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Dengsø KE, Berg A, Hansen CP, Burgdorf SK, Krohn PS, Sillesen M, Spiegelhauer N, Bach MT, Melton M, Nielsen B, Christensen BM, Finderup J, Hillingsø J. Have a vital end-user been overlooked? Developing a shared decision intervention for patients with potential pancreatic cancer regarding the choice of surgery. PEC INNOVATION 2024; 4:100269. [PMID: 38435237 PMCID: PMC10907832 DOI: 10.1016/j.pecinn.2024.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Objective To develop a patient decision aid facilitating shared decision making for patients with potential pancreatic cancer deciding about no treatment, surgical or medical treatment. Methods Based on a user-centred design by Wittemann et al., we developed a shared decision making intervention in three phases: 1) Understanding decision needs 2) Development of a patient decision aid (PtDA) based on a generic template 3) Assessment of the intervention from interviews with patients (n = 11), relatives (n = 11), nurses (n = 4) and surgeons (n = 2) analysed with thematic analysis, and measuring patients' perceptions of choice of options with the Decisional Conflict Scale. Results Results showed varying experiences with the use of the PtDA, with surgeons not finding PtDA useful as it was impractical and constraining with patients' conversations. There was no difference in patients' perceptions in choosing options for those being presented vs those patients not being presented for the PtDA. Conclusion The format and structure of the PtDA was not feasible for the surgeons as fundamental users in the present clinic. Innovation This study highlights the urgent need to consider clinical context before introducing a predefined tool and shows the importance of a multistakeholder approach. Research should focus on finding means to successful implement shared decision making.
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Affiliation(s)
- Kristine Elberg Dengsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Berg
- Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stefan K. Burgdorf
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Paul S. Krohn
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Sillesen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nina Spiegelhauer
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette Tholstrup Bach
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marianne Melton
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Betina Nielsen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Marcel Christensen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Denmark
| | - Jens Hillingsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Coon ER, Greene T, Fritz J, Desai AD, Ray KN, Hersh AL, Bardsley T, Bonafide CP, Brady PW, Wallace SS, Schroeder AR. A multicenter randomized trial to compare automatic versus as-needed follow-up for children hospitalized with common infections: The FAAN-C trial protocol. J Hosp Med 2024. [PMID: 38840329 DOI: 10.1002/jhm.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Physicians commonly recommend automatic primary care follow-up visits to children being discharged from the hospital. While automatic follow-up provides an opportunity to address postdischarge needs, the alternative is as-needed follow-up. With this strategy, families monitor their child's symptoms and decide if they need a follow-up visit in the days after discharge. In addition to being family centered, as-needed follow-up has the potential to reduce time and financial burdens on both families and the healthcare system. As-needed follow-up has been shown to be safe and effective for children hospitalized with bronchiolitis, but the extent to which hospitalized children with other common conditions might benefit from as-needed follow-up is unclear. METHODS The Follow-up Automatically versus As-Needed Comparison (FAAN-C, or "fancy") trial is a multicenter randomized controlled trial. Children who are hospitalized for pneumonia, urinary tract infection, skin and soft tissue infection, or acute gastroenteritis are eligible to participate. Participants are randomized to an as-needed versus automatic posthospitalization follow-up recommendation. The sample size estimate is 2674 participants and the primary outcome is all-cause hospital readmission within 14 days of discharge. Secondary outcomes are medical interventions and child health-related quality of life. Analyses will be conducted in an intention-to-treat manner, testing noninferiority of as-needed follow-up compared with automatic follow-up. DISCUSSION FAAN-C will elucidate the relative benefits of an as-needed versus automatic follow-up recommendation, informing one of the most common decisions faced by families of hospitalized children and their medical providers. Findings from FAAN-C will also have implications for national quality metrics and guidelines.
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Affiliation(s)
- Eric R Coon
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Julie Fritz
- Department of Physical Therapy & Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Arti D Desai
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam L Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Tyler Bardsley
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Christopher P Bonafide
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | | | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Sensky T. The Person-Centred Clinical Interview. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024:1-7. [PMID: 38830341 DOI: 10.1159/000539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Tom Sensky
- Centre for Mental Health, Department of Brain Sciences, Imperial College London, London, UK
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James D, Smith J, Lane E, Thomas R, Brown S, Seage H. Adherence to Parkinson's disease medication: A case study to illustrate reasons for non-adherence, implications for practice and engaging under-represented participants in research. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100450. [PMID: 38800618 PMCID: PMC11127522 DOI: 10.1016/j.rcsop.2024.100450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease which primarily presents with the core symptoms of rigidity, postural instability, tremor, and bradykinesia. Non-adherence to prescribed PD treatments can have significant ramifications, such as poor symptom control and greater disease burden. Reasons for poor adherence are multifaceted, particularly when medication regimens are complex and often based on perceptual and practical barriers. Additionally, engaging fully non-adherent patients in research is challenging since they may have dropped out of service provision, yet their contribution is vital to fully understand the rationale for non-adherence. This paper aims to present a case study on the perspectives of one person with PD, a participant in a previously published qualitative study investigating the barriers and facilitators to medication adherence in PD. In this paper, the participant's diagnostic journey is described, and experiences of medical consultations are summarised to explain their reasons for not adhering to any of the standard UK PD treatments prescribed. The participant's preferences for using Vitamin B1 (thiamine) injections to manage the symptoms are reported and the rationale for doing so is discussed. We consider the case through the lens of a behavioural science approach, drawing on health psychology theory, the Theoretical Domains Framework (TDF), to inform the review and the practical challenges faced when analysing the data for this participant. Implications for pharmacy practice, in particular, are also put forward with view to ensuring that patients such as Mr. Wilkinson are provided with the opportunity to discuss treatment choices and self-management of long-term conditions such as PD. We also discuss the importance of reaching under-represented members of the population in medication adherence research, which embraces the principles of equality, diversity, and inclusion in research.
