019; 235:350-366. [PMID: 30691817 PMCID: PMC10647019 DOI: 10.1016/j.jss.2018.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/29/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
Abstract
With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.
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Affiliation(s)
| | - Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Ravinder Kang
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Spencer W Trooboff
- VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Philip P Goodney
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
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Evaluating the content and development of decision aid tools for the management of menopause: A scoping review. Maturitas 2017; 106:80-86. [DOI: 10.1016/j.maturitas.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 11/17/2022]
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Jones G, Hughes J, Mahmoodi N, Smith E, Skull J, Ledger W. What factors hinder the decision-making process for women with cancer and contemplating fertility preservation treatment? Hum Reprod Update 2017; 23:433-457. [DOI: 10.1093/humupd/dmx009] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/27/2017] [Indexed: 02/07/2023] Open
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1171] [Impact Index Per Article: 167.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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Jones GL, Hughes J, Mahmoodi N, Greenfield D, Brauten-Smith G, Skull J, Gath J, Yeomanson D, Baskind E, Snowden JA, Jacques RM, Velikova G, Collins K, Stark D, Phillips R, Lane S, Bekker HL. Observational study of the development and evaluation of a fertility preservation patient decision aid for teenage and adult women diagnosed with cancer: the Cancer, Fertility and Me research protocol. BMJ Open 2017; 7:e013219. [PMID: 28289046 PMCID: PMC5353284 DOI: 10.1136/bmjopen-2016-013219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women diagnosed with cancer and facing potentially sterilising cancer treatment have to make time-pressured decisions regarding fertility preservation with specialist fertility services while undergoing treatment of their cancer with oncology services. Oncologists identify a need for resources enabling them to support women's fertility preservation decisions more effectively; women report wanting more specialist information to make these decisions. The overall aim of the 'Cancer, Fertility and Me' study is to develop and evaluate a new evidence-based patient decision aid (PtDA) for women with any cancer considering fertility preservation to address this unmet need. METHODS AND ANALYSIS This is a prospective mixed-method observational study including women of reproductive age (16 years +) with a new diagnosis of any cancer across two regional cancer and fertility centres in Yorkshire, UK. The research involves three stages. In stage 1, the aim is to develop the PtDA using a systematic method of evidence synthesis and multidisciplinary expert review of current clinical practice and patient information. In stage 2, the aim is to assess the face validity of the PtDA. Feedback on its content and format will be ascertained using questionnaires and interviews with patients, user groups and key stakeholders. Finally, in stage 3 the acceptability of using this resource when integrated into usual cancer care pathways at the point of cancer diagnosis and treatment planning will be evaluated. This will involve a quantitative and qualitative evaluation of the PtDA in clinical practice. Measures chosen include using count data of the PtDAs administered in clinics and accessed online, decisional and patient-reported outcome measures and qualitative feedback. Quantitative data will be analysed using descriptive statistics, paired sample t-tests and CIs; interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Research Ethics Committee approval (Ref: 16/EM/0122) and Health Research Authority approval (Ref: 194751) has been granted. Findings will be published in open access peer-reviewed journals, presented at conferences for academic and health professional audiences, with feedback to health professionals and program managers. The Cancer, Fertility and Me patient decision aid (PtDA) will be disseminated via a diverse range of open-access media, study and charity websites, professional organisations and academic sources. External endorsement will be sought from the International Patient Decision Aid Standards (IPDAS) Collaboration inventory of PtDAs and other relevant professional organisations, for example, the British Fertility Society. TRIAL REGISTRATION NUMBER NCT02753296; pre-results.
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Affiliation(s)
- G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - J Hughes
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, City Centre Campus, Leeds, UK
| | - D Greenfield
- Department of Oncology, Sheffield Teaching NHS Hospitals Foundation Trust, Sheffield University, Sheffield, UK
| | | | - J Skull
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Gath
- Independent Cancer Patients' Voice, London, UK
| | - D Yeomanson
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - E Baskind
- Seacroft Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - R M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Velikova
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - K Collins
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - D Stark
- University of Leeds, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - R Phillips
- Center for Review and Dissemination, University of York, Leeds General Infirmary, Leeds Teaching Hospitals, York, UK
| | - S Lane
- Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - H L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Book Reviews : A Woman Doctor's Guide to Hormone Therapy— How to Choose What's Right for You. By NANANDA FRANCETTE COL. Worcester, Massachusetts: Tatnuck Book-seller Press, 1997, 205 pages. $24.95. Med Decis Making 2016. [DOI: 10.1177/0272989x9801800418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tiller K, Meiser B, Gaff C, Kirk J, Dudding T, Phillips KA, Friedlander M, Tucker K. A Randomized Controlled Trial of a Decision Aid for Women at Increased Risk of Ovarian Cancer. Med Decis Making 2016; 26:360-72. [PMID: 16855125 DOI: 10.1177/0272989x06290486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. Methods. This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. Participants. 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. Outcome measures. Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. Results. Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. Conclusion. This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk.
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Affiliation(s)
- K Tiller
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia.
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Trenaman L, Selva A, Desroches S, Singh K, Bissonnette J, Bansback N, Stacey D. A measurement framework for adherence in patient decision aid trials applied in a systematic review subanalysis. J Clin Epidemiol 2016; 77:15-23. [DOI: 10.1016/j.jclinepi.2016.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision Aids for Benign Prostatic Hyperplasia: Applicability across Race and Education. Med Decis Making 2016; 24:359-66. [PMID: 15271274 DOI: 10.1177/0272989x04267010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background/Method. Decision aids have not been widely tested in diverse audiences. The authors conducted interviews in a 2 2 race by education design with participants who were 50 years old (n = 188). The decision aid was a benign prostatic hyperplasia videotape. Results. There was an increase in knowledge equal in all groups, with baseline knowledge higher in whites. The decision stage increased in all groups and was equivalent in the marginal-illiterate subgroup (n = 0.15). Conclusion. Contrary to expectations, results show no difference by race or college education in knowledge gain or increase in reported readiness to decide. The video appeared to produce change across race and education. The end decision stage was high, especially in less educated men. Results suggest that decision aids may be effective without tailoring, as suggested previously to enhance health communication in diverse audiences. Research should test findings in representative samples and in clinical encounters and identify types of knowledge absorbed from decision aids and whether the shift to decision reflects data/ knowledge or shared decision-making message.
