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Osuna E, Luna A, Pérez-Cárceles MD. [The right to patient autonomy. Updating in daily clinical care]. Med Clin (Barc) 2024; 162:e52-e55. [PMID: 38471981 DOI: 10.1016/j.medcli.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Eduardo Osuna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - Aurelio Luna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - María D Pérez-Cárceles
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España.
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Mosnaim G, Rathkopf M. Digital inhalers for asthma management. Curr Opin Pulm Med 2024; 30:330-335. [PMID: 38411213 DOI: 10.1097/mcp.0000000000001056] [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: 02/28/2024]
Abstract
PURPOSE OF REVIEW Although digital inhaler systems for asthma management have been commercially available for over a decade, their current use in clinical practice is limited. This review outlines barriers and offers potential solutions to their implementation. RECENT FINDINGS Digital inhaler systems demonstrate increased controller medication adherence, decreased quick-relief medication use, and improved asthma control. SUMMARY Use of digital inhaler systems is supported by data from large clinical trials demonstrating improved asthma outcomes. Navigating telemedicine during the coronavirus disease 2019 pandemic has led to advances clearing the path for increased adoption of digital inhaler systems. Progress in areas including patient education and onboarding, clinical management, coding and billing, privacy and security have facilitated implementation in clinical practice.
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Affiliation(s)
- Giselle Mosnaim
- Division of Allergy & Immunology, Department of Medicine, Endeavor Health, Glenview
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Melinda Rathkopf
- Allergy and Immunology, Children's Healthcare of Atlanta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Estevan-Vilar M, Parker LA, Caballero-Romeu JP, Ronda E, Hernández-Aguado I, Lumbreras B. Barriers and facilitators of shared decision-making in prostate cancer screening in primary care: A systematic review. Prev Med Rep 2024; 37:102539. [PMID: 38179441 PMCID: PMC10764268 DOI: 10.1016/j.pmedr.2023.102539] [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: 10/05/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care. Design Systematic review of articles. Data sources PubMed, Scopus, Embase and Web of Science. Eligibility criteria Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied. Data extraction and synthesis Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies. Results The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information. Conclusions SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM.
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Affiliation(s)
- María Estevan-Vilar
- Pharmacy Faculty, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Juan Pablo Caballero-Romeu
- Department of Urology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Elena Ronda
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Public Health Research Group, Alicante University, 03690 San Vicente del Raspeig, Spain
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
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Nagase H, Ito R, Ishii M, Shibata H, Suo S, Mukai I, Zhang S, Rothnie KJ, Trennery C, Yuanita L, Ishii T. Relationship Between Asthma Control Status and Health-Related Quality of Life in Japan: A Cross-Sectional Mixed-Methods Study. Adv Ther 2023; 40:4857-4876. [PMID: 37698717 PMCID: PMC10567960 DOI: 10.1007/s12325-023-02660-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION There is limited information regarding multidimensional relationships between asthma control and health-related quality of life (HRQoL), work productivity, and asthma symptom burden in Japan. Furthermore, systematic qualitative investigations about asthma burden have not been performed. METHODS This cross-sectional, mixed-methods study included Japanese patients (≥ 20 years) with asthma adherent to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The primary endpoint was impact of asthma on HRQoL, measured using the Asthma Health Questionnaire-33 (AHQ-33). Secondary endpoints were cough burden (Japanese-adapted Leicester Cough Questionnaire [J-LCQ]) and impact of asthma on work/activities (asthma-specific Work Productivity and Activity Impairment Questionnaire [WPAI:Asthma]). Quantitative data were assessed for the overall population and for well-controlled (WC) and not well-controlled (NWC) asthma subgroups. Qualitative verbal interviews further assessed the impact of NWC asthma on patients' HRQoL; emergent themes were extracted using thematic analyses. RESULTS Of 454 patients, 45.2% (n = 205) had NWC asthma. Patients with NWC asthma had significantly worse asthma- and cough-related HRQoL across all AHQ-33 and J-LCQ domains and significantly greater work and activity impairment versus patients with WC asthma, across all assessed WPAI:Asthma domains. AHQ-33 total score was highly correlated with J-LCQ total and domain scores (r = - 0.8132 to r = - 0.7407). Nine themes emerged from qualitative interviews and confirmed that patients with NWC asthma had considerable HRQoL impairment due to asthma symptoms. CONCLUSIONS Patients with NWC asthma had higher symptom burden and worse HRQoL than patients with WC asthma, despite ICS/LABA adherence. Cough burden correlated with HRQoL, suggesting cough may be one of the key markers to inform treatment strategy for patients with asthma.