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Affiliation(s)
- Delyth James
- Department of Applied Psychology, Cardiff School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, Wales, UK
| | - Joshua Smith
- Department of Applied Psychology, Cardiff School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, Wales, UK
| | - Emma Lane
- Cardiff School of Pharmacy & Pharmaceutical Sciences, Cardiff University, King Edward VIIth Avenue, Cardiff CF10 3NB, Wales, UK
| | - Rhian Thomas
- Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Sarah Brown
- Department of Applied Psychology, Cardiff School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, Wales, UK
| | - Heidi Seage
- Department of Applied Psychology, Cardiff School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, 200 Western Avenue, Cardiff CF5 2YB, Wales, UK
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Pranav K, Goel S, Ghosh A. Empowering tobacco users for improving outcomes: The transformative potential of shared decision making in tobacco cessation. J Eval Clin Pract 2024; 30:622-624. [PMID: 38558494 DOI: 10.1111/jep.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Kshtriya Pranav
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. THE PATIENT 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
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Wattanapisit A, Nicolle E, Ratnapalan S. Shared Decision-Making Training in Family Medicine Residency: A Scoping Review. Korean J Fam Med 2024; 45:134-143. [PMID: 38779714 PMCID: PMC11116119 DOI: 10.4082/kjfm.23.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 05/25/2024] Open
Abstract
Shared decisions, in which physicians and patients share their agendas and make clinical decisions together, are optimal for patient-centered care. Shared decision-making (SDM) training in family medicine residency is always provided, but the best training approach for improving clinical practice is unclear. This review aims to identify the scope of the literature on SDM training in family medicine residency to better understand the opportunities for training in this area. Four databases (Embase, MEDLINE, Scopus, and Web of Science) were searched from their inception to November 2022. The search was limited to English language and text words for the following four components: (1) family medicine, (2) residency, (3) SDM, and (4) training. Of the 522 unique articles, six studies were included for data extraction and synthesis. Four studies referenced three training programs that included SDM and disease- or condition-specific issues. These programs showed positive effects on family medicine residents' knowledge, skills, and willingness to engage in SDM. Two studies outlined the requirements for SDM training in postgraduate medical education at the national level, and detailed the educational needs of family medicine residents. Purposeful SDM training during family medicine residency improves residents' knowledge, skills, and willingness to engage in SDM. Future studies should explore the effects of SDM training on clinical practice and patient care.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
- Family Medicine Clinic, Walailak University Hospital, Walailak University, Nakhon Si Thammarat, Thailand
| | - Eileen Nicolle
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med 2024; 20:801-812. [PMID: 38189353 PMCID: PMC11063707 DOI: 10.5664/jcsm.10994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. METHODS Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. RESULTS Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. CONCLUSIONS Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. CITATION Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.
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Affiliation(s)
- Adam R. Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Lisa A. Brenner
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Aurora, Colorado
| | - Morgan Nance
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Joseph Mignogna
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Audrey D. Cobb
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jeri E. Forster
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Christi S. Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Risa Nakase-Richardson
- Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida, Tampa, Florida
| | - Nazanin H. Bahraini
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation and Psychiatry, Aurora, Colorado
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Sensky T. Practical application of the biopsychosocial model to medical care-Are we nearly there yet? Acta Psychiatr Scand 2024; 149:365-367. [PMID: 38511394 DOI: 10.1111/acps.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Tom Sensky
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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Brotto LA, Walker L, Sears C, Woo S, Millman R, Zdaniuk B. A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors. J Sex Med 2024; 21:452-463. [PMID: 38465848 DOI: 10.1093/jsxmed/qdae022] [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: 10/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Lauren Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, T2N 4N2, Canada
| | - Carly Sears
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Shannon Woo
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Roanne Millman
- Private Practice, West Coast Centre for Sex Therapy , Vancouver, British Columbia, V6H 3H4, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
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Billian J, Imfeld L, Roth CB, Moeller J, Lang UE, Huber CG. Patient-reported experience measures (PREMs) in outpatient psychiatry - is there an association to perceived discrimination and devaluation? Front Psychiatry 2024; 15:1378487. [PMID: 38699444 PMCID: PMC11064698 DOI: 10.3389/fpsyt.2024.1378487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Patient-Reported Experience Measures (PREMs) are gaining significance in the field of psychiatry, with patient satisfaction being a key measure. However, it is unclear if patient satisfaction in psychiatry is influenced by variables outside the treatment setting. This brief report thus examines the possible impact of perceived discrimination and devaluation (PDD) on patient satisfaction in the psychiatric outpatient setting. Data from 1,126 individuals who were undergoing or had recently completed treatment at 15 outpatient centers of the Psychiatric University Clinic in Basel, Switzerland, was analyzed. Patient satisfaction was assessed using the Münsterlingen Patient Satisfaction Questionnaire (MüPF), and perceived stigma was measured with the Perceived Discrimination Devaluation Scale. The results revealed a positive small effect size relationship between MüPF and PDD, suggesting that patients who perceived less stigma report higher treatment satisfaction. This relationship may affect most ratings, with the total MüPF score remaining relatively robust against this potential influence. Linear regression analysis indicated that a one-unit increase in PDD score could lead to a maximum change of 1.8 points on the 7-point Likert scale for the MüPF item correlating highest with PDD and 0.4 points on the total MüPF score. These findings highlight the importance of considering perceived stigma when evaluating patient satisfaction with psychiatric outpatient treatment. Future research should investigate associations between stigma, patient satisfaction, treatment outcome, as well as other external factors that may influence patient satisfaction in psychiatric settings.
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Affiliation(s)
- Janina Billian
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lukas Imfeld
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Institute for Evaluation Research, Basel, Universitäre Psychiatrische Kliniken (UPK) Basel, University of Basel, Basel, Switzerland
| | - Carl B. Roth
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
- Faculty of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
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Cincidda C, Pizzoli SFM, Oliveri S, Guiddi P, Pravettoni G. Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study. Front Med (Lausanne) 2024; 11:1356385. [PMID: 38646557 PMCID: PMC11027503 DOI: 10.3389/fmed.2024.1356385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels. Methods 16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires. Results Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged. Conclusion On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.
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Affiliation(s)
- Clizia Cincidda
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Serena Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutics, Department of Health Science, DISS, University of Milan, Milan, Italy
- Neurological Clinic, ASST-Santi Paolo e Carlo, Milan, Italy
| | - Paolo Guiddi
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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13
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Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int 2024; 35:561-574. [PMID: 37996546 PMCID: PMC10957669 DOI: 10.1007/s00198-023-06942-0] [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: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023]
Abstract
Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.
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Affiliation(s)
- Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
| | - Wieke S Nijmeijer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Annemieke Witteveen
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
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Anagnostou A. Shared decision-making in food allergy: Navigating an exciting era. Ann Allergy Asthma Immunol 2024; 132:313-320. [PMID: 37742794 DOI: 10.1016/j.anai.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is increasingly used in food allergy. We review its use in the areas of prevention, diagnosis, and management. DATA SOURCES PubMed and online SDM resources. STUDY SELECTIONS Studies and reviews relevant to SDM and areas in food allergy that decision-making may be applied were selected for discussion. RESULTS Food allergy represents an area with multiple opportunities for SDM. Patients, on one hand, need to obtain the necessary information and understanding of existing options from the allergist. The allergist, on the other hand, needs to understand "where the patient is coming from," their needs, preferences, and values, so that jointly they can reach a decision that is responsive to these. Benefits of SDM include a better understanding of disease by patients, improved compliance with medication, better health outcomes, decreased health care costs, and improved ability of patients to manage their disease and make informed choices. CONCLUSION In food allergy prevention, diagnosis, and management, multiple preference-sensitive options exist for patients where SDM may be used during allergy consultations, alongside decision aids. Decision aids are tools that assist and support patients during the SDM process, by supplementing the patient-physician interaction.