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Affiliation(s)
- David R Rovner
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing 48823, USA
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Elkin EB, Cowen ME, Cahill D, Steffel M, Kattan MW. Preference Assessment Method Affects Decision-Analytic Recommendations: A Prostate Cancer Treatment Example. Med Decis Making 2016; 24:504-10. [PMID: 15358999 DOI: 10.1177/0272989x04268954] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To evaluate the effect of preference assessment method on treatment recommended by an individualized decision-analytic model for early prostate cancer. Methods. Health state preferences were elicited by time tradeoff, rating scale, and a power transformation of the rating scale from 63 men ages 55 to 75. The authors used these values in a Markov model to determine whether radical prostatectomy or watchful waiting yielded the greater quality-adjusted life expectancy. Results. Time tradeoff and transformed rating scale recommendations differed widely. Time tradeoff and transformed rating scale utilities differed in their treatment recommendation for 21% to 52% of men, and the mean difference in quality-adjusted life years varied from less than 0.5 to greater than 1.0. Conclusions. Treatment recommendations from the prostate cancer decision model were sensitive to the method of preference assessment. If decision analysis is used to counsel individual patients, careful considerationmust be given to the method of preference elicitation.
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Affiliation(s)
- Elena B Elkin
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Witteman HO, Scherer LD, Gavaruzzi T, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Design Features of Explicit Values Clarification Methods. Med Decis Making 2016; 36:453-71. [DOI: 10.1177/0272989x15626397] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Background. Values clarification is a recommended element of patient decision aids. Many different values clarification methods exist, but there is little evidence synthesis available to guide design decisions. Purpose. To describe practices in the field of explicit values clarification methods according to a taxonomy of design features. Data Sources. MEDLINE, all EBM Reviews, CINAHL, EMBASE, Google Scholar, manual search of reference lists, and expert contacts. Study Selection. Articles were included if they described 1 or more explicit values clarification methods. Data Extraction. We extracted data about decisions addressed; use of theories, frameworks, and guidelines; and 12 design features. Data Synthesis. We identified 110 articles describing 98 explicit values clarification methods. Most of these addressed decisions in cancer or reproductive health, and half addressed a decision between just 2 options. Most used neither theory nor guidelines to structure their design. “Pros and cons” was the most common type of values clarification method. Most methods did not allow users to add their own concerns. Few methods explicitly presented tradeoffs inherent in the decision, supported an iterative process of values exploration, or showed how different options aligned with users’ values. Limitations. Study selection criteria and choice of elements for the taxonomy may have excluded values clarification methods or design features. Conclusions. Explicit values clarification methods have diverse designs but can be systematically cataloged within the structure of a taxonomy. Developers of values clarification methods should carefully consider each of the design features in this taxonomy and publish adequate descriptions of their designs. More research is needed to study the effects of different design features.
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Affiliation(s)
- Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Laura D. Scherer
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Teresa Gavaruzzi
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Arwen H. Pieterse
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Andrea Fuhrel-Forbis
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nicole Exe
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Valerie C. Kahn
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Deb Feldman-Stewart
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Nananda F. Col
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Alexis F. Turgeon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
| | - Angela Fagerlin
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Population Health and Optimal Health Practices Unit, Research Center of the CHU de Québec, Québec City, Québec, Canada (HOW, AFT)
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
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Drake ER, Engler-Todd L, O'Connor AM, Surh LC, Hunter A. Development and Evaluation of a Decision Aid About Prenatal Testing for Women of Advanced Maternal Age. J Genet Couns 2015; 8:217-33. [PMID: 26142262 DOI: 10.1023/a:1022998415890] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop and evaluate a decision aid designed to prepare patients of advanced maternal age for counseling about prenatal diagnostic testing. SETTING A regional genetics center. DESIGN A before/after study. INTERVENTIONS Participants used an audioguided workbook to learn about options and outcomes and to clarify personal risks, values, questions, and predispositions. SUBJECTS 21 women of advanced maternal age and 17 spouses. MAIN OUTCOME MEASURES Knowledge of prenatal testing alternatives, decisional conflict, level of anxiety, and acceptability of the decision aid. RESULTS After using the decision aid, participants had significantly reduced decisional conflict (uncertainty) and a significant increase in knowledge. There was no effect on state or trait anxiety. More than three-quarters of participants were satisfied with the length, clarity, balance, and acceptability of the decision aid. CONCLUSIONS The decision aid shows promise as a useful aid for preparing couples for counseling.
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Affiliation(s)
- E R Drake
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Rashidian H, Nedjat S, Mounesan L, Haghjou L, Majdzadeh R. The Attitude of Physicians toward the Use of Patient Decision Aids in Iran as a Developing Country. Int J Prev Med 2015; 6:18. [PMID: 25789150 PMCID: PMC4362286 DOI: 10.4103/2008-7802.151827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/18/2014] [Indexed: 11/06/2022] Open
Abstract
Background: The patient decision aids (PDAs), which can facilitate the decision-making process when choosing the optimal method of treatment, are a challenge to patients. This study tried to determine the attitude of physicians on the barriers of using PDAs in the way of prioritizing and proposing solutions to them. Methods: This study was a cross-sectional research carried out on 150 clinical faculty members of research centers and scientific associations affiliated with Tehran University of Medical Sciences. The participants were chosen using the convenience sampling method. The attitude of physicians toward the application of PDAs was interviewed using a self-made questionnaire composed of 23 questions. The association between physicians’ attitude to the use of PDAs and their characteristics was examined using the t-test, analysis of variance, and correlation test. Results: The mean score of physicians’ attitude was 76.2 (standard deviation =11.9) and the range was 33–107. There was a significant and direct association between the attitude toward the use of PDA and the respondents’ age (r = 0.237, P = 0.007), years of experience (r = 0.205, P = 0.02), being male (P = 0.04), and working in the private sector (P = 0.009). The attitude score of instructors was significantly lower than that of professors (P = 0.02). Conclusions: The general attitude of physicians toward the use of PDAs was positive. However, apparently as a result of problems mentioned in this study for the developing countries such as Iran, it is much easier to employ these tools in centers run by the private sector. Usage of such tools in public centers necessitates systemic infrastructure as well as credits and budgets required for the training of patients and physicians.
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Affiliation(s)
- Hamideh Rashidian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Mounesan
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Haghjou
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Sehhatie Shafaie F, Mirghafourvand M, Jafari M. Effect of Education through Support -Group on Early Symptoms of Menopause: a Randomized Controlled Trial. J Caring Sci 2014; 3:247-56. [PMID: 25709980 PMCID: PMC4333897 DOI: 10.5681/jcs.2014.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Menopause is one of the most important crises in the life of women. The control of menopause symptoms is a main challenge in providing care to this population. So, the aim of present study was to investigate the effect of education through support -group on early symptoms of menopause. METHODS In this randomized controlled clinical trial 124 postmenopausal women who had a health records in Valiasr participatory health center of Eslamshahr city were participated. These women were allocated by block randomization method into support group (62 women) and control group (62 women).Women in support group was assigned into 6 groups. Three 60-minutes educational sessions were conducted in 3 sequential weekly sessions. Early menopausal symptoms were measured before and 4 weeks after the intervention by using Greene scale (score ranged from 0 to 63). Data analysis was performed by ANCOVA statistical test. RESULTS There were no statistical differences between two groups in demographic characteristics and the total score of the Greene scale before intervention. The mean score of the Greene scale in support group was statistically less than control group 4 weeks after intervention. The number of hot flashes in the support group was significantly lower than control group, 4 weeks after intervention. CONCLUSION Education through support group was effective in reducing the early symptoms of menopause. Thus, this educational method can be used as an appropriate strategy for enhancing women' health and their dealing with annoying symptoms of menopause.