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Affiliation(s)
- Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Risako Ito
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.
| | - Moe Ishii
- Mebix, Inc., Minato-ku, Tokyo, Japan
| | | | | | - Isao Mukai
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Shiyuan Zhang
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
| | | | | | - Liza Yuanita
- Medical Affairs Asthma & COPD, GSK, Minato-ku, Tokyo, Japan
| | - Takeo Ishii
- Value Evidence and Outcomes, GSK, 1-8-1 Akasaka, Minato-ku, Tokyo, 107-0052, Japan
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Achterbosch M, Vart P, van Dijk L, van Boven JFM. Shared decision making and medication adherence in patients with COPD and/or asthma: the ANANAS study. Front Pharmacol 2023; 14:1283135. [PMID: 37954848 PMCID: PMC10634231 DOI: 10.3389/fphar.2023.1283135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Background: Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM's association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence. Objective: To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms. Methods: Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence. Results: A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0-45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect <3%). Conclusion: The patient experienced level of SDM in daily practice and medication adherence have room for improvement. No association between SDM and medication adherence was observed. Factors related to feeling of competence, relatedness and feeling of autonomy did not meaningfully explain this finding.
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Affiliation(s)
- Maria Achterbosch
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Liset van Dijk
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
- Department of PharmacoTherapy, Epidemiology and Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
- Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, Netherlands
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Peralta A, Drainoni ML, Declercq ER, Belanoff CM, Radoff K, Bearse E, Iverson RE. Development and testing of a decision aid to achieve shared decision-making for routine labor induction. Birth 2023; 50:636-645. [PMID: 36825853 DOI: 10.1111/birt.12716] [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] [Received: 06/02/2022] [Revised: 09/20/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND This quality improvement project aimed to create a decision aid for labor induction in healthy pregnancies at or beyond 39 weeks that met the needs of pregnant people least likely to experience shared decision-making and to identify and test implementation strategies to support its use in prenatal care. METHODS We used quality improvement and qualitative methods to develop, test, and refine a patient decision aid. The decision aid was tested in three languages by providers across obstetrics, family medicine, and midwifery practices at a tertiary care hospital and two community health centers. Outcomes included patients' understanding of their choices, pros and cons of choices, and the decision being theirs or a shared one with their provider. RESULTS Patient interview data indicated that shared decision-making on labor induction was achieved. Across three Plan-Do-Study-Act cycles, we interviewed a diverse group of 24 pregnant people: 20 were people of color, 16 were publicly insured, and 15 were born outside the United States. All but one (23/24) reported feeling the decision was theirs or a shared one with their provider. The majority could name induction choices they had along with pros and cons. Interviewees described the decision-making experience as empowering and positive. Nine medical providers tested the decision aid and gave feedback. Providers stated the tool helped improve the quality of their counseling and reduce bias. CONCLUSION This project suggests that using an evidence-based and well-tested decision aid can help achieve shared decision-making on labor induction for a diverse group of pregnant people.
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Affiliation(s)
| | - Mari-Lynn Drainoni
- School of Public Health, Boston University, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Eugene R Declercq
- School of Public Health, Boston University, Boston, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | | | - Kari Radoff
- School of Medicine, Boston University, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Emily Bearse
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Dartmouth, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Ronald E Iverson
- School of Medicine, Boston University, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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Israel E, Farooqui N, Gillette C, Gilbert I, Gandhi H, Tervonen T, Balantac Z, Thomas C, Krucien N, George M. A Discrete Choice Experiment to Assess Patient Preferences for Asthma Rescue Therapy and Disease Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2781-2791.e4. [PMID: 37182565 DOI: 10.1016/j.jaip.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/10/2023] [Accepted: 04/19/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND With the expanding treatment landscape for asthma, the process of identifying best-fit, individualized management options is becoming increasingly complicated. Understanding patients' preferences can inform shared decision-making between clinicians and patients. OBJECTIVES To examine preferences of adults with asthma for therapeutic and management attributes and determine how these preferences vary among patients. METHODS We conducted an online discrete choice experiment survey in US adults with asthma. Patient preferences were analyzed using logit models. Factors affecting patients' preferences were identified by least absolute shrinkage and selection operator analysis. RESULTS A total of 1,184 patients completed the survey (60% female; mean [SD] age, 49.2 [15.0] years). Patients most valued fewer asthma attacks requiring urgent health care professional visits, fewer exacerbations requiring oral corticosteroids, and a reduced risk for oral thrush. Higher value was placed on reducing the risk of short-term (oral thrush) versus long-term side effects (diabetes). Patients were willing to increase rescue medication use in exchange for decreasing exacerbations requiring oral corticosteroids and attacks requiring urgent health care professional visits. Patients preferred a single inhaler for rescue and maintenance and least valued asthma action plans. Demographic, socioeconomic, and clinical factors affected patient preferences. CONCLUSIONS Patients sought convenient management options that focused mainly on decreasing the short-term morbidity associated with asthma exacerbations and therapies. Preferences varied by demographics, clinical factors, and socioeconomics. It is important for shared decision-making discussions to include conversations about morbidity and how available therapeutic options align with individual patient preferences.