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Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
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15
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Ten Haaft BHEA, Furumaya A, Nooijen LE, Kazemier G, Ubbink DT, Erdmann JI. Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA). HPB (Oxford) 2024; 26:451-460. [PMID: 38161079 DOI: 10.1016/j.hpb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Shared decision-making (SDM) may improve patient autonomy and health outcomes. This study assessed the level of SDM at both ends of the spectrum of hepatobiliary surgery to identify needs and opportunities for improvement. METHODS A mixed-methods study was performed. Consultations regarding surgery for perihilar cholangiocarcinoma (pCCA) or hepatocellular adenoma (HCA) were prospectively included between September 2020 and December 2022. The level of patient involvement in treatment decision-making was assessed objectively by analysis of audio-recorded consultations using the OPTION-5 instrument. The perceived level of SDM was appreciated by patients (SDM-Q-9) and surgeons (SDM-Q-doc) through questionnaires. Higher scores indicated higher levels of SDM. Outcomes were compared between patient groups and two focus groups were held. RESULTS Ten pCCA- and nine HCA-patients were included in the quantitative part of the study. Median OPTION-5, SDM-Q-9 and SDM-Q-doc scores were 35% (IQR: 25-45%), 86% (IQR: 76-96%), and 73% (IQR: 71-78%), respectively. SDM-Q-9 scores among HCA-patients (79% [IQR: 71-82%]) were significantly lower than in pCCA-patients (96% [IQR: 93-100%], p < 0.001). In focus groups, patients reported a lack of information, support, and expressed positive attitudes towards decision support tools (DSTs). CONCLUSION Patient involvement and information provision among HPB-surgical patients show room for improvement, particularly for HCA-patients. DSTs may be helpful for this purpose.
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Affiliation(s)
- Britte H E A Ten Haaft
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lynn E Nooijen
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
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16
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Nielsen LS, Primdahl J, Clausen B, Bremander A. A joint venture: patients' experiences with goal setting in rheumatology rehabilitation - a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38375771 DOI: 10.1080/09638288.2024.2313122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To explore how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to interdisciplinary rehabilitation. METHODS We conducted semi-structured interviews with 22 participants admitted to an interdisciplinary rehabilitation stay for patients with RMDs at two Danish rehabilitation centres. Qualitative content analysis was applied. RESULTS The participants perceived goal setting as a joint venture between two parties: the health professionals and the participant. Three categories were formed, which described both facilitators and barriers in the process. Responsibility for goal setting described the importance of shared responsibility, or health professionals as experts, taking full responsibility for goal setting. Equipped for goal setting included perceptions of being well prepared for the process, or considerations that goal setting was difficult because of a lack of information. An equal member of the team entailed both the feeling of being recognised as one in the team, or feeling like an outsider. CONCLUSION Goal setting is perceived as a challenge by some patients. Participation in goal setting depends on both the capacity and the opportunity to participate which are factors linked to patients' level of health literacy.
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Affiliation(s)
- Lisbeth Skovly Nielsen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- The Danish Rheumatism Association's Rehabilitation Centre, Sano, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Brian Clausen
- The Danish Rheumatism Association's Rehabilitation Centre, Sano, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
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17
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Siegal AR, Ferrer FA, Herndon CDA, Wallis MC, Schaeffer AJ, Malhotra NR. Inter-disciplinary provider development of an online, interactive adolescent varicocele decision aid prototype. Andrology 2024; 12:429-436. [PMID: 37417400 PMCID: PMC10771535 DOI: 10.1111/andr.13491] [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: 04/13/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Decision-making regarding varicocele management can be a complex process for patients and families. However, to date, no studies have presented ways to mitigate the decisional conflict surrounding varicoceles. OBJECTIVE To facilitate a discussion among physicians in order to develop a framework of the decision-making process regarding adolescent varicocele management, which will inform the development of the first online, interactive decision aid. MATERIALS AND METHODS Semi-structured interviews with pediatric urologists and interventional radiologists were conducted to discuss their rationale for varicocele decision-making. Interviews were audio recorded, transcribed, and coded. Key themes were identified, grouped, and then qualitatively analyzed using thematic analysis. Utilizing the common themes identified and the Ottawa Decision Support Framework, a decision aid prototype was developed and transformed into a user-friendly website: varicoceledecisionaid.com. RESULTS Pediatric urologists (n = 10) and interventional radiologists (n = 2) were interviewed. Key themes identified included: (1) definition/epidemiology; (2) observation as an appropriate management choice; (3) reasons to recommend repair; (4) types of repair; (5) reasons to recommend one repair over another; (6) shared decision-making; and (7) appropriate counseling. With this insight, a varicocele decision aid prototype was developed that engages patients and parents in the decision-making process. DISCUSSION AND CONCLUSIONS This is the first interactive and easily accessible varicocele decision aid prototype developed by inter-disciplinary physicians for patients. This tool aids in decision-making surrounding varicocele surgery. It can be used before or after consultation to help families understand more about varicoceles and their repair, and why intervention may or may not be offered. It also considers a patient and family's personal values. Future studies will incorporate the patient and family perspective into the decision-making aid as well as implement and test the usability of this decision aid prototype in practice and in the wider urologic community.
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Affiliation(s)
- Alexandra R Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fernando A Ferrer
- Department of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - C D Anthony Herndon
- Division of Urology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
| | - M Chad Wallis
- Division of Pediatric Urology, Intermountain Primary Children at the University of Utah, Salt Lake City, Utah, USA
| | - Anthony J Schaeffer
- Division of Pediatric Urology, Intermountain Primary Children at the University of Utah, Salt Lake City, Utah, USA
| | - Neha R Malhotra
- Department of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, New York, USA
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18
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Sanabria-Mazo JP, D'Amico F, Cardeñosa E, Ferrer M, Edo S, Borràs X, McCracken LM, Feliu-Soler A, Sanz A, Luciano JV. Economic Evaluation of Videoconference Group Acceptance and Commitment Therapy and Behavioral Activation Therapy for Depression Versus Usual Care Among Adults With Chronic Low Back Pain Plus Comorbid Depressive Symptoms. THE JOURNAL OF PAIN 2024:104472. [PMID: 38242333 DOI: 10.1016/j.jpain.2024.01.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Chronic pain and depression are frequently comorbid conditions associated with significant health care and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and health care perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year. Compared to TAU, ACT achieved a significant reduction in total costs (d = .47), and BATD achieved significant reductions in indirect (d = .61) and total costs (d = .63). Significant improvements in BPI-IS (d = .73 and d = .66, respectively) and Quality Adjusted Life Year scores (d = .46 and d = .28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and health care perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (∆BPI-IS = -1.57 and -1.39, respectively) and BATD (∆BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (∆BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the 2 active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions can be used in decision-making and resource allocation. This study provides evidence that ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. TRIAL NUMBER: NCT04140838.