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Affiliation(s)
- Fahimeh Sehhatie Shafaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of
Medical Sciences, Tabriz, Iran
| | - Mozhgan Mirghafourvand
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of
Medical Sciences, Tabriz, Iran
| | - Maryam Jafari
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of
Medical Sciences, Tabriz, Iran
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The cost-effectiveness of patient decision aids: A systematic review. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:251-7. [PMID: 26250632 DOI: 10.1016/j.hjdsi.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/09/2014] [Indexed: 12/11/2022]
Abstract
The Affordable Care Act includes provisions to encourage patient-centered care through the use of shared decision making (SDM) and patient decision aids (PtDA). PtDAs are tools that can help encourage SDM by providing information about competing treatment options and elucidating patients׳ values and preferences. Implementing PtDAs into routine practice may incur additional costs through training or increases in physician time. Prominent commentaries have proposed that these costs might be offset if patients choose less expensive options than their providers. However, the cost-effectiveness of PtDAs to date is unclear. The aim of this study was to review the economic evidence from PtDA trials. Our search identified 5347 articles, with 29 included following full-text review. Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities). Our review suggests that policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs.
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Garvelink MM, ter Kuile MM, Stiggelbout AM, de Vries M. Values clarification in a decision aid about fertility preservation: does it add to information provision? BMC Med Inform Decis Mak 2014; 14:68. [PMID: 25106453 PMCID: PMC4236594 DOI: 10.1186/1472-6947-14-68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 07/25/2014] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to evaluate the effect of a decision aid (DA) with information only compared to a DA with values clarification exercise (VCE), and to study the role of personality and information seeking style in DA-use, decisional conflict (DC) and knowledge. Methods Two scenario-based experiments were conducted with two different groups of healthy female participants. Dependent measures were: DC, knowledge, and DA-use (time spent, pages viewed, VCE used). Respondents were randomized between a DA with information only (VCE-) and a DA with information plus a VCE(VCE+) (experiment 1), or between information only (VCE-), information plus VCE without referral to VCE(VCE+), and information plus a VCE with specific referral to the VCE, requesting participants to use the VCE(VCE++) (experiment 2). In experiment 2 we additionally measured personality (neuroticism/conscientiousness) and information seeking style (monitoring/blunting). Results Experiment 1. There were no differences in DC, knowledge or DA-use between VCE- (n=70) and VCE+ (n=70). Both DAs lead to a mean gain in knowledge from 39% at baseline to 73% after viewing the DA. Within VCE+, VCE-users (n=32, 46%) reported less DC compared to non-users. Since there was no difference in DC between VCE- and VCE+, this is likely an effect of VCE-use in a self-selected group, and not of the VCE per se. Experiment 2. There were no differences in DC or knowledge between VCE- (n=65), VCE+ (n=66), VCE++ (n=66). In all groups, knowledge increased on average from 42% at baseline to 72% after viewing the DA. Blunters viewed fewer DA-pages (R=0.38, p<.001). More neurotic women were less certain (R=0.18, p<.01) and felt less supported in decision making (R=0.15, p<.05); conscientious women felt more certain (R=-0.15, p<.05) and had more knowledge after viewing the DA (R=0.15, p<.05). Conclusions Both DAs lead to increased knowledge in healthy populations making hypothetical decisions, and use of the VCE did not improve knowledge or DC. Personality characteristics were associated to some extent with DA-use, information seeking styles with aspects of DC. More research is needed to make clear recommendations regarding the need for tailoring of information provision to personality characteristics, and to assess the effect of VCE use in actual patients.
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Affiliation(s)
- Mirjam M Garvelink
- Department of Gynecology, Leiden University Medical Center (LUMC), Mail zone VRSP, P/O Box 9600, 2300 RC Leiden, the Netherlands.
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Vélez Toral M, Godoy-Izquierdo D, Padial García A, Lara Moreno R, Mendoza Ladrón de Guevara N, Salamanca Ballesteros A, de Teresa Galván C, Godoy García JF. Psychosocial interventions in perimenopausal and postmenopausal women: A systematic review of randomised and non-randomised trials and non-controlled studies. Maturitas 2014; 77:93-110. [DOI: 10.1016/j.maturitas.2013.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
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Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014:CD001431. [PMID: 24470076 DOI: 10.1002/14651858.cd001431.pub4] [Citation(s) in RCA: 834] [Impact Index Per Article: 83.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. OBJECTIVES To assess the effects of decision aids for people facing treatment or screening decisions. SEARCH METHODS For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). SELECTION CRITERIA We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:A) 'choice made' attributes;B) 'decision-making process' attributes.Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. MAIN RESULTS This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies).A) Criteria involving 'choice made' attributes:Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13).B) Criteria involving 'decision-making process' attributes:Decision aids compared to usual care interventions resulted in:a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18);b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); andc) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18).Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to be made, or understanding that values affect the choice.C) Secondary outcomes Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable.The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. AUTHORS' CONCLUSIONS There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
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Abstract
Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed. Conclusion Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.
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Stacey D, Kryworuchko J, Belkora J, Davison BJ, Durand MA, Eden KB, Hoffman AS, Koerner M, Légaré F, Loiselle MC, Street RL. Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S11. [PMID: 24624995 PMCID: PMC4045677 DOI: 10.1186/1472-6947-13-s2-s11] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts "coaching" and "guidance"; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. METHODS We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. RESULTS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. CONCLUSIONS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 451 Smyth Road (RGN Room 1118), Ottawa, Ontario, K1H 8M5, Canada
| | - Jennifer Kryworuchko
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Jeff Belkora
- Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, California 94118, USA
| | - B Joyce Davison
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Marie-Anne Durand
- Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL 109AB, UK
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239-3098, USA
| | - Aubri S Hoffman
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway (HB7250), Lebanon, New Hampshire 03766, USA
| | - Mirjam Koerner
- Department of Medical Psychology and Medical Sociology, University of Freiburg, Hebelstr. 29, 79104 Freiburg, Germany
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Local 4617, Quebec, Province of Quebec G1V 0A6, Canada
| | - Marie-Chantal Loiselle
- School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150, place Charles-Le Moyne (Bureau 200), Longueuil, Province of Quebec J4K 0A8, Canada
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, Texas 77843-4234, USA
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Sepucha KR, Borkhoff CM, Lally J, Levin CA, Matlock DD, Ng CJ, Ropka ME, Stacey D, Joseph-Williams N, Wills CE, Thomson R. Establishing the effectiveness of patient decision aids: key constructs and measurement instruments. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S12. [PMID: 24625035 PMCID: PMC4044563 DOI: 10.1186/1472-6947-13-s2-s12] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in the measurement of effectiveness. METHODS This updated overview incorporates: a) an examination of the instruments used to measure five key decision-making process constructs (i.e., recognize decision, feel informed about options and outcomes, feel clear about goals and preferences, discuss goals and preferences with health care provider, and be involved in decisions) and decision quality constructs (i.e., knowledge, realistic expectations, values-choice agreement) within the 86 trials in the Cochrane review; and b) a summary of the 2011 Cochrane Collaboration's review of PtDAs for these key constructs. Data on the constructs and instruments used were extracted independently by two authors from the 86 trials and any disagreements were resolved by discussion, with adjudication by a third party where required. RESULTS The 86 studies provide considerable evidence that PtDAs improve the decision-making process and decision quality. A majority of the studies (76/86; 88%) measured at least one of the key decision-making process or decision quality constructs. Seventeen different measurement instruments were used to measure decision-making process constructs, but no single instrument covered all five constructs. The Decisional Conflict Scale was most commonly used (n = 47), followed by the Control Preference Scale (n = 9). Many studies reported one or more constructs of decision quality, including knowledge (n = 59), realistic expectation of risks and benefits (n = 21), and values-choice agreement (n = 13). There was considerable variability in how values-choice agreement was defined and determined. No study reported on all key decision-making process and decision quality constructs. CONCLUSIONS Evidence of PtDA effectiveness in improving the quality of the decision-making process and decision quality is strong and growing. There is not, however, consensus or standardization of measurement for either the decision-making process or decision quality. Additional work is needed to develop and evaluate measurement instruments and further explore theoretical issues to advance future research on PtDA effectiveness.