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Affiliation(s)
- Elliot Israel
- Department of Pulmonology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Chris Gillette
- Department of PA Studies, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ileen Gilbert
- US Medical Affairs-Respiratory, AstraZeneca, Wilmington, Del.
| | - Hitesh Gandhi
- US Medical Affairs-Respiratory, AstraZeneca, Wilmington, Del
| | - Tommi Tervonen
- Patient-Centered Research, Evidera, London, United Kingdom
| | | | - Caitlin Thomas
- Patient-Centered Research, Evidera, London, United Kingdom
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Bosnic-Anticevich S, Bakerly ND, Chrystyn H, Hew M, van der Palen J. Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management. Patient Prefer Adherence 2023; 17:259-272. [PMID: 36741814 PMCID: PMC9891071 DOI: 10.2147/ppa.s385857] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/09/2022] [Indexed: 01/30/2023] Open
Abstract
Maintenance therapy delivered via inhaler is central to asthma and chronic obstructive pulmonary disease (COPD) management. Poor adherence to inhaled medication and errors in inhalation technique have long represented major barriers to the optimal management of these chronic conditions. Technological innovations may provide a means of overcoming these barriers. This narrative review examines ongoing advances in digital technologies relevant to asthma and COPD with the potential to inform clinical decision-making and improve patient care. Digital inhaler devices linked to mobile apps can help bring about changes in patients' behaviors and attitudes towards disease management, particularly when they build in elements of interactivity and gamification. They can also support ongoing technique education, empowering patients and helping providers maximize the value of consultations and develop effective action plans informed by insights into the patient's inhaler use patterns and their respiratory health. When combined with innovative techniques such as machine learning, digital devices have the potential to predict exacerbations and prompt pre-emptive intervention. Finally, digital devices may support an advanced precision medicine approach to respiratory disease management and help support shared decision-making. Further work is needed to increase uptake of digital devices and integrate their use into care pathways before their full potential in personalized asthma and COPD management can be realized.
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Affiliation(s)
- Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Correspondence: Sinthia Bosnic-Anticevich, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, 2037, NSW, Australia, Tel +61 414 015 614, Email
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, United Kingdom, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, VIC, Australia
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands, and Section Cognition, Data and Education, University of Twente, Enschede, the Netherlands
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Murphy KR, Winders T, Smith B, Millette L, Chipps BE. Identifying Patients for Self-Administration of Omalizumab. Adv Ther 2023; 40:19-24. [PMID: 36173511 PMCID: PMC9859916 DOI: 10.1007/s12325-022-02308-w] [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: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Omalizumab, a recombinant anti-immunoglobulin E (IgE) monoclonal antibody, is indicated for moderate to severe allergic asthma, chronic spontaneous urticaria, and nasal polyps, and is approved for self-administration. However, specific guidance on identifying candidates with characteristics suitable for this type of administration is lacking. To help address this issue, this article provides practical considerations for the health care provider treating patients with omalizumab. We encourage health care providers to consider self-administration of omalizumab as an option for all appropriate, but not all, patients, and we recommend an individualized approach when considering self-administration of omalizumab.
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Affiliation(s)
| | - Tonya Winders
- Allergy and Asthma Network, Vienna, VA USA ,Global Allergy and Airways Patient Platform, Vienna, Austria
| | | | | | - Bradley E. Chipps
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA 95819 USA
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Cameron A, Pollock K, Wilson E, Burford J, England G, Freeman S. Scoping review of end-of-life decision-making models used in dogs, cats and equids. Vet Rec 2022; 191:e1730. [PMID: 35703328 DOI: 10.1002/vetr.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning. METHODS A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted. RESULTS A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these. CONCLUSIONS A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.