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Affiliation(s)
- Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Francesco D'Amico
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Eugenia Cardeñosa
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Basic Health Area (ABS) Maria Bernades, Direcció d'Atenció Primària Metropolitana Sud, Institut Català de la Salut, Viladecans, Spain
| | - Montse Ferrer
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Sílvia Edo
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Xavier Borràs
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | | | - Albert Feliu-Soler
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Antoni Sanz
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Donneyong MM, Bynum M, Kemavor A, Crossnohere NL, Schuster A, Bridges J. Patient satisfaction with the quality of care received is associated with adherence to antidepressant medications. PLoS One 2024; 19:e0296062. [PMID: 38180988 PMCID: PMC10769059 DOI: 10.1371/journal.pone.0296062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/05/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on the association between satisfaction with quality of care and adherence to antidepressants. OBJECTIVES To examine the association between patient satisfaction with healthcare and adherence to antidepressants. METHODS A cohort study design was used to identify antidepressant users from the 2010-2016Medical Expenditure Panel Survey data, a national longitudinal complex survey study design on the cost and healthcare utilization of the noninstitutionalized population in the United States. The Consumer Assessment of Healthcare Providers and Systems were used to measure participants' satisfaction with access and quality of care, patient-provider communication and shared decision-making (SDM). Patients were considered satisfied if they ranked the quality of care at ≥9 (range: 0[worst]- 10[best]). Antidepressant adherence was measured based on medication refill and complete discontinuation. MEPS sampling survey-weighted multivariable-adjusted logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between satisfaction and adherence to antidepressants. We tested for the potential presence of reverse associations by restricting the analysis to new users of antidepressants. The roles of patient-provider communication and SDM on the satisfaction-adherence association were examined through structural equation models (SEM). RESULTS Among 4,990 (weighted counts = 8,661,953) antidepressant users, 36% were adherent while 39% discontinued antidepressants therapy. Half of antidepressant users were satisfied with the healthcare received. Satisfied patients were 26% (OR = 1.26, 95%CI: 1.08, 1.47) more likely to adhere and 17% (OR = 0.83, 95%CI: 0.71, 0.96) less likely to discontinue, compared to unsatisfied antidepressant users. Patient satisfaction was also associated with higher odds (OR = 1.41, 95%CI: 1.06, 1.88) of adherence among a subgroup of new users of antidepressants. The SEM analysis revealed that satisfaction was a manifestation of patient-provider communication (β = 2.03, P-value<0.001) and SDM (β = 1.14, P-value<0.001). CONCLUSIONS Patient satisfaction is a potential predictor of antidepressant adherence. If our findings are confirmed through intervention studies, improving patient-provider communication and SDM could likely drive both patient satisfaction and adherence to antidepressants.
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Affiliation(s)
- Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH, United States of America
| | - Mary Bynum
- Healthcare Management, Franklin University, Columbus, Ohio, United States of America
| | - Ameena Kemavor
- ADAMH Board of Franklin County, Columbus, OH, United States of America
| | - Norah L. Crossnohere
- Division of General Internal Medicine, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
| | - John Bridges
- Department of Biomedical Informatics, The Ohio State College of Medicine, Columbus, Ohio, United States of America
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20
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Huyen NTT, Tsakitzidis G, Tam NM, Valcke M, Chuong HV, Wens J. Perceptions and experiences of primary healthcare providers toward interprofessional collaboration in chronic disease management in Hue, Vietnam. J Interprof Care 2024; 38:52-61. [PMID: 37366565 DOI: 10.1080/13561820.2023.2227650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/19/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
In Vietnam, each primary care community health center (CHC) consists of a multi-professional team with six disciplines, including a physician, assistant physician, nurse, pharmacist, midwife, and Vietnamese traditional physician, who are able to meet the majority of patient's needs at the primary care level. How they collaborate, especially in chronic disease management (CDM), is still limited described in the literature. This study aims to gain insight into the perceptions and the experiences of primary health care providers (PHCPs) toward interprofessional collaboration (IPC) in CDM in CHCs in (Hue) Vietnam. A qualitative study of descriptive phenomenology was performed using two focus groups and 15 semi-structured interviews with PHCPs from six professions relevant to CDM in CHCs. The data were analyzed using NVivo 12.0 with a thematic analysis method by a multiprofessional research team. From the analysis, the data were classified into three main themes: "lack of collaborative practice," "knowledge," and "facilitators and barriers to IPC." This study provided evidence of the awareness that actual collaboration in daily care is fragmentarily organized and that PHCPs try to finish their tasks within their profession. PHCPs work multiprofessionally and lack shared decision-making in patient-centered care. There is a need to develop an interprofessional education program and training to address these deficiencies in the Vietnamese context to improve interprofessional collaboration in health care.
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Affiliation(s)
- Nguyen Thi Thanh Huyen
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Giannoula Tsakitzidis
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Nguyen Minh Tam
- Department of Family Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Huynh Van Chuong
- The Education Quality Management Agency, Ministry of Education and Training, Vietnam
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
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Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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22
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Ng XR, Tey YXS, Lew KJ, Lee PSS, Lee ES, Sim SZ. Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore. BMJ Open 2023; 13:e079990. [PMID: 38081675 PMCID: PMC10729092 DOI: 10.1136/bmjopen-2023-079990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Managing older adults with multimorbidity may be challenging due to the conflicting benefits and harms of multiple treatments. Thus, it is important to identify patients' health outcome priorities to align treatment goals with their health preferences. This study aimed to use the Outcome Prioritisation Tool (OPT) to describe the health outcome priorities of older adults with multimorbidity and determine the factors associated with these priorities. Additionally, it aimed to assess the ease of completing the OPT in Singapore's primary care population. DESIGN Cross-sectional study conducted from January to March 2022. SETTING A public primary care centre in Singapore. PARTICIPANTS 65 years and older with multimorbidity. OUTCOME MEASURES Primary outcome measure was the most important health outcome priorities on the OPT. Secondary outcome measures were factors affecting these priorities and ease of completing the OPT. RESULTS We enrolled 180 participants (mean age: 73.2±6.1 years). Slightly more than half (54.4%) prioritised 'staying alive', while the remainder (45.6%) prioritised 'maintaining independence' (25.6%), 'relieving pain' (10.6%) and 'relieving other symptoms' (9.4%). Participants with six or more chronic conditions were three times (OR 3.03 (95% CI1.09 to 8.42)) more likely to prioritise 'staying alive' compared with participants with three conditions. Most participants (69.4%) agreed that the OPT was easy to complete, and the mean time taken to complete the OPT was 3.8±1.6 minutes. CONCLUSION 'Staying alive' was the most important health outcome priority, especially for older adults with six or more chronic conditions. The OPT was easily completed among older adults with multimorbidity in primary care. Further qualitative studies can be conducted to understand the factors influencing patients' priorities and explore the relevance of the OPT in guiding treatment decisions.
