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Yan J, Wei Y, Teng Y, Liu S, Li F, Bao S, Ren Y, Chen Y. Physician Preferences and Shared-Decision Making for the Traditional Chinese Medicine Treatment of Lung Cancer: A Discrete-Choice Experiment Study in China. Patient Prefer Adherence 2022; 16:1487-1497. [PMID: 35747587 PMCID: PMC9211799 DOI: 10.2147/ppa.s365109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND With progress being made in the treatment of cancer, various clinical and treatment options are being pursued. In China, Traditional Chinese Medicine (TCM) is used widely in the treatment of cancer. OBJECTIVE To estimate TCM treatment preferences and SDM mode of physicians in China. METHODS This study was conducted among physicians (n=185) from nine tertiary hospitals in China by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-physician version (SDM-Q-Doc) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of physicians were performed using mixed logit models. Additionally, subgroup analysis was conducted. RESULTS In total, 185 respondents completed the questionnaire. All attributes were statistically significant except out-of-pocket costs. Physicians showed the strongest preferences for increasing disease control rate, relieving nausea and vomiting, and reducing the risk of side effects. Most of the physicians (78.38%) self-reported a high willingness to use SDM during the decision-making process. The physicians with a higher SDM-Q-Doc score had more preference for improving all three attributes than those with a lower score. Little variation was found in preferences among the physicians with other sociodemographic characteristics. CONCLUSION In China, physicians considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The physicians in China mainly preferred SDM, and the preference was different according to SDM mode when involving the TCM therapy for patients with lung cancer. The study findings could inform future TCM therapy for lung cancer and promote SDM.
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Affiliation(s)
- Juntao Yan
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yan Wei
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Yan Wei, National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, People’s Republic of China, Tel +86-18930749707, Email
| | - Yue Teng
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
- Outpatient Department of Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Shimeng Liu
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Fuming Li
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Shiyi Bao
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yanfeng Ren
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, People’s Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People’s Republic of China
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Comparing “Leaf-to-Root”, “Nose-to-Tail” and Other Efficient Food Utilization Options from a Consumer Perspective. SUSTAINABILITY 2019. [DOI: 10.3390/su11174779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The efficient use of natural raw materials is a key element of sustainable development and is also gaining importance in the food sector. Consumers are increasingly realizing that food is too valuable to be used only partially. However, consumer acceptance is an important precondition for establishing efficient food utilization options. A total of 470 German consumers were surveyed through an online-questionnaire where they had to evaluate three options each for the efficient use of plant-based foods as well as animal-based foods with respect to eight different criteria. The results show that the six options differed significantly regarding consumer acceptance. The efficient use of plant-based foods (especially non-standard fruits/vegetables and the “leaf-to-root” principle) was more accepted than the efficient utilization of animal-based foods. Furthermore, it can be seen that options using the by-products in a natural form were considered more acceptable than those which subject the by-products to some form of processing. These results provide an insight into the views of consumers on food waste reduction strategies, which are frequently debated in the sustainability discussion.
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Lofland JH, Johnson PT, Ingham MP, Rosemas SC, White JC, Ellis L. Shared decision-making for biologic treatment of autoimmune disease: influence on adherence, persistence, satisfaction, and health care costs. Patient Prefer Adherence 2017; 11:947-958. [PMID: 28572722 PMCID: PMC5441672 DOI: 10.2147/ppa.s133222] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM), a process whereby physicians and patients collaborate to select interventions, is not well understood for biologic treatment of autoimmune conditions. METHODS This was a cross-sectional survey of adults initiating treatment for Crohn's disease or ulcerative colitis (inflammatory bowel disease, IBD) or psoriatic arthritis or rheumatoid arthritis (RA/PA). Survey data were linked to administrative claims for 6 months before (baseline) and after (follow-up) therapy initiation. Measures included the Shared Decision Making Questionnaire, Patient Activation Measure (PAM), Morisky Medication Adherence Scale (MMAS), general health, and treatment satisfaction. Claims-based Quan-Charlson comorbidity scores, persistence, medication possession ratio (MPR), and health care costs were examined. Patients were compared by participation (SDM) and nonparticipation (non-SDM) in SDM. RESULTS Among 453 respondents, 357 were eligible, and 306 patients (204 RA/PA and 102 IBD) were included in all analyses. Overall (n=357), SDM participants (n=120) were more often females (75.0% vs 62.5%, P=0.018), had lower health status (48.0 vs 55.4, P=0.005), and higher Quan-Charlson scores (1.0 vs 0.7, P=0.035) than non-SDM (n=237) participants. Lower MMAS scores (SDM 0.17 vs non-SDM 0.41; P<0.05) indicated greater likelihood of adherence; SDM participants also reported higher satisfaction with medication and had greater activation (PAM: SDM vs non-SDM: 66.9 vs 61.6; P<0.001). Mean MPR did not differ, but persistence was longer among SDM participants (111.2 days vs 102.2 days for non-SDM; P=0.029). Costs did not differ by SDM status overall, or among patients with RA/PA. The patients with IBD, however, experienced lower (P=0.003) total costs ($9,404 for SDM vs $25,071 for non-SDM) during follow-up. CONCLUSION This study showed greater likelihood of adherence and satisfaction for patients who engaged in SDM and reduced health care costs among patients with IBD who engaged in SDM. This study provides a basis for defining SDM participation and detecting differences by SDM participation for biologic treatment selection for autoimmune conditions.