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Affiliation(s)
- Amelia Cameron
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Kristian Pollock
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care (NCARE), School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End-of-Life Care (NCARE), School of Health Sciences, University of Nottingham, Nottingham, UK
| | - John Burford
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Gary England
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
| | - Sarah Freeman
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, UK
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11
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Bøgelund M, Ingelmo AR, Ruiz JMA, Vivó AG, Brandi H, Pedersen MH, Loftager ASL, Aagren M. Preference for sublingual immunotherapy with tablets in a Spanish population with allergic rhinitis. Clin Transl Allergy 2022; 12:e12118. [PMID: 35140910 PMCID: PMC8814907 DOI: 10.1002/clt2.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study investigated patients' preference for allergy immunotherapy (AIT) administered as either sublingual immunotherapy‐tablets versus monthly or weekly subcutaneous immunotherapy (SCIT) from a Spanish patient perspective. Methods A discrete choice experiment (DCE) consisting of two blocks with eight choice sets in each was constructed to elicit the preferences for AIT. Three attributes were included in the DCE for the mode of administration, including the frequency of administration, the risk of systemic reactions and the co‐payment. Adults and caregivers of children with moderate to severe allergic rhinitis (AR) were included if they were not currently receiving or had not previously received AIT. Results In total, 587 adults and 613 caregivers started the survey. Of those, 579 adults and 611 caregivers completed the survey and were included in the study. Both adults and caregivers had a significant preference for tablets compared with both monthly and weekly injections (p ≤ 0.0001). Furthermore, the respondents showed a significant preference for reducing the risk of systemic reactions. Subgroup analyses showed that caregivers of polyallergic children and female caregivers were significantly less price sensitive when choosing their preferred treatment. Conclusion Our study demonstrated that both adults with AR and caregivers of children with AR prefer daily SLIT‐tablets to SCIT with either a weekly or monthly dose schedule.
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Affiliation(s)
| | | | | | | | - Henrik Brandi
- Global Market Access & Public AffairsALKHørsholmDenmark
- Global Pricing & Market AccessLEO PharmaBallerupDenmark
| | | | | | - Mark Aagren
- Global Market Access & Public AffairsALKHørsholmDenmark
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12
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Sanftenberg L, Kuehne F, Lukaschek K, Meissner K, Gensichen J. Shared Decision Making - A Key Competence of All Health Care Professionals. Evaluation and Adaptation of a Digitally Enhanced Learning and Teaching Unit. J Eur CME 2021; 10:1987119. [PMID: 34790434 PMCID: PMC8592585 DOI: 10.1080/21614083.2021.1987119] [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] [Indexed: 11/15/2022] Open
Abstract
The Covid-19 pandemic induced a radical shift towards digitally enhanced learning and teaching (DELT). Success of this adaptation depended on how much DELT had been provided before. The Bavarian Virtual University (BVU) is a university network to fund, promote and support DELT. The Ludwig-Maximilians-University Munich as a part of this network implemented the DELT course “Shared decision making (SDM) - a part of evidence-based medicine” in 2015. Based on regular evaluations and due to the latest developments, a media-didactic and content-related adaptation will be conducted now. Clinical cases will be embedded in a framework structure of SDM. Videos, podcasts and literature of doctor–patient interaction will be provided. To enable different health care professions to have a positive learning experience, the course will be linguistically adapted. The interaction between students and teacher will be enhanced by a transparent distribution of tasks and an issue-specific chat forum. SDM is an interdisciplinary general concept. With regard to the academization of different health care professions, the demand for DELT will increase. However, medical competencies can`t be taught fully online, since face-to-face patient interaction is mandatory. Communication skills can be practiced theoretically but have to be applied in reality.
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Affiliation(s)
- Linda Sanftenberg
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Flora Kuehne
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karin Meissner
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Patrick M, Venkatesh RD, Stukus DR. Social media and its impact on health care. Ann Allergy Asthma Immunol 2021; 128:139-145. [PMID: 34555532 DOI: 10.1016/j.anai.2021.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Social media has fundamentally changed how the world shares and receives information. This review offers a perspective for the practicing clinician regarding how patients are being influenced by their online interactions and considerations for proactively discussing medical decision making with patients. DATA SOURCES Literature search of PubMed database and online published market research data surrounding social media use. STUDY SELECTIONS Peer-reviewed studies, Pew research data, and editorials in the English language were selected and reviewed. RESULTS There has been a substantial increase in the breadth and depth of literature surrounding the use of social media by patients and medical professionals. Increased focus on how it contributes to medical decision making and patient-clinician interactions has occurred in recent years. The coronavirus disease 2019 pandemic has highlighted the various sources of misinformation and disinformation and how they impact care on many levels. Best practices have been established to assist medical professionals in developing an online presence to combat misinformation or address individual patients. CONCLUSION There is growing understanding and recognition of the myriad of ways in which social media is impacting health care. Health care professionals from all backgrounds need to increase their understanding of these complex interactions to best assist patients with their medical decision making.