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Affiliation(s)
- Xin Rong Ng
- National Healthcare Group Polyclinics, Singapore
| | | | - Kaiwei Jeremy Lew
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | | | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Sai Zhen Sim
- National Healthcare Group Polyclinics, Singapore
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23
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Coetzee S, Mahajan C, França K. The Diagnostic Workup, Screening, and Treatment Approaches for Patients with Delusional Infestation. Dermatol Ther (Heidelb) 2023; 13:2993-3006. [PMID: 37872445 PMCID: PMC10689332 DOI: 10.1007/s13555-023-01053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023] Open
Abstract
Delusional infestation (DI) is a psychiatric disorder defined by the fixed, false belief that one has been infested by an organism without evidence to support this. Patients may present with skin lesions and report abnormal cutaneous sensations. The diagnostic workup for patients presenting with delusional infestation is essential to ensuring accurate diagnosis in ruling out other explanations for symptoms and investigating potential secondary causes of DI. In addition to a comprehensive history and physical examination, laboratory workup should be considered depending on the clinical picture. Antipsychotic medications are the most common drugs used in management of adults with DI and tailor the choice of treatment according to patient characteristics. This article serves as a guide for dermatologists, psychiatrists, and other clinicians as it reviews the workup and screening that should be considered when managing a patient with delusional infestation and subsequent treatment protocols once the diagnosis has been made.
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Affiliation(s)
- Skyler Coetzee
- University of Miami/Holy Cross Health, Fort Lauderdale, FL, USA
| | - Chandrally Mahajan
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Katlein França
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1295 NW 14th St Suite K/L/M, Miami, FL, 33125, USA.
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, 33136, FL, USA.
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, P.O. Box 016960 (M-825), Miami, 33101, FL, USA.
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24
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Sweeney J, Tichnell C, Christian S, Pendelton C, Murray B, Roter DL, Jamal L, Calkins H, James CA. Characterizing Decision-Making Surrounding Exercise in ARVC: Analysis of Decisional Conflict, Decisional Regret, and Shared Decision-Making. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e004133. [PMID: 38014565 PMCID: PMC10729899 DOI: 10.1161/circgen.123.004133] [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: 03/01/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Limiting high-intensity exercise is recommended for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) due to its association with penetrance, arrhythmias, and structural progression. Guidelines recommend shared decision-making (SDM) for exercise level, but there is little evidence regarding its impact. Therefore, we sought to evaluate the extent and implications of SDM for exercise, decisional conflict, and decisional regret in patients with ARVC and at-risk relatives. METHODS Adults diagnosed with ARVC or with positive genetic testing enrolled in the Johns Hopkins ARVC Registry were invited to complete a questionnaire that included exercise history and current exercise, SDM (SDM-Q-9), decisional conflict, and decisional regret. RESULTS The response rate was 64.8%. Two-thirds of participants (68.0%, n=121) reported clinically significant decisional conflict regarding exercise at diagnosis/genetic testing (DCS [decisional conflict scale]≥25), and half (55.1%, n=98) in the past year. Prevalence of decisional regret was also high with 55.3% (n=99) reporting moderate to severe decisional regret (DRS [decisional regret scale]≥25). The extent of SDM was highly variable ranging from no (0) to perfect (100) SDM (mean, 59.6±25.0). Those diagnosed in adolescence (≤age 21) reported significantly more SDM (P=0.013). Importantly, SDM was associated with less decisional conflict (ß=-0.66, R2=0.567, P<0.01) and decisional regret (ß=-0.37, R2=0.180, P<0.001) and no difference in vigorous intensity aerobic exercise in the 6 months after diagnosis/genetic testing or the past year (P=0.56; P=0.34, respectively). CONCLUSIONS SDM is associated with lower decisional conflict and decisional regret; and no difference in postdiagnosis exercise. Our data thus support SDM as the preferred model for exercise discussions for ARVC.
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Affiliation(s)
- Jessica Sweeney
- Johns Hopkins Bloomberg School of Public Health (J.S., D.L.R.), Johns Hopkins University, Baltimore
- National Human Genome Research Institute (J.S.), National Institutes of Health, Bethesda, MD
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Susan Christian
- Department of Medical Genetics, University of Alberta, Edmonton, Canada (S.C.)
| | - Catherine Pendelton
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Brittney Murray
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Debra L. Roter
- Johns Hopkins Bloomberg School of Public Health (J.S., D.L.R.), Johns Hopkins University, Baltimore
| | - Leila Jamal
- Center for Cancer Research, National Cancer Institute (L.J.), National Institutes of Health, Bethesda, MD
- Department of Bioethics, Clinical Center (L.J.), National Institutes of Health, Bethesda, MD
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine (C.T., C.P., B.M., H.C., C.A.J.), Johns Hopkins University, Baltimore
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25
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Orsi F. Interventional oncology in breast cancer. J Med Imaging Radiat Oncol 2023; 67:876-885. [PMID: 37964687 DOI: 10.1111/1754-9485.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well-selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra-arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well-selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described.
