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Tinetti ME, Hashmi A, Ng H, Doyle M, Goto T, Esterson J, Naik AD, Dindo L, Li F. Patient Priorities-Aligned Care for Older Adults With Multiple Conditions: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352666. [PMID: 38261319 PMCID: PMC10807252 DOI: 10.1001/jamanetworkopen.2023.52666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/01/2023] [Indexed: 01/24/2024] Open
Abstract
Importance Older adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients' health priorities may improve outcomes. Objective To assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes. Design, Setting, and Participants In this nonrandomized controlled trial with propensity adjustment, enrollment occurred between August 21, 2020, and May 14, 2021, with follow-up continuing through February 26, 2022. Patients who were aged 65 years or older and with 3 or more chronic conditions were enrolled at 1 PPC and 1 UC site within the Cleveland Clinic primary care multisite practice. Data analysis was performed from March 2022 to August 2023. Intervention Health professionals at the PPC site guided patients through identification of values, health outcome goals, health care preferences, and top priority (ie, health problem they most wanted to focus on because it impeded their health outcome goal). Primary clinicians followed PPC decisional strategies (eg, use patients' health priorities as focus of communication and decision-making) to decide with patients what care to stop, start, or continue. Main Outcomes and Measures Main outcomes included perceived treatment burden, Patient-Reported Outcomes Measurement Information System (PROMIS) social roles and activities, CollaboRATE survey scores, the number of nonhealthy days (based on healthy days at home), and shared prescribing decision quality measures. Follow-up was at 9 months for patient-reported outcomes and 365 days for nonhealthy days. Results A total of 264 individuals participated, 129 in the PPC group (mean [SD] age, 75.3 [6.1] years; 66 women [48.9%]) and 135 in the UC group (mean [SD] age, 75.6 [6.5] years; 55 women [42.6%]). Characteristics between sites were balanced after propensity score weighting. At follow-up, there was no statistically significant difference in perceived treatment burden score between groups in multivariate models (difference, -5.2 points; 95% CI, -10.9 to -0.50 points; P = .07). PPC participants were almost 2.5 times more likely than UC participants to endorse shared prescribing decision-making (adjusted odds ratio, 2.40; 95% CI, 0.90 to 6.40; P = .07), and participants in the PPC group experienced 4.6 fewer nonhealthy days (95% CI, -12.9 to -3.6 days; P = .27) compared with the UC participants. These differences were not statistically significant. CollaboRATE and PROMIS Social Roles and Activities scores were similar in the 2 groups at follow-up. Conclusions and Relevance This nonrandomized trial of priorities-aligned care showed no benefit for social roles or CollaboRATE. While the findings for perceived treatment burden and shared prescribing decision-making were not statistically significant, point estimates for the findings suggested that PPC may hold promise for improving these outcomes. Randomized trials with larger samples are needed to determine the effectiveness of priorities-aligned care. Trial Registration ClinicalTrials.gov Identifier: NCT04510948.
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Affiliation(s)
- Mary E. Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Ardeshir Hashmi
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Henry Ng
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Margaret Doyle
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | - Jessica Esterson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Aanand D. Naik
- Institute on Aging, University of Texas Health Science Center, Houston
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Lilian Dindo
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut
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Connor MJ, Hazelton D, Dela Cruz NJM, Brown S, Issa A, Mayor N, Tagle J, Vyas L, Khoubehi B, Bedi N, Attar H, Dinneen M. Improving informed consent in elective urological surgery using a digital consent platform. BJU Int 2023; 132:502-504. [PMID: 37528456 DOI: 10.1111/bju.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Martin J Connor
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Hazelton
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Nina Jyne Minette Dela Cruz
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Sarah Brown
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Allaudin Issa
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Nikhil Mayor
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Tagle
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Lona Vyas
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Bijan Khoubehi
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Nishant Bedi
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Hama Attar
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Michael Dinneen
- Department of Urology, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK
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Warinner C, Loyo M, Gu J, Wamkpah NS, Chi JJ, Lindsay RW. Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation. Facial Plast Surg 2023; 39:517-526. [PMID: 37290455 DOI: 10.1055/s-0043-1769806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.
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Affiliation(s)
- Chloe Warinner
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Jeffrey Gu
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Nneoma S Wamkpah
- Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri
| | - Robin W Lindsay
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
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Vo H, Valentine KD, Barry MJ, Sepucha KR. Evaluation of the shared decision-making process scale in cancer screening and medication decisions. PATIENT EDUCATION AND COUNSELING 2023; 108:107617. [PMID: 36593166 DOI: 10.1016/j.pec.2022.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Examine reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. METHODS Secondary data analysis from 6174 participants who made decisions about cancer screening (breast, colon or prostate) or medication (menopause, depression, hypertension or high cholesterol). Key measures included the SDM Process scale, decisional conflict, decision regret, and decision quality. Construct validity was examined by testing whether higher SDM Process scores were associated with lower regret, lower decisional conflict and higher decision quality. Meta-analyses summarized data across studies. Some studies assessed the scale's reliability. RESULTS Average SDM Process scores ranged from 1.2 to 2.5. There was a moderate-to-large, positive association between scores and lack of decisional conflict (cancer screening: d=0.61, CI(0.38, 0.84), p < .001; medications: d=0.36, CI(0.29, 0.44), p < .001). High scores were associated with lower decision regret (cancer screening: d=-0.24, CI(-0.37, -0.11), p < .001; medications: d=-0.30, CI(-0.40,-0.20), p < .001). There was no relationship with decision quality. Retest reliability was acceptable (ICC>0.7) for seven of eight clinical samples. CONCLUSIONS The SDM Process scale demonstrated construct validity and retest reliability in cancer screening and medication decisions. PRACTICE IMPLICATIONS The validated SDM Process scale is a short, patient reported metric to evaluate the current state of SDM.