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Affiliation(s)
- Karen R Sepucha
- Harvard Medical School and General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, Massachusetts, 02114, USA
| | - Cornelia M Borkhoff
- Women’s College Research Institute, Women's College Hospital, 790 Bay Street, Room 728, Toronto, Ontario, M5G 1N8, Canada
| | - Joanne Lally
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Carrie A Levin
- Informed Medical Decisions Foundation, 40 Court Street, Boston, Massachusetts, 02108, USA
| | - Daniel D Matlock
- School of Medicine, University of Colorado, 12631 E 17th Avenue, Aurora, Colorado, 80045, USA
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mary E Ropka
- School of Medicine, University of Virginia, P.O. Box 800717, Charlottesville, Virginia, 22908-0717, USA
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road. Ottawa, Ontario, K1H 8L6, Canada
| | - Natalie Joseph-Williams
- Institute of Primary Care and Public Health, Cardiff University, 2nd Floor, Neuadd Meirionnydd, HeathPark, Cardiff, CF14 4YS, UK
| | - Celia E Wills
- Ohio State University, 384 Newton Hall, 1585 Neil Avenue, Columbus, Ohio, 43210, USA
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Rashidian H, Nedjat S, Majdzadeh R, Gholami J, Haghjou L, Abdollahi BS, Davatchi F, Rashidian A. The perspectives of Iranian physicians and patients towards patient decision aids: a qualitative study. BMC Res Notes 2013; 6:379. [PMID: 24066792 PMCID: PMC3849268 DOI: 10.1186/1756-0500-6-379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Patient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians' and patients' viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools. METHODS This qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software. RESULTS The results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians' trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making. CONCLUSIONS No doubt these barriers demand the health authorities' special attention. Hence, despite patients and physicians' inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran--as a developing country.
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Affiliation(s)
- Hamideh Rashidian
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Haghjou
- Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Sadeghi Abdollahi
- Rheumatology Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Arash Rashidian
- Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Stacey D, Kryworuchko J, Belkora J, Davison BJ, Durand MA, Eden KB, Hoffman AS, Koerner M, Légaré F, Loiselle MC, Street RL. Coaching and guidance with patient decision aids: A review of theoretical and empirical evidence. BMC Med Inform Decis Mak 2013. [PMID: 24624995 DOI: 10.1186/1472-6947-13-s2-s11.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts "coaching" and "guidance"; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. METHODS We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. RESULTS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. CONCLUSIONS Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.
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Pieterse AH, de Vries M, Kunneman M, Stiggelbout AM, Feldman-Stewart D. Theory-informed design of values clarification methods: A cognitive psychological perspective on patient health-related decision making. Soc Sci Med 2013; 77:156-63. [DOI: 10.1016/j.socscimed.2012.11.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 11/09/2012] [Accepted: 11/16/2012] [Indexed: 01/13/2023]
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Stacey D, Kryworuchko J, Bennett C, Murray MA, Mullan S, Légaré F. Decision Coaching to Prepare Patients for Making Health Decisions. Med Decis Making 2012; 32:E22-33. [DOI: 10.1177/0272989x12443311] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Decision coaching is individualized, nondirective facilitation of patient preparation for shared decision making. Purpose. To explore characteristics and effectiveness of decision coaching evaluated within trials of patient decision aids (PtDAs) for health decisions. Data Sources. A subanalysis of trials included in the 2011 Cochrane Review of PtDAs. Study Selection. Eligible trials allowed the effectiveness of decision coaching to be compared with another intervention and/or usual care. Data Extraction. Two reviewers independently screened 86 trials, extracted data, and appraised quality. Data Synthesis. Ten trials were eligible. Decision coaching was provided by genetic counselors, nurses, pharmacists, physicians, psychologists, or health educators. Coaching compared with usual care ( n = 1 trial) improved knowledge. Coaching plus PtDA compared with usual care ( n = 4) improved knowledge and participation in decision making without reported dissatisfaction. Coaching compared with PtDA alone ( n = 4) increased values-choice agreement and improved satisfaction with the decision-making process without any difference in knowledge or participation in decision making. Coaching plus PtDA compared with PtDA alone ( n = 4) had no difference in knowledge, values-choice agreement, participation in decision making, or satisfaction with the process. Decision coaching plus PtDA was more cost-effective compared with PtDA alone or usual care ( n = 1). Limitations. Methodological quality, number of trials, and description of decision coaching. Conclusions. Compared with usual care, decision coaching improved knowledge. However, the improvement in knowledge was similar when coaching was compared with PtDA alone. Outcomes for other comparisons are more variable, some trials showing positive effects and other trials reporting no difference. Given the small number of trials and variability in results, further research is required to determine the effectiveness of decision coaching.