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Affiliation(s)
- Franco Orsi
- IRCCS Istituto Europeo di Oncologia, Milan, Italy
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26
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van der Horst DEM, Hofstra N, van Uden-Kraan CF, Stiggelbout AM, van den Dorpel MA, Pieterse AH, Bos WJW. Shared Decision Making in Health Care Visits for CKD: Patients' Decisional Role Preferences and Experiences. Am J Kidney Dis 2023; 82:677-686. [PMID: 37516297 DOI: 10.1053/j.ajkd.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Research on shared decision making (SDM) in chronic kidney disease (CKD) has focused almost exclusively on the modality of kidney replacement treatment. We explored what other CKD decisions are recognized by patients, what their preferences and experiences are regarding these decisions, and how decisions are made during their interactions with medical care professionals. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Patients with CKD receiving (outpatient) care in 1 of 2 Dutch hospitals. EXPOSURE Patients' preferred decisional roles for treatment decisions were measured using the Control Preferences Scale survey administered after a health care visit with medical professionals. OUTCOME Number of decisions for which patients experienced a decisional role that did or did not match their preferred role. Observed levels of SDM and motivational interviewing in audio recordings of health care visits, measured using the 4-step SDM instrument (4SDM) and Motivational Interviewing Treatment Integrity coding tools. ANALYTICAL APPROACH The results were characterized using descriptive statistics, including differences in scores between the patients' experienced and preferred decisional roles. RESULTS According to the survey (n=122) patients with CKD frequently reported decisions regarding planning (112 of 122), medication changes (82 of 122), or lifestyle changes (59 of 122). Of the 357 reported decisions in total, patients preferred that clinicians mostly (125 of 357) or fully (101 of 357) make the decisions. For 116 decisions, they preferred a shared decisional role. For 151 of 357 decisions, the patients' preferences did not match their experiences. Decisions were experienced as "less shared/patient-directed" (76 of 357) or "more shared/patient-directed" (75 of 357) than preferred. Observed SDM in 118 coded decisions was low (median4; range, 0 - 22). Motivational interviewing techniques were rarely used. LIMITATIONS Potential recall and selection bias, and limited generalizability. CONCLUSIONS We identified multiple discrepancies between preferred, experienced, and observed SDM in health care visits for CKD. Although patients varied in their preferred decisional role, a considerable number of patients expressed a preference for shared decision making for many decisions. However, SDM behavior during the health care visits was observed infrequently. PLAIN-LANGUAGE SUMMARY Shared decision making (SDM) may be a valuable approach for common chronic kidney disease (CKD) decisions, but our knowledge is limited. We collected patient surveys after health care visits for CKD. Patients most frequently experienced decisions regarding planning, medication, and lifestyle. Three decisional roles were preferred by comparable numbers of patients: let the clinician alone decide, let the clinician decide for the most part, or "equally share" the decision. Patients' experiences of who made the decision did not always match their preferences. In audio recordings of the health care visits, we observed low levels of SDM behavior. These findings suggest that the preference for "sharing decisions" is often unmet for a large number of patients.
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Affiliation(s)
- Dorinde E M van der Horst
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein; Santeon, Utrecht, Leiden University Medical Centre, Leiden; Department of Internal Medicine, Leiden University Medical Centre, Leiden.
| | | | | | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam
| | | | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden
| | - Willem Jan W Bos
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein; Department of Internal Medicine, Leiden University Medical Centre, Leiden
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27
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Björk M, Knutsson S, Odzakovic E, Hellström A, Sandlund C, Ulander M, Lind J, Pakpour AH, Broström A. Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome. J Sleep Res 2023:e14071. [PMID: 37909257 DOI: 10.1111/jsr.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.
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Affiliation(s)
- Maria Björk
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Susanne Knutsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Elzana Odzakovic
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Martin Ulander
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Jonas Lind
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Amir H Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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28
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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29
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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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30
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Blum L, Jarach CM, Ellen ME. Perceptions of shared decision making in gastroenterology and inflammatory bowel disease: A qualitative analysis. PATIENT EDUCATION AND COUNSELING 2023; 115:107877. [PMID: 37437510 DOI: 10.1016/j.pec.2023.107877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is the partnership and discussion between clinicians and patients to make an appropriate decision based on scientific evidence and patient preferences. Many benefits are associated with SDM; however, little is known about its awareness or use by inflammatory bowel disease (IBD) clinicians in gastroenterology departments across Israel. This study aims to identify barriers and facilitators in implementing SDM as standard practice to achieve optimal disease management and personalized care for patients with IBD. METHODS Sixteen semi-structured interviews were conducted with IBD clinicians across Israel to identify the barriers and facilitators for SDM use. An interview guide was developed, based on the systematic approach of the Theoretical Domain Framework (TDF). Interview transcripts were coded into theoretical domains to identify factors that may impact SDM. RESULTS Sixteen gastroenterologists from nine different hospitals were interviewed. Common TDF domains that presented as barriers were: knowledge, skills, social/professional role and identity, environmental context and resources, and reinforcement. Most participants had never heard the precise term "shared decision making" and lacked formal training on SDM. CONCLUSION This study identified key barriers and facilitators to SDM in IBD clinics across Israel. Main barriers of SDM include limited or nonexistent training; clinicians were unaware of SDM guidelines or techniques. The main facilitators of SDM were clinicians' social and professional role and identity and their beliefs about the influence of IBD and/or CD. PRACTICE IMPLICATIONS These influencing factors and TDF domains identified provide a basis for developing future interventions to improve the implementation of SDM within IBD management.
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Affiliation(s)
- Livnat Blum
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
| | - Carlotta Micaela Jarach
- Laboratory of Lifestyle Research, Department of Medical Epidemiology, Mario Negri Institute of Pharmacological Research, IRCCS, Italy.
| | - Moriah E Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Israel Implementation Science and Policy Engagement Centre, Ben-Gurion University of the Negev, Israel.
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31
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Kim DE, Kim MJ. Factors influencing shared decision-making in long-term care facilities. BMC Geriatr 2023; 23:577. [PMID: 37726675 PMCID: PMC10508015 DOI: 10.1186/s12877-023-04301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Shared decision-making, a communicative process to reach decisions based on informed preferences, evidence, and co-created goals, improves care satisfaction and patients' quality of life. However, shared decision-making has not been widely implemented in long-term care facilities, and few studies have examined how to promote the shared decision-making practice. This study aimed to identify the influencing factors of shared decision-making based on the Person-centered Practice Framework in long-term care facilities. METHODS A total of 300 staff (nursing staff, social workers, and personal care workers) in 13 Korean long-term care facilities participated in this study. Data from 280 respondents were finally analyzed, excluding respondents with missing values. Data were collected using structured questionnaires that included items on shared decision-making, personal factors (e.g., knowledge about dementia, person-centered care education, person-centered attitude, communication behavior, and job tenure), and care environment factors (e.g., person-centered climate, staffing level, effective staff relationships, supportive supervisors, and power-sharing). Multilevel linear regression analyses were performed using Mplus Version 8.8. RESULTS The mean shared decision-making score was 35.78 (range 8-45). Staff with experience of person-centered care education (β = 0.198, p = 0.034), a higher person-centered attitude score (β = 0.201, p = 0.007), and a higher communication behavior score (β = 0.242, p < 0.001) were more likely to report a higher shared decision-making score. In addition, staff who viewed their care environment as more person-centered were more likely to report a higher shared decision-making score (β = 0.416, p < 0.001). CONCLUSIONS This study highlights that personal (e.g., person-centered care education, person-centered attitude, and communication behavior) and care environment (e.g., person-centered climate) factors could influence shared decision-making for long-term care residents. These findings could be foundational evidence for facilitating shared decision-making practice in long-term care settings.