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Affiliation(s)
- Michael Patrick
- Division of Emergency Medicine, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Rajitha D Venkatesh
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - David R Stukus
- Division of Allergy and Immunology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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Bukstein DA, Guerra DG. Severe asthma and biologics: Data are good, listening to patients is better. Ann Allergy Asthma Immunol 2021; 127:285-286. [PMID: 34479728 DOI: 10.1016/j.anai.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Don A Bukstein
- The Allergy, Asthma & Sinus Center, Milwaukee, Wisconsin; The Problem Based Learning Institute, LLC, Chesterfield, Missouri.
| | - Daniel G Guerra
- AltusLearn, Madison, Wisconsin; SDM Analytics, Inc, Madison, Wisconsin
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15
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Gurgel RK, Briggs SE, Dhepyasuwan N, Rosenfeld RM. Quality Improvement in Otolaryngology-Head and Neck Surgery: Age-Related Hearing Loss Measures. Otolaryngol Head Neck Surg 2021; 165:765-774. [PMID: 33752512 DOI: 10.1177/01945998211000442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND SIGNIFICANCE There is a high and growing prevalence of age-related hearing loss (ARHL), defined as presbycusis or bilateral, symmetric sensorineural hearing loss in older adults. Due to the increasing prevalence of ARHL, the potential delays in its diagnosis and treatment, and the significant disability associated with ARHL, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) convened a Measures Development Group (MDG) to develop quality measures (QMs) of clinical practice that could be incorporated into the AAO-HNSF's data registry Reg-ent. Although the AAO-HNSF has been engaged in robust clinical practice guideline development since 2006, the development of quality and performance measures is more recent. METHODS We report the process, experience, and outcomes in developing a de novo QM set for ARHL in the absence of a preexisting clinical practice guideline on this topic. Steps include the MDG review of evidentiary literature on ARHL, followed by stakeholder discussions to develop measure specifications. Key considerations included discussion on the relative importance, usability, and feasibility of each measure within the Reg-ent or similar databases. RESULTS The MDG created 4 QMs for the diagnosis and treatment of AHRL. These measures represent the AAO-HNSF's quality initiatives to develop evidence-based QMs and improve patient care and outcomes, and they are intended to assist providers in enhancing quality of care. CONCLUSION Development of the ARHL measures is intended for clinicians to evaluate the patient perception, structure, process, and outcomes of care. This process represents a new stage in the AAO-HNSF's measure development efforts to facilitate future efforts in evidence-based QM.
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Affiliation(s)
| | - Selena E Briggs
- MedStar Washington Hospital Center, Washington, DC, USA.,Department of Otolaryngology, Georgetown University, Washington DC, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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16
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Patient-Selected Treatment Goals in Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2732-2741.e1. [PMID: 33577946 DOI: 10.1016/j.jaip.2021.01.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Goal-orientated health care accounts for patient preferences and values, not just physician treatment aims. The Global Initiative for Asthma (GINA) management strategy states that clinicians should elicit patients' own treatment goals as a central part of care. Despite this recommendation, data on patients' treatment goals are sparse among patients with severe asthma. OBJECTIVE The objective of this study is to investigate the relationship between rates of treatment adherence and goal achievement, and patient-selected goals. METHODS Thematic analysis was used to characterize patient-selected goals. Previously undescribed goal categories in asthma were identified, quantified, and related to clinical characteristics. Goal achievement was aligned with objectively measured treatment adherence. RESULTS Three categories of patients-selected goals were identified from 2 randomized control trials: disease-specific (n = 98 [51%] and n = 92 [54%], respectively), function-related (n = 90 [48%] and n = 61 [36%]), and knowledge (n = 1 [1%] and n = 17 [10%]). Only 53% of goals aligned with clinician treatment goals. Patients who chose disease-specific goals were more likely to achieve both control and their specified goal (n = 98 [45%], odds ratio: 1.789, confidence interval: 1.066-3.001). Male participants are more likely to focus on disease-specific goals. Patients who achieved their goals were more likely to be T2-high, have an elevated fractional exhaled nitric oxide (FeNO) at their first visit, and have a lower FeNO value at their final visit. Interestingly, adherence rates decline significantly for those who achieve their goals. CONCLUSION Almost half of patient-selected goals do not align with GINA clinical asthma management goals. Participants who chose goals that do align with clinicians were more likely to achieve them.