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Affiliation(s)
- Dawn Stacey
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
| | - Jennifer Kryworuchko
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
| | - Carol Bennett
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
| | - Mary Ann Murray
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
| | - Sarah Mullan
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
| | - France Légaré
- University of Ottawa, Ottawa, Canada (DS)
- Ottawa Hospital Research Institute, Ottawa, Canada (DS, CB, MAM, SM)
- University of Saskatchewan, Saskatoon, Canada (JK)
- Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada (FL)
- Ottawa Hospital, Ottawa, Canada (MAM)
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Kryworuchko J, Hill E, Murray MA, Stacey D, Fergusson DA. Interventions for Shared Decision-Making About Life Support in the Intensive Care Unit: A Systematic Review. Worldviews Evid Based Nurs 2012; 10:3-16. [DOI: 10.1111/j.1741-6787.2012.00247.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2011] [Indexed: 12/12/2022]
Affiliation(s)
- Jennifer Kryworuchko
- Assistant Professor, College of Nursing; University of Saskatchewan; Saskatoon; SK; Canada
| | - Elina Hill
- Student, Department of English; University of Victoria; Victoria; BC; Canada
| | - Mary Ann Murray
- School of Nursing, Faculty of Health Sciences; University of Ottawa; Ottawa; ON; Canada
| | - Dawn Stacey
- Associate Professor, School of Nursing, Faculty of Health Sciences; University of Ottawa; Associate Scientist and Director Patient Decision Aids Research Group Ottawa Hospital Research Institute; Nursing Best Practice Research Unit; Ottawa; ON; Canada
| | - Dean A. Fergusson
- Senior Scientist and Associate Director, Clinical Epidemiology Program, Ottawa Health Research Institute; Director, OHRI Methods Centre; Director, University of Ottawa Centre for Transfusion Research; Assistant Professor, Departments of Medicine, Surgery, & of Epidemiology and Community Medicine; University of Ottawa; Ottawa; ON; Canada
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Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011:CD001431. [PMID: 21975733 DOI: 10.1002/14651858.cd001431.pub3] [Citation(s) in RCA: 550] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Decision aids prepare people to participate in decisions that involve weighing benefits, harms, and scientific uncertainty. OBJECTIVES To evaluate the effectiveness of decision aids for people facing treatment or screening decisions. SEARCH STRATEGY For this update, we searched from January 2006 to December 2009 in MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 4 2009); CINAHL (Ovid) (to September 2008 only); EMBASE (Ovid); PsycINFO (Ovid); and grey literature. Cumulatively, we have searched each database since its start date. SELECTION CRITERIA We included published randomised controlled trials (RCTs) of decision aids, which are interventions designed to support patients' decision making by providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies in which participants were not making an active treatment or screening decision. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts for inclusion, extracted data, and assessed potential risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards, were:A) decision attributes;B) decision making process attributes.Secondary outcomes were behavioral, health, and health system effects. We pooled results of RCTs using mean differences (MD) and relative risks (RR), applying a random effects model. MAIN RESULTS Of 34,316 unique citations, 86 studies involving 20,209 participants met the eligibility criteria and were included. Thirty-one of these studies are new in this update. Twenty-nine trials are ongoing. There was variability in potential risk of bias across studies. The two criteria that were most problematic were lack of blinding and the potential for selective outcome reporting, given that most of the earlier trials were not registered.Of 86 included studies, 63 (73%) used at least one measure that mapped onto an IPDAS effectiveness criterion: A) criteria involving decision attributes: knowledge scores (51 studies); accurate risk perceptions (16 studies); and informed value-based choice (12 studies); and B) criteria involving decision process attributes: feeling informed (30 studies) and feeling clear about values (18 studies).A) Criteria involving decision attributes:Decision aids performed better than usual care interventions by increasing knowledge (MD 13.77 out of 100; 95% confidence interval (CI) 11.40 to 16.15; n = 26). When more detailed decision aids were compared to simpler decision aids, the relative improvement in knowledge was significant (MD 4.97 out of 100; 95% CI 3.22 to 6.72; n = 15). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.74; 95% CI 1.46 to 2.08; n = 14). The effect was stronger when probabilities were expressed in numbers (RR 1.93; 95% CI 1.58 to 2.37; n = 11) rather than words (RR 1.27; 95% CI 1.09 to 1.48; n = 3). Exposure to a decision aid with explicit values clarification compared to those without explicit values clarification resulted in a higher proportion of patients achieving decisions that were informed and consistent with their values (RR 1.25; 95% CI 1.03 to 1.52; n = 8).B) Criteria involving decision process attributes:Decision aids compared to usual care interventions resulted in: a) lower decisional conflict related to feeling uninformed (MD -6.43 of 100; 95% CI -9.16 to -3.70; n = 17); b) lower decisional conflict related to feeling unclear about personal values (MD -4.81; 95% CI -7.23 to -2.40; n = 14); c) reduced the proportions of people who were passive in decision making (RR 0.61; 95% CI 0.49 to 0.77; n = 11); and d) reduced proportions of people who remained undecided post-intervention (RR 0.57; 95% CI 0.44 to 0.74; n = 9). Decision aids appear to have a positive effect on patient-practitioner communication in the four studies that measured this outcome. For satisfaction with the decision (n = 12) and/or the decision making process (n = 12), those exposed to a decision aid were either more satisfied or there was no difference between the decision aid versus comparison interventions. There were no studies evaluating the decision process attributes relating to helping patients to recognize that a decision needs to be made or understand that values affect the choice.C) Secondary outcomesExposure to decision aids compared to usual care continued to demonstrate reduced choice of: major elective invasive surgery in favour of conservative options (RR 0.80; 95% CI 0.64 to 1.00; n = 11). Exposure to decision aids compared to usual care also resulted in reduced choice of PSA screening (RR 0.85; 95% CI 0.74 to 0.98; n = 7). When detailed compared to simple decision aids were used, there was reduced choice of menopausal hormones (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable. The effect of decision aids on length of consultation varied from -8 minutes to +23 minutes (median 2.5 minutes). Decision aids do not appear to be different from comparisons in terms of anxiety (n = 20), and general health outcomes (n = 7), and condition specific health outcomes (n = 9). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. AUTHORS' CONCLUSIONS New for this updated review is evidence that: decision aids with explicit values clarification exercises improve informed values-based choices; decision aids appear to have a positive effect on patient-practitioner communication; and decision aids have a variable effect on length of consultation.Consistent with findings from the previous review, which had included studies up to 2006: decision aids increase people's involvement, and improve knowledge and realistic perception of outcomes; however, the size of the effect varies across studies. Decision aids have a variable effect on choices. They reduce the choice of discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, patient-practitioner communication, cost-effectiveness, and use with developing and/or lower literacy populations need further evaluation. Little is known about the degree of detail that decision aids need in order to have positive effects on attributes of the decision or decision-making process.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
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Carpenter JS, Studts JL, Byrne MM. A systematic review of menopausal symptom management decision aid trials. Maturitas 2011; 69:11-21. [DOI: 10.1016/j.maturitas.2011.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/02/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Doubova SV, Espinosa-Alarcón P, Flores-Hernández S, Infante C, Pérez-Cuevas R. Integrative health care model for climacteric stage women: design of the intervention. BMC WOMENS HEALTH 2011; 11:6. [PMID: 21333027 PMCID: PMC3050836 DOI: 10.1186/1472-6874-11-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/20/2011] [Indexed: 11/29/2022]
Abstract
Background Climacteric stage women experience significant biological, psychological and social changes. With demographic changes being observed in the growing number of climacteric stage women in Mexico, it is important to improve their knowledge about the climacteric stage and its potential associated problems, encourage their participation in screening programs, and promote the acquisition of healthy lifestyles. At Mexican health care institutions the predominant health care model for climacteric stage women has a biomedical perspective. Medical doctors provide mostly curative services and have limited support from other health professionals. This study aims to design an integrative health care model (IHCM: bio-psycho-social, multidisciplinary and women-centered) applicable in primary care services aimed at climacteric stage women. Methods/Design We present the design, inclusion criteria and detailed description of an IHCM. The IHCM consists of collaborative and coordinated provision of services by a health team, which is involves a family doctor, nurse, psychologist, and the woman herself. The health team promotes the empowerment of women through individual and group counseling on the climacteric stage and health related self-care. The intervention lasts three months followed by a three-month follow-up period to evaluate the effectiveness of the model. The effectiveness of the model will be evaluated through the following aspects: health-related quality of life (HR-QoL), empowerment, self-efficacy and knowledge regarding the climacteric stage and health-related self-care activities, use of screening services, and improvement in lifestyles (regular leisure time physical activity and healthy diet). Discussion Participation in preventive activities should be encouraged among women in Mexico. Designing and evaluating the effectiveness of an integrative health care model for women at the climacteric stage, based on the empowerment approach and focus on health-related self-care to improve their HR-QoL is pertinent for current health conditions of this age group. Trial registration The study is registered at the ClinicalTrials.gov (NCT01272115).