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Affiliation(s)
- Da Eun Kim
- College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea.
| | - Min Jung Kim
- Department of Nursing, Kyongbuk Science College, Gyeongsangbuk-do, Republic of Korea
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Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc 2023; 16:2655-2665. [PMID: 37706183 PMCID: PMC10496844 DOI: 10.2147/jmdh.s425315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction. Patients and Methods A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM. Results The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching. Conclusion This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.
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Affiliation(s)
- Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aloraifi
- Salamat Medical Hospital, Department of Physiotherapy, Hail, Saudi Arabia
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Ravaldi C, Mercuro C, Mosconi L, Roper F, Lotto L, Vannacci A, Gavaruzzi T. Communication and shared decision-making after stillbirth: Results of the ShaDeS study. Women Birth 2023; 36:e518-e526. [PMID: 37062619 DOI: 10.1016/j.wombi.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is included in guidelines for bereavement care after a stillbirth, as it can improve women's long-term health and wellbeing. SDM within the stillbirth context is still not common, and Italy does not yet have standardised guidelines. AIM The ShaDeS (Shared Decision-Making in Stillbirth) study aims to investigate how Italian women with a stillbirth perceive their own centrality in decision-making processes around bereavement care and how this might impact satisfaction of care. METHODS The ShaDeS study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic information and medical history, communication of bad news and bereavement care, decisions about childbirth (SDM-Q-9, SHARED, and DCS), and decisions and communication about autopsy (CPS). FINDINGS 187 women answered the survey. For the 41.1% of women that did not have an emergency childbirth, the SDM-Q-9 median score was 66.6 (0-100 range), and the SHARED median score was 3.5 (1-5 range). 29.4% of participants reached the proposed cutoff of 37.5 in the DCS (0-100 range) suggesting a difficulty in reaching decisions. Satisfaction scores were lower for those with such difficulties (p < 0.0001). Of the 64.5% of women that discussed autopsy, 28.3% were involved in an SDM approach, despite this being associated with higher levels of satisfaction of care (p < 0.05). CONCLUSION An SDM approach is only moderately widespread amongst our participants, despite it being significantly related to higher levels of satisfaction. Further studies should investigate the tools that both patients and healthcare professionals need for an SDM approach.
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Affiliation(s)
- Claudia Ravaldi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy; PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Chiara Mercuro
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Laura Mosconi
- CiaoLapo Foundation for Perinatal Health, Prato, Italy; PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Lorella Lotto
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Alfredo Vannacci
- CiaoLapo Foundation for Perinatal Health, Prato, Italy; PeaRL - Perinatal Research Laboratory, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Somohano VC, Smith CL, Saha S, McPherson S, Morasco BJ, Ono SS, Zaccari B, Lovejoy J, Lovejoy T. Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain. J Gen Intern Med 2023; 38:2755-2760. [PMID: 37118560 PMCID: PMC10506962 DOI: 10.1007/s11606-023-08212-5] [Citation(s) in RCA: 2] [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: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Patient-provider shared decision-making is associated with better treatment adherence and pain outcomes in opioid-specific pain management. One possible mechanism through which shared decision-making may impact pain management outcomes is trust in one's prescribing provider. Elucidating relationships between factors that enhance the patient-provider relationship, such as shared decision-making and trust, may reduce risks associated with opioid treatment, such as opioid misuse. OBJECTIVE The purpose of this study was to investigate the mediating effect of trust in one's prescribing provider on the relationship between shared decision-making and current opioid misuse. DESIGN A secondary analysis of data from a prospective cohort study of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. PARTICIPANTS Eligibility criteria included being prescribed LTOT, ability to speak and read English, and access to a telephone. Veterans were excluded if they had a cancer diagnosis, received opioid agonist therapy for opioid use disorder, or evidence of pending discontinuation of LTOT. Stratified random sampling was employed to oversample racial and ethnic minorities and women veterans. MAIN MEASURES Physician Participatory Decision-Making assessed level of patient involvement in medical decision-making, the Trust in Provider Scale assessed interpersonal trust in patient-provider relationships, and the Current Opioid Misuse Measure assessed opioid misuse. KEY RESULTS Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator (c = - 0.243, p < 0.001), such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant (c' = - 0.147, p = 0.007). CONCLUSIONS Shared decision-making is associated with less prescription opioid misuse through the trust that is fostered between patients and providers.
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Affiliation(s)
- Vanessa C Somohano
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Crystal L Smith
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine and the Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Belle Zaccari
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennette Lovejoy
- Department of Communication Studies, University of Portland, Portland, OR, USA
| | - Travis Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
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Penney SR, Faziluddin S, Simpson AIF, Socha P, Wilkie T. Risk, resilience, and recovery in forensic mental health: An integrated conceptual model. BEHAVIORAL SCIENCES & THE LAW 2023; 41:280-291. [PMID: 36898979 DOI: 10.1002/bsl.2615] [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: 10/25/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
In this paper we describe a novel, integrated conceptual model that brings together core elements across structured tools assessing risk for future violence, protective factors, and progress in treatment and recovery in forensic mental health settings. We argue that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment planning activities and increase the accessibility of clinical assessments to principal users of this information. The four domains appearing in the model (treatment engagement, stability of illness and behavior, insight, and professional and personal support) are described, and common clinical manifestations of each domain within a forensic context are illustrated. We conclude with a discussion of the types of research that would be needed to validate a concept model such as the one presented here as well as implications for clinical practice and implementation.
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Affiliation(s)
- Stephanie R Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suraya Faziluddin
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Socha
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Treena Wilkie
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Sedlakova J, Westermair AL, Biller-Andorno N, Meier CA, Trachsel M. Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review. Front Digit Health 2023; 5:1208889. [PMID: 37744684 PMCID: PMC10513051 DOI: 10.3389/fdgth.2023.1208889] [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: 04/19/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development. Methods A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles. Results We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards. Discussion More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.