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Affiliation(s)
- Jennifer H Lofland
- Janssen Global Commercial Strategic Organization – Immunology, Raritan, NJ
| | - Phaedra T Johnson
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
- Correspondence: Phaedra T Johnson, Health Economics and Outcomes Research, Optum Inc., 11000 Optum Circle, Eden Prairie, MN 55344, USA, Tel +1 952 205 7737, Email
| | - Mike P Ingham
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Sarah C Rosemas
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
| | - John C White
- Health Economics and Outcomes Research, Optum Inc., Eden Prairie, MN
| | - Lorie Ellis
- Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
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Szendroedi J, Saxena A, Weber KS, Strassburger K, Herder C, Burkart V, Nowotny B, Icks A, Kuss O, Ziegler D, Al-Hasani H, Müssig K, Roden M. Cohort profile: the German Diabetes Study (GDS). Cardiovasc Diabetol 2016; 15:59. [PMID: 27053136 PMCID: PMC4823856 DOI: 10.1186/s12933-016-0374-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/24/2016] [Indexed: 12/16/2022] Open
Abstract
Background The German Diabetes Study (GDS) is a prospective longitudinal cohort study describing the impact of subphenotypes on the course of the disease. GDS aims at identifying prognostic factors and mechanisms underlying the development of related comorbidities. Study design and methods The study comprises intensive phenotyping within 12 months after clinical diagnosis, at 5-year intervals for 20 years and annual telephone interviews in between. Dynamic tests, including glucagon, mixed meal, intravenous glucose tolerance and hyperinsulinemic clamp tests, serve to assess beta-cell function and tissue-specific insulin sensitivity. Magnetic resonance imaging and multinuclei spectroscopy allow quantifying whole-body fat distribution, tissue-specific lipid deposition and energy metabolism. Comprehensive analyses of microvascular (nerve, eye, kidney) and macrovascular (endothelial, cardiorespiratory) morphology and function enable identification and monitoring of comorbidities. The GDS biobank stores specimens from blood, stool, skeletal muscle, subcutaneous adipose tissue and skin for future analyses including multiomics, expression profiles and histology. Repeated questionnaires on socioeconomic conditions, patient-reported outcomes as quality of life, health-related behavior as physical activity and nutritional habits are a specific asset of GDS. This study will recruit 3000 patients and a group of humans without familiy history of diabetes. 237 type 1 and 456 type 2 diabetes patients have been already included. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0374-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Szendroedi
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Aaruni Saxena
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Katharina S Weber
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Klaus Strassburger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Volker Burkart
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,Public Health Unit, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
| | - Dan Ziegler
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hadi Al-Hasani
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Biochemistry and Pathobiochemistry German Diabetes Center, Leibniz Institute for Diabetes Research, Düsseldorf, Germany
| | - Karsten Müssig
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, Leibniz Institute for Diabetes Research, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
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Puschner B, Neumann P, Jordan H, Slade M, Fiorillo A, Giacco D, Égerházi A, Ivánka T, Bording MK, Sørensen HØ, Bär A, Kawohl W, Loos S. Development and psychometric properties of a five-language multiperspective instrument to assess clinical decision making style in the treatment of people with severe mental illness (CDMS). BMC Psychiatry 2013; 13:48. [PMID: 23379280 PMCID: PMC3570278 DOI: 10.1186/1471-244x-13-48] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study was to develop and evaluate psychometric properties of the Clinical Decision Making Style (CDMS) scale which measures general preferences for decision making as well as preferences regarding the provision of information to the patient from the perspectives of people with severe mental illness and staff. METHODS A participatory approach was chosen for instrument development which followed 10 sequential steps proposed in a current guideline of good practice for the translation and cultural adaptation of measures. Following item analysis, reliability, validity, and long-term stability of the CDMS were examined using Spearman correlations in a sample of 588 people with severe mental illness and 213 mental health professionals in 6 European countries (Germany, UK, Italy, Denmark, Hungary, and Switzerland). RESULTS In both patient and staff versions, the two CDMS subscales "Participation in Decision Making" and "Information" reliably measure distinct characteristics of decision making. Validity could be demonstrated to some extent, but needs further investigation. CONCLUSIONS Together with two other five-language patient- and staff-rated measures developed in the CEDAR study (ISRCTN75841675) - "Clinical Decision Making in Routine Care" and "Clinical Decision Making Involvement and Satisfaction" - the CDMS allows empirical investigation of the complex relation between clinical decision making and outcome in the treatment of people with severe mental illness across Europe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Petra Neumann