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Affiliation(s)
- Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México.
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Puschner B, Steffen S, Slade M, Kaliniecka H, Maj M, Fiorillo A, Munk-Jørgensen P, Larsen JI, Égerházi A, Nemes Z, Rössler W, Kawohl W, Becker T. Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol. BMC Psychiatry 2010; 10:90. [PMID: 21062508 PMCID: PMC2992484 DOI: 10.1186/1471-244x-10-90] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 11/10/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. METHODS/DESIGN The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome. DISCUSSION The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. TRIAL REGISTER ISRCTN75841675.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str 2, 89312 Günzburg, Germany.
| | - Sabine Steffen
- Department of Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Mike Slade
- King's College London, Institute of Psychiatry, Box P029, De Crespigny Park, London SE5 8AF, UK
| | - Helena Kaliniecka
- King's College London, Institute of Psychiatry, Box P029, De Crespigny Park, London SE5 8AF, UK
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Povl Munk-Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Jens Ivar Larsen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark
| | - Anikó Égerházi
- Medical and Health Science Center, Department of Psychiatry, University of Debrecen, Nagyerdei krt. 98, 4012 Debrecen, Hungary
| | - Zoltan Nemes
- Medical and Health Science Center, Department of Psychiatry, University of Debrecen, Nagyerdei krt. 98, 4012 Debrecen, Hungary
| | - Wulf Rössler
- Department of General and Social Psychiatry, University of Zurich, Militärstrasse 8, 8021 Zurich, Switzerland
| | - Wolfram Kawohl
- Department of General and Social Psychiatry, University of Zurich, Militärstrasse 8, 8021 Zurich, Switzerland
| | - Thomas Becker
- Department of Psychiatry and Psychotherapy II, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
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Stacey D, Légaré F, Pouliot S, Kryworuchko J, Dunn S. Shared decision making models to inform an interprofessional perspective on decision making: a theory analysis. PATIENT EDUCATION AND COUNSELING 2010; 80:164-172. [PMID: 19945813 DOI: 10.1016/j.pec.2009.10.015] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 10/19/2009] [Accepted: 10/28/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To conduct a theory analysis of shared decision making (SDM) conceptual models and determine the extent to which the models are relevant to interprofessional collaboration in clinical practice. METHODS Theory analysis of SDM models identified from three systematic reviews and personal files. Eligible publications: model of SDM; described concepts with relational statements. Two independently appraised models. RESULTS Of 54 publications, 15 unique models included 18 core concepts. Of two models that included more than one health professional collaborating with the patient, one included 3 of 10 elements of interprofessional collaboration and the other included 1 element. Fourteen were rated as having no logical fallacies, 10 as parsimonious, 7 had been empirically tested, 4 provided testable hypotheses, and 3 described the development process. CONCLUSION Most SDM models failed to encompass an interprofessional approach. Those that included at least two professionals met few of the elements of interprofessional collaboration and had limited description of SDM processes. Although models were rated as logically adequate and parsimonious, only half were tested and few were developed using an explicit process. PRACTICE IMPLICATIONS Appraisal of SDM models highlights the need for a model that is more inclusive of an interprofessional approach.
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Affiliation(s)
- Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
BACKGROUND Patient adherence to medication or lifestyle interventions is a serious concern. Interventions to improve adherence exist, but their effects are usually small. Several authors suggested that decision aids may positively affect adherence. OBJECTIVE . This presentation examines the role of decision aids in adherence research through development of a model and a narrative review. METHODS and RESULTS . I: A model was developed to organize pathways relating decision aids and adherence. There is clinical evidence for these pathways, suggesting that decision aids may potentially improve adherence. The model is helpful when considering measures to study decision aids and adherence. II: A narrative review of decision aids and adherence was done. A systematic search resulted in 11 randomized studies. Two studies, both in the hypertension management domain, were positive. Shortcomings were identified regarding the range of adherence measures, the sample size, and the STUDY DESIGN It is argued that outcomes for the option "nonadherent" behavior should be described explicitly in the decision aid to inform patients about the costs and benefits of nonadherent behavior. CONCLUSIONS . A relation between decision aids and adherence is plausible in view of the psychological and medical literature. A systematic search showed that experimental evidence relating decision aids and adherence is inconclusive. Rigorous trials on this topic are worthwhile. Such trials should employ adequate sample sizes, multiple adherence measures, and a control arm delivering usual care. The decision aid should describe the option "being nonadherent" and its outcomes.
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Affiliation(s)
- Peep F M Stalmeier
- Department of Radiation Oncology, Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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van Til JA, Drossaert CHC, Renzenbrink GJ, Snoek GJ, Dijkstra E, Stiggelbout AM, Ijzerman MJ. Feasibility of web-based decision aids in neurological patients. J Telemed Telecare 2010; 16:48-52. [PMID: 20086268 DOI: 10.1258/jtt.2009.001012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of arm-hand function in cervical spinal cord injury (SCI). Data collection comprised a telephone interview and a self-reported paper questionnaire. Of the patients who agreed to participate, 39 stroke patients (44%) and 38 patients with SCI (78%) returned a questionnaire. More than 75% of patients expressed a need for more information about the treatment of disease-related impairment. The DAs were highly appreciated by both patient groups. Nearly all patients expressed a positive attitude towards the use of the web-based DAs in general practice. The DAs had a positive effect on the knowledge about the treatment alternatives in the stroke patients (P = 0.001), although not in the patients with SCI. The DAs reduced patients' conflict about treatment (P < 0.05). The effect of the DAs on patients' desired role in decision-making was limited. Web-based aids are feasible in the rehabilitation population with access to a computer and can improve the knowledge gaps in patients.