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Abrams EM, Singer AG, Shaker M, Greenhawt M. What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:608-612. [PMID: 33253924 PMCID: PMC7691847 DOI: 10.1016/j.jaip.2020.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022]
Abstract
The coronavirus disease 2019 pandemic has forever changed how we view health care service delivery. Although there are undoubtedly some unintended consequences that will result from current health care service reallocation, it provides a unique opportunity to consider how to deliver quality care currently, and after the pandemic. In the context of lessons learned, moving forward some of what was previously routine could remain reserved for more exceptional circumstances. To determine what is "routine," what is "essential," and what is "exceptional," it is necessary to view medical decisions within the paradigm of high-quality care. The Institute for Healthcare Improvement definition of the dimensions of quality is based on whether the care is safe, effective, patient-centered, timely, efficient, and equitable. This type of stewardship has been applied to many interventions already deemed unnecessary by organizations such as the Choosing Wisely initiative, but the coronavirus disease 2019 pandemic provides a lens from which to consider other aspects of care. The following will provide examples from Allergy/Immunology that outline how we can reconsider what quality means in the post-coronavirus disease health care system.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
| | - Alexander G Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcok Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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18
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Chan KH, Misseri R, Carroll A, Frankel R, Moore CM, Cockrum B, Wiehe SE. User-centered development of a hypospadias decision aid prototype. J Pediatr Urol 2020; 16:684.e1-684.e9. [PMID: 32863127 PMCID: PMC7686073 DOI: 10.1016/j.jpurol.2020.07.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Many parents who choose hypospadias repair for their sons experience decisional conflict (DC) and decisional regret (DR). We previously found that parental decision-making about hypospadias surgery is a complex process characterized by cyclic information-seeking to alleviate anxiety and confusion. OBJECTIVE The objective of this study was to engage parents of hypospadias patients and pediatric providers in the co-design of a decision aid (DA) prototype to facilitate shared decision-making about hypospadias surgery and address DC and DR. METHODS From August 2018 to January 2019, we conducted three co-design workshops with parents of hypospadias patients, pediatric urology and general pediatric providers to discuss their recommendations for a DA prototype. Activities were audio recorded and professionally transcribed. Transcripts and worksheets were analyzed by six coders using qualitative analysis to identify key aspects of a hypospadias DA desired by stakeholders. We conducted a collaborative design and prototyping session to establish key features and requirements, created a content map visualizing this work, and then developed a DA prototype. RESULTS Parent participants included 6 mothers and 4 fathers: 8 Caucasian, 2 African-American; median age 31 years. Providers included pediatric urology (n = 7) and general pediatric providers (n = 10): median age 47.5 years, 83.3% Caucasian, 58.3% male, 58.3% MD's and 41.7% nurse practitioners. Participants created user-friendly, interactive DA prototypes with "24/7" availability that had three key functions: 1) provide accurate, customizable, educational content, 2) connect parents with each other, and 3) engage them in a decision-making activity. The prototype consisted of five modules (Extended Summary Figure). "Hypospadias Basics" includes epidemiology and a hypospadias severity scale. "Surgery Basics" includes goals, illustrated steps, and pros/cons of surgery. "Testimonials" includes videos of parents and adolescents discussing their experiences. "Help me Decide" includes a decisional conflict scale and a decision-making activity (i.e. values clarification method). "Frequently Asked Questions" covers general hypospadias information, perioperative expectations and a review of postoperative care. DISCUSSION To our knowledge, this is the first DA prototype developed for a pediatric urology condition using a human-centered design approach to engage many key stakeholders in the development process. One limitation of this study is the small population sampled, which limits generalizability and means that our findings may not reflect the views of all parents or pediatric providers involved in hypospadias decision-making. CONCLUSIONS We created a parent-centered hypospadias DA prototype that provides decision support in an online, interactive format. Future directions include further testing with usability experts, providers and parents.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Aaron Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Richard Frankel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Cleveland Clinic Learner Institute, Cleveland, OH, USA.
| | - Courtney M Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA; Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
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