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Affiliation(s)
- Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Hackert MQN, Ankersmid JW, Engels N, Prick JCM, Teerenstra S, Siesling S, Drossaert CHC, Strobbe LJA, van Riet YEA, van den Dorpel RMA, Bos WJW, van der Nat PB, van den Berg-Vos RM, van Schaik SM, Garvelink MM, van der Wees PJ, van Uden-Kraan CF. Effectiveness and implementation of SHared decision-making supported by OUTcome information among patients with breast cancer, stroke and advanced kidney disease: SHOUT study protocol of multiple interrupted time series. BMJ Open 2022; 12:e055324. [PMID: 35914919 PMCID: PMC9345077 DOI: 10.1136/bmjopen-2021-055324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Within the value-based healthcare framework, outcome data can be used to inform patients about (treatment) options, and empower them to make shared decisions with their health care professional. To facilitate shared decision-making (SDM) supported by outcome data, a multicomponent intervention has been designed, including patient decision aids on the organisation of post-treatment surveillance (breast cancer); discharge location (stroke) and treatment modality (advanced kidney disease), and training on SDM for health care professionals. The SHared decision-making supported by OUTcome information (SHOUT) study will examine the effectiveness of the intervention and its implementation in clinical practice. METHODS AND ANALYSIS Multiple interrupted time series will be used to stepwise implement the intervention. Patients diagnosed with either breast cancer (N=630), stroke (N=630) or advanced kidney disease (N=473) will be included. Measurements will be performed at baseline, three (stroke), six and twelve (breast cancer and advanced kidney disease) months. Trends on outcomes will be measured over a period of 20 months. The primary outcome will be patients' perceived level of involvement in decision-making. Secondary outcomes regarding effectiveness will include patient-reported SDM, decisional conflict, role in decision-making, knowledge, quality of life, preferred and chosen care, satisfaction with the intervention, healthcare utilisation and health outcomes. Outcomes regarding implementation will include the implementation rate and a questionnaire on the health care professionals' perspective on the implementation process. ETHICS AND DISSEMINATION The Medical research Ethics Committees United in Nieuwegein, the Netherlands, has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. Bureau Onderzoek & Innovatie of Santeon, the Netherlands, approved this study. The results will contribute to insight in and knowledge on the use of outcome data for SDM, and can stimulate sustainable implementation of SDM. TRIAL REGISTRATION NUMBER NL8374, NL8375 and NL8376.
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Affiliation(s)
| | - Jet W Ankersmid
- Santeon Hospital Group, Utrecht, The Netherlands
- Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Noel Engels
- Santeon Hospital Group, Utrecht, The Netherlands
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Janine C M Prick
- Santeon Hospital Group, Utrecht, The Netherlands
- Neurology, OLVG, Amsterdam, The Netherlands
| | - Steven Teerenstra
- Radboud Institute for Health Sciences, Health Evidence, section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sabine Siesling
- Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Luc J A Strobbe
- Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | - Willem Jan W Bos
- Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
- Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul B van der Nat
- Value-Based Health Care, St. Antonius Hospital, Nieuwegein, The Netherlands
- Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Renske M van den Berg-Vos
- Neurology, OLVG, Amsterdam, The Netherlands
- Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | | | - Mirjam M Garvelink
- Value-Based Health Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
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van der Weijden T, van der Kraan J, Brand PLP, van Veenendaal H, Drenthen T, Schoon Y, Tuyn E, van der Weele G, Stalmeier P, Damman OC, Stiggelbout A. Shared decision-making in the Netherlands: Progress is made, but not for all. Time to become inclusive to patients. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:98-104. [PMID: 35613990 DOI: 10.1016/j.zefq.2022.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
Dutch initiatives targeting shared decision-making (SDM) are still growing, supported by the government, the Federation of Patients' Organisations, professional bodies and healthcare insurers. The large majority of patients prefers the SDM model. The Dutch are working hard to realise improvement in the application of SDM in daily clinical practice, resulting in glimpses of success with objectified improvement on observed behavior. Nevertheless, the culture shift is still ongoing. Large-scale uptake of SDM behavior is still a challenge. We haven't yet fully reached the patients' needs, given disappointing research data on patients' experiences and professional behavior. In all Dutch implementation projects, early adopters, believers or higher-educated persons have been overrepresented, while patients with limited health literacy have been underrepresented. This is a huge problem as 25% of the Dutch adult population have limited health literacy. To further enhance SDM there are issues to be addressed: We need to make physicians conscious about their limited application of SDM in daily practice, especially regarding preference and decision talk. We need to reward clinicians for the extra work that comes with SDM. We need to be inclusive to patients with limited health literacy, who are less often actually involved in decision-making and at the same time more likely to regret their chosen treatment compared to patients with higher health literacy.
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Affiliation(s)
- Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | | | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Yvonne Schoon
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline Tuyn
- Program manager health care innovation, CZ Health Care Insurance, Tilburg, The Netherlands
| | | | - Peep Stalmeier
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C Damman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anne Stiggelbout
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam and Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, The Netherlands
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