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Affiliation(s)
- Janine A van Til
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
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Sheridan SL, Griffith JM, Behrend L, Gizlice Z, Pignone MP. Effect of adding a values clarification exercise to a decision aid on heart disease prevention: a randomized trial. Med Decis Making 2010; 30:E28-39. [PMID: 20484089 DOI: 10.1177/0272989x10369008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DAs) as a means of improving their effectiveness, but little research has examined the effects of such exercises. OBJECTIVE To determine whether adding a VC exercise to a DA on heart disease prevention improves decision-making outcomes. DESIGN Randomized trial. SETTING UNC Decision Support Laboratory. PATIENTS Adults ages 40 to 80 with no history of cardiovascular disease. INTERVENTION A Web-based heart disease prevention DA with or without a VC exercise. MEASUREMENTS Pre- and postintervention decisional conflict and intent to reduce coronary heart disease (CHD) risk and postintervention self-efficacy and perceived values concordance. RESULTS The authors enrolled 137 participants (62 in DA; 75 in DA + VC with moderate decisional conflict (DA 2.4; DA + VC 2.5) and no baseline differences among groups. After the interventions, they found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; DA + VC 1.9; absolute difference VC-DA 0.1, 95% confidence interval [CI]: -0.1 to 0.3), intent to reduce CHD risk (DA 98%; DA + VC 100%; absolute difference VC-DA: 2%, 95% CI: -0.02% to 5%), perceived values concordance (DA 95%; DA + VC 92%; absolute difference VC-DA -3%, 95% CI: -11% to +5%), or self-efficacy for risk reduction (DA 97%; DA + VC 92%; absolute difference VC-DA -5%, 95% CI: -13% to +3%). However, DA + VC tended to change some decisions about risk reduction strategies. LIMITATIONS Use of a hypothetical scenario; ceiling effects for some outcomes. CONCLUSIONS Adding a VC intervention to a DA did not further improve decision-making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.
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Affiliation(s)
- Stacey L Sheridan
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, 27599, USA.
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Deschamps MA, Taylor JG, Neubauer SL, Whiting S, Green K. Impact of pharmacist consultation versus a decision aid on decision making regarding hormone replacement therapy. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357022999] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To compare the effects of pharmacist consultation versus a decision aid on women's decisional conflict regarding use of hormone replacement therapy (HRT) and subsequent satisfaction with the decision-making process.
Setting
A family medicine clinic in Canada.
Method
The study was a prospective, randomised comparative trial. Peri- and post-menopausal female patients aged 48 to 52 years were invited to participate. Volunteers (n=128) received either a private consultation with a pharmacist or a take-home decision aid. Data collection was undertaken prior to the intervention and again following an appointment with a physician to discuss HRT. Outcome measures included: perception of being informed about HRT, decisional conflict, satisfaction with the education and the decision made regarding HRT, and adherence to HRT if prescribed. Telephone follow-up occurred three and 12 months after the physician appointment.
Key findings
After discussing HRT with their physicians, 35 of 91 women (38.5%) chose HRT, 15 (16.5%) declined it and 41 (45.1%) opted to delay their decision. Both interventions significantly increased women's perception of being informed about this form of therapy and decreased decisional conflict. Satisfaction with the education and with the HRT decision was high. More postmenopausal women in the pharmacist group reached a yes/no decision than in the decision aid group. Of those initiating HRT during the study (n =18), 16.7% had discontinued it at 12 months.
Conclusion
Consultation with a pharmacist and use of a decision aid are both effective methods for decreasing decisional conflict in peri- and post-menopausal women considering HRT.
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Affiliation(s)
| | - Jeff G Taylor
- College of Pharmacy and Nutrition, University of Saskatchewan, Canada
| | | | - Susan Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Canada
| | - Kathryn Green
- Department of Community Health and Epidemiology, University of Saskatchewan, Canada
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Sepucha K, Ozanne EM. How to define and measure concordance between patients' preferences and medical treatments: A systematic review of approaches and recommendations for standardization. PATIENT EDUCATION AND COUNSELING 2010; 78:12-23. [PMID: 19570647 DOI: 10.1016/j.pec.2009.05.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 04/03/2009] [Accepted: 05/23/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose is to systematically review the methods used to calculate the association between patients' preferences and treatment choices and to present a set of recommendations for definition and measurement of this concept. METHODS A systematic review of the literature from 1967 to 2007 identified articles that reported a relationship between patients' preferences and their treatment choices. Potential citations were identified from electronic databases, the Cochrane Collaborative review, and identified experts. Relevant articles were abstracted by two reviewers independently using standard forms. RESULTS The search identified 3114 unique citations, the full text of 180 articles was examined, and 49 articles were included. These 49 studies used a variety of definitions of preferences and choices, and calculated concordance in different ways. Half of the studies tied their method to a theoretical framework. There were problems with many of the studies that limit the ability to generalize or make comparisons across studies. CONCLUSION There is no consistent method for defining or calculating the match between patients' preferences and treatment choices. There is a need for more clarity in the definition and reporting of this type of concordance in measures of decision quality. PRACTICE IMPLICATIONS The match between an informed patient's preferences and treatment choices is a key component of patient-centered care. Valid and reliable measures of the level of concordance are needed.
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Affiliation(s)
- Karen Sepucha
- Health Decision Research Unit, Massachusetts General Hospital (MGH), Harvard Medical School (HMS), 50 Staniford Street, Suite 936, Boston, MA 02114, USA
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Becker H, Stuifbergen AK, Dormire SL. The effects of hormone therapy decision support for women with mobility impairments. Health Care Women Int 2009; 30:845-54. [PMID: 19657820 PMCID: PMC2750856 DOI: 10.1080/07399330903066236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Deciding about hormone therapy (HT) use is particularly complex for women with mobility impairments. While HT controls menopausal symptoms, the potential increased risk of blood clots resulting from physical inactivity can contraindicate HT use. These women, therefore, may benefit from interventions to help them tailor standard information about HT. We randomly assigned women to receive either a tailored decision support intervention or standard menopausal information. Both groups (n = 176) significantly decreased their decisional conflict and uncertainty and increased knowledge after receiving the treatment materials. We interpret the findings in the context of limited medical information about HT for women with disabilities.