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Harriet Jordan
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Mike Slade
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Andrea Fiorillo
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Domenico Giacco
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Anikó Égerházi
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Tibor Ivánka
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Malene Krogsgaard Bording
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark Sørensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Arlette Bär
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Sabine Loos
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
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Scholl I, Kriston L, Dirmaier J, Härter M. Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale - an attempt to establish convergent validity. Health Expect 2012; 18:137-50. [PMID: 23176071 DOI: 10.1111/hex.12022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While there has been a clear move towards shared decision-making (SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. OBJECTIVE To test convergent validity of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) by comparing it to the OPTION Scale. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. METHODS Consultations were evaluated using the OPTION Scale. Patients completed the SDM-Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM-Q-9, correlation between the patient (SDM-Q-9) and expert ratings (OPTION Scale) was calculated. RESULTS A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM-Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. DISCUSSION By the use of the OPTION Scale convergent validity of the SDM-Q-9 could not be established. Several possible explanations for this result are discussed. CONCLUSION This study shows that the measurement of SDM remains challenging.
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Affiliation(s)
- Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
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Strube W, Steger F. Patient autonomy and informed consent—individual preferences of senior study participants in Germany. Wien Klin Wochenschr 2012; 124:384-90. [DOI: 10.1007/s00508-012-0187-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 05/21/2012] [Indexed: 12/01/2022]
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Kasper J, Heesen C, Köpke S, Fulcher G, Geiger F. Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared decision making. PLoS One 2011; 6:e26255. [PMID: 22043310 PMCID: PMC3197148 DOI: 10.1371/journal.pone.0026255] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022] Open
Abstract
Objective Patient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered. Methods The study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale). Results OPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations. Conclusion Existing SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement. Practice Implications Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement. Trial Registration Controlled-Trials.com ISRCTN25267500.
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Affiliation(s)
- Jürgen Kasper
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
- Unit of Health Sciences and Education, MIN-Faculty, University of Hamburg, Hamburg, Germany
- * E-mail:
| | - Christoph Heesen
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
| | - Sascha Köpke
- MIN-Faculty, Institute of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | | | - Friedemann Geiger
- Tumor Center, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
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Hirsch O, Keller H, Krones T, Donner-Banzhoff N. Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study. Implement Sci 2011; 6:70. [PMID: 21736724 PMCID: PMC3143082 DOI: 10.1186/1748-5908-6-70] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/07/2011] [Indexed: 11/29/2022] Open
Abstract
Background Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. Methods The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Conclusions Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual characteristics.
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Affiliation(s)
- Oliver Hirsch
- Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany.
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Neuner-Jehle S, Senn O, Wegwarth O, Rosemann T, Steurer J. How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats. BMC FAMILY PRACTICE 2011; 12:15. [PMID: 21466686 PMCID: PMC3080293 DOI: 10.1186/1471-2296-12-15] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 04/05/2011] [Indexed: 11/10/2022]
Abstract
Background Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs) compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11%) and visual (16%) formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively). Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001). Conclusions Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education.