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Affiliation(s)
- Heather Becker
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, Texas 78701, Phone: 512-471-9097, Fax: 512-475-8755
| | - Alexa K. Stuifbergen
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, Texas 78701, Phone: 512-471-9097, Fax: 512-475-8755
| | - Sharon L. Dormire
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, Texas 78701, Phone: 512-471-9097, Fax: 512-475-8755
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O'Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2009:CD001431. [PMID: 19588325 DOI: 10.1002/14651858.cd001431.pub2] [Citation(s) in RCA: 409] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Decision aids prepare people to participate in 'close call' decisions that involve weighing benefits, harms, and scientific uncertainty. OBJECTIVES To conduct a systematic review of randomised controlled trials (RCTs) evaluating the efficacy of decision aids for people facing difficult treatment or screening decisions. SEARCH STRATEGY We searched MEDLINE (Ovid) (1966 to July 2006); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library; 2006, Issue 2); CINAHL (Ovid) (1982 to July 2006); EMBASE (Ovid) (1980 to July 2006); and PsycINFO (Ovid) (1806 to July 2006). We contacted researchers active in the field up to December 2006. There were no language restrictions. SELECTION CRITERIA We included published RCTs of interventions designed to aid patients' decision making by providing information about treatment or screening options and their associated outcomes, compared to no intervention, usual care, and alternate interventions. We excluded studies in which participants were not making an active treatment or screening decision, or if the study's intervention was not available to determine that it met the minimum criteria to qualify as a patient decision aid. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts for inclusion, and extracted data from included studies using standardized forms. The primary outcomes focused on the effectiveness criteria of the International Patient Decision Aid Standards (IPDAS) Collaboration: attributes of the decision and attributes of the decision process. We considered other behavioural, health, and health system effects as secondary outcomes. We pooled results of RCTs using mean differences (MD) and relative risks (RR) using a random effects model. MAIN RESULTS This update added 25 new RCTs, bringing the total to 55. Thirty-eight (69%) used at least one measure that mapped onto an IPDAS effectiveness criterion: decision attributes: knowledge scores (27 trials); accurate risk perceptions (11 trials); and value congruence with chosen option (4 trials); and decision process attributes: feeling informed (15 trials) and feeling clear about values (13 trials).This review confirmed the following findings from the previous (2003) review. Decision aids performed better than usual care interventions in terms of: a) greater knowledge (MD 15.2 out of 100; 95% CI 11.7 to 18.7); b) lower decisional conflict related to feeling uninformed (MD -8.3 of 100; 95% CI -11.9 to -4.8); c) lower decisional conflict related to feeling unclear about personal values (MD -6.4; 95% CI -10.0 to -2.7); d) reduced the proportion of people who were passive in decision making (RR 0.6; 95% CI 0.5 to 0.8); and e) reduced proportion of people who remained undecided post-intervention (RR 0.5; 95% CI 0.3 to 0.8). When simpler decision aids were compared to more detailed decision aids, the relative improvement was significant in knowledge (MD 4.6 out of 100; 95% CI 3.0 to 6.2) and there was some evidence of greater agreement between values and choice.In this review, we were able to explore the use of probabilities in decision aids. Exposure to a decision aid with probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.6; 95% CI 1.4 to 1.9). The effect was stronger when probabilities were measured quantitatively (RR 1.8; 95% CI 1.4 to 2.3) versus qualitatively (RR 1.3; 95% CI 1.1 to 1.5).As in the previous review, exposure to decision aids continued to demonstrate reduced rates of: elective invasive surgery in favour of conservative options, decision aid versus usual care (RR 0.8; 95% CI 0.6 to 0.9); and use of menopausal hormones, detailed versus simple aid (RR 0.7; 95% CI 0.6 to 1.0). There is now evidence that exposure to decision aids results in reduced PSA screening, decision aid versus usual care (RR 0.8; 95% CI 0.7 to 1.0) . For other decisions, the effect on decisions remains variable.As in the previous review, decision aids are no better than comparisons in affecting satisfaction with decision making, anxiety, and health outcomes. The effects of decision aids on other outcomes (patient-practitioner communication, consultation length, continuance, resource use) were inconclusive.There were no trials evaluating the IPDAS decision process criteria relating to helping patients to recognize a decision needs to be made, understand that values affect the decision, or discuss values with the practitioner. AUTHORS' CONCLUSIONS Patient decision aids increase people's involvement and are more likely to lead to informed values-based decisions; however, the size of the effect varies across studies. Decision aids have a variable effect on decisions. They reduce the use of discretionary surgery without apparent adverse effects on health outcomes or satisfaction. The degree of detail patient decision aids require for positive effects on decision quality should be explored. The effects on continuance with chosen option, patient-practitioner communication, consultation length, and cost-effectiveness need further evaluation.
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Affiliation(s)
- Annette M O'Connor
- Professor, School of Nursing, Department of Epidemiology, University of Ottawa, Senior Scientist, Clinical Epidemiology Program, Ottawa Health Research Institute, 1053 Carling Avenue, (ASB 2-008), Ottawa, Ontario, Canada, K1Y 4E9
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Armitage GD, Suter E, Verhoef MJ, Bockmuehl C, Bobey M. Women's needs for CAM information to manage menopausal symptoms. Climacteric 2009; 10:215-24. [PMID: 17487648 DOI: 10.1080/13697130701342475] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify the information needs of women regarding complementary and alternative medicine (CAM) treatment options to alleviate menopausal symptoms. METHODS Self-administered questionnaires were mailed to women responding to notices posted in family physicians' offices and a women's health center. Survey questions addressed preferred topics, formats and sources of information; experiences with information searching; and what signified good, trustworthy information. RESULTS The women in this study (n = 413) indicated several challenges including a lack of time to gather information, gaps in, and lack of, relevant information, and poor information quality. They expressed interest in information about the menopausal process, conventional and CAM treatment options, and the safety of treatments. Personal consultation with health-care professionals was the preferred way for obtaining information. The majority of women preferred evidence-based information but there was also a substantial number of women who chose to rely on 'softer' evidence such as personal accounts. These results suggested two different subgroups; however, the data indicate that these are not mutually exclusive since many respondents showed a preference for both types of information. CONCLUSIONS Women feel they are not sufficiently informed to make safe decisions regarding CAM treatment options to alleviate menopausal symptoms. Family physicians are a trusted information source and have an important role in providing women with that information. Brochures containing evidence-based information and a list of newsletters or books that include personal accounts, available in physician's offices and during personal consultations at women's health centers, are offered as a possible solution. A website is another possibility for distributing this information.
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Affiliation(s)
- G D Armitage
- Health Systems and Workforce Research Unit, Calgary Health Region, Calgary, AB, Canada
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Légaré F, Brouillette MH. Shared decision-making in the context of menopausal health: Where do we stand? Maturitas 2009; 63:169-75. [DOI: 10.1016/j.maturitas.2009.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 01/25/2009] [Indexed: 10/21/2022]
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Clinical decision support tools for osteoporosis disease management: a systematic review of randomized controlled trials. J Gen Intern Med 2008; 23:2095-105. [PMID: 18836782 PMCID: PMC2596508 DOI: 10.1007/s11606-008-0812-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 06/05/2008] [Accepted: 09/12/2008] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps. OBJECTIVE To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management. DATA SOURCES Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field. REVIEW METHODS Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms. RESULTS Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17). CONCLUSION Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management.
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