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Affiliation(s)
- Stefan Neuner-Jehle
- Institute of General Medicine and Health Services Research, University of Zürich, Switzerland.
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Simon D, Kriston L, Loh A, Spies C, Scheibler F, Wills C, Härter M. Confirmatory factor analysis and recommendations for improvement of the Autonomy-Preference-Index (API). Health Expect 2010; 13:234-43. [PMID: 20579122 DOI: 10.1111/j.1369-7625.2009.00584.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Validation of the German version of the Autonomy-Preference-Index (API), a measure of patients' preferences for decision making and information seeking. METHODS Stepwise confirmatory factor analysis was conducted on a sample of patients (n = 1592) treated in primary care for depression (n = 186), surgical and internal medicine inpatients (n = 811) and patients with minor trauma treated in an emergency department (n = 595). An initial test of the model was done on calculation and validation halves of the sample. Both local and global indexes-of-fit suggested modifications to the scale. The scale was modified and re-tested in the calculation sample and confirmed in the validation sample. Subgroup analyses for age, gender and type of treatment setting were also performed. RESULTS The confirmatory analysis led to a modified version of the API with better local and global indexes-of-fit for samples of German-speaking patients. Two items of the sub-scale, 'preference for decision-making', and one item of the sub-scale, 'preference for information seeking', showed very low reliability scores and were deleted. Thus, several global indexes-of-fit clearly improved significantly. The modified scale was confirmed on the validation sample with acceptable to good indices of fit. Results of subgroup analyses indicated that no adaptations were necessary. DISCUSSION AND CONCLUSIONS This first confirmatory analysis for a German-speaking population showed that the API was improved by the removal of several items. There were theoretically plausible explanations for this improvement suggesting that the modifications might also be appropriate in English and other language versions.
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Affiliation(s)
- Daniela Simon
- Section of Clinical Epidemiology and Health Services Research, University Medical Center, Freiburg, Germany.
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Krones T, Keller H, Sönnichsen A, Sadowski EM, Baum E, Wegscheider K, Rochon J, Donner-Banzhoff N. Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial. Ann Fam Med 2008; 6:218-27. [PMID: 18474884 PMCID: PMC2384995 DOI: 10.1370/afm.854] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations. METHODS The study was based on a pragmatic, cluster randomized controlled trial (phase III) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured. Forty-seven physicians in the control arm (7 CME groups) similarly included 582 patients. Four hundred sixty patients (83.6%) of the intervention arm and 466 patients (80.1%) of the control arm were seen at follow-up. Physicians attended 2 interactive CME sessions and received a booklet, a paper-based risk calculator, and individual summary sheets for each patient. Control physicians attended 1 CME-session on an alternative topic. Main outcome measures were patient satisfaction and participation after the index consultation, change in CVD risk status, and decisional regret at 6 months' follow-up. RESULTS Intervention patients were significantly more satisfied with process and result (Patient Participation Scale, difference 0.80, P<.001). Decisional regret was significantly lower at follow-up (difference 3.39, P = .02). CVD risk decreased in both groups without a significant difference between study arms. CONCLUSION A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret, without negatively affecting global CVD risk.
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Affiliation(s)
- Tanja Krones
- Department of General Practice/Family Medicine, Phillips-University Marburg, Marburg, Germany.
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Simon D, Loh A, Härter M. Measuring (shared) decision-making--a review of psychometric instruments. ACTA ACUST UNITED AC 2007; 101:259-67. [PMID: 17601182 DOI: 10.1016/j.zgesun.2007.02.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In recent years shared decision-making (SDM) has gained importance as an appropriate approach to patient-physician communication and decision-making. However, there is a conceptual variety that implies problems of inconsistent measurement, of defining relationships of SDM and outcome measures, and of comparisons across different studies. This article presents the results of a literature search of psychometric instruments measuring aspects of decision-making. Altogether 18 scales were found. The majority covers the patients' perspective and relates to preferences for information and participation, decisional conflict, self-efficacy as well as to the evaluation of decision-making process and outcomes. The scales differ widely in their extent of validation. Although this review is not exhaustive, it presents a variety of available decision-making instruments. Yet, many of them still need to show their psychometric quality for other settings in further studies.
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Affiliation(s)
- Daniela Simon
- University Medical Centre Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Epidemiology and Health Services Research.
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