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Affiliation(s)
- Jana Sedlakova
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Anna Lisa Westermair
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland
| | - Christoph A. Meier
- Department of Internal Medicine, University Hospital Zurich (USZ), Zürich, Switzerland
- Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit, University Hospital of Basel (USB), Basel, Switzerland
- Clinical Ethics Unit, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
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Woolley JC, Edmondson SN, Sathe MN, Rodriguez Francis JK. Patient Attitudes Regarding Health Care Clinician Communication in Adolescents With Cystic Fibrosis. J Pediatr Gastroenterol Nutr 2023; 77:e23-e28. [PMID: 37229765 DOI: 10.1097/mpg.0000000000003844] [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] [Indexed: 05/27/2023]
Abstract
BACKGROUND The quality of health care clinician (HCC) communication varies, yet few studies evaluate ways to improve communication among adolescents with cystic fibrosis (CF). We sought to characterize the attitudes of adolescents and young adults (AYA) with CF about HCC communication and describe the components important for high-quality communication. METHODS AYA with CF aged 12-20 years from a single large pediatric CF care center participated in a brief survey and semi-structured individual and group virtual interviews that were recorded, transcribed, coded, and analyzed with a combined deductive and inductive approach. Discrepancies were resolved by consensus. RESULTS Among the 39 survey respondents, most were White (77%), male (51%), and averaged 15.51 years (range 12-20 years). Many (40%) perceived their health status as " neutral " and over half (61%) were " very satisfied " with HCC communication. Overall, among the 17 interviews (averaged 53.6 min, range 31.5-74 min), participants reported a desire to be actively engaged in discussions about their health and included in the decision-making process with HCC to support adolescent autonomy and cultivate trust. Some factors detract (loss of control and fear of diagnosis), and others strengthen (transition to adult care and external motivators) adolescent autonomy. Some factors detract (perceived lack of interdisciplinary communication, statements of noncompliance, and being compared to others) and others strengthen (inherent trust and familiarity over time) the cultivation of trust. CONCLUSIONS The development of adolescent autonomy and the cultivation and maintenance of trust between the patient and HCC are 2 essential components of quality communication that should inform future communication-focused interventions.
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Affiliation(s)
- Joseph C Woolley
- From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children's Health, Dallas, TX
| | | | - Meghana N Sathe
- From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children's Health, Dallas, TX
| | - Jenny K Rodriguez Francis
- From the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
- Children's Health, Dallas, TX
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Smelt HJM, Pouwels S, Heusschen L, Hazebroek EJ, van Rutte PWJ, Theel W, Smulders JF. Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: Thematic Analysis of Qualitative Data From a Multicenter Study. Cureus 2023; 15:e42928. [PMID: 37667703 PMCID: PMC10475153 DOI: 10.7759/cureus.42928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023] Open
Abstract
Introduction Adherence to daily intake of multivitamin supplementation (MVS) is a major challenge after bariatric surgery (BS). The aim of this study was to identify insights into patients' beliefs and experiences on adherence to MVS intake. Methods A thematic analysis of qualitative data from four high-volume bariatric centers in the Netherlands was conducted. A series of texts from the open-ended question of 1,246 patients were thematically analyzed for common or overarching themes, ideas, and patterns. Results Five key themes emerged regarding participants' suggestions on adherence to daily MVS intake: "gastrointestinal side effects to MVS intake" (n = 850, 68.2%), "negative features of MVS" (n = 296, 23.8%), "satisfaction with advice on MVS" (n = 272, 21.8%), "dissatisfaction with service provision" (n = 160, 12.8%), and "costs" (n = 93, 7.5%). Most problems were experienced when using specialized weight loss surgery (WLS) MVS. These supplements may cause gastrointestinal side effects, and costs are too high. After bariatric surgery, numerous patients strongly felt that information provision was poor in several aspects, and the aftercare pathway process did not provide sufficient support. Conclusion This study found five major themes involved in patient adherence to multivitamin intake after BS: gastrointestinal side effects to MVS intake, negative features of MVS, satisfaction with advice on MVS, dissatisfaction with service provision, and costs of specialized MVS. Challenges lie in stronger education for both patients and healthcare professionals. More personalized care could probably increase patient satisfaction, and MVS companies should look at further optimizing supplements for better tolerability and reducing costs.
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Affiliation(s)
- H J M Smelt
- Department of Surgery, Catharina Hospital, Eindhoven, NLD
| | - S Pouwels
- Department of Surgery, Helios Klinikum, Krefeld, DEU
| | - L Heusschen
- Department of Surgery, Rijnstate, Arnhem, NLD
| | - E J Hazebroek
- Department of Surgery, Rijnstate, Arnhem, NLD
- Department of Human Nutrition and Health, Wageningen University, Wageningen, NLD
| | - P W J van Rutte
- Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, NLD
| | - W Theel
- Surgery, Franciscus Gasthuis, Rotterdam, NLD
| | - J F Smulders
- Department of Surgery, Catharina Hospital, Eindhoven, NLD
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Hæsum LKE, Cichosz SL, Hejlesen OK. Using machine learning to design a short test from a full-length test of functional health literacy in adults-The development of a short form of the Danish TOFHLA. PLoS One 2023; 18:e0280613. [PMID: 37498890 PMCID: PMC10373996 DOI: 10.1371/journal.pone.0280613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Patients are compelled to become more involved in shared decision making with healthcare professionals in the self-management of chronic disease and general adherence to treatment. Therefore, it is valuable to be able to identify patients with low functional health literacy so they can be given special instructions about the management of chronic disease and medications. However, time spent by both patients and clinicians is a concern when introducing a screening instrument in the clinical setting, which raises the need for short instruments for assessing health literacy that can be used by patients without the involvement of healthcare personnel. This paper describes the development of a short version of the full-length Danish TOFHLA (DS-TOFHLA) that is easily applicable in the clinical context and where the use does not require a trained interviewer. MATERIALS AND METHODS Data were collected as a part of a large-scale telehomecare project (TeleCare North), which was a randomized controlled trial that included 1225 patients with chronic obstructive pulmonary disease. The DS-TOFHLA was developed solely using an algorithm-based selection of variables and multiple linear regression. A multiple linear regression model was developed using an exhaustive search strategy. RESULTS The exhaustive search showed that the number of items in the full-length TOFHLA could be reduced from 17 numeracy items and 50 reading comprehension items to 20 reading comprehension items while maintaining a correlation of r = 0.90 between the scores from full-length and short versions. A generic model-based approach was developed, which is suitable for development of short versions of the TOFHLA in other languages, including the original American version. CONCLUSIONS This study demonstrated how a generic model-based approach could be applied in the development of a short version of the TOFHLA, thereby reducing the 67 items to 20 items in the short version. Furthermore, this study showed that the inclusion of numeracy items was not necessary. The development of the DS-TOFHLA presents an opportunity to reliably identify patients with inadequate functional health literacy in approximately 5 minutes without involvement of healthcare personnel. The approach may be used in the development of short versions of any scaling questionnaire.
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Affiliation(s)
- Lisa Korsbakke Emtekær Hæsum
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
- Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Simon Lebech Cichosz
- Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ole Kristian Hejlesen
- Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Vinayagam R, Tanner C, Harley D, Karatella S, Brooker K. "My Autism is Linked with Everything": at the Crossroads of Autism and Diabetes. J Autism Dev Disord 2023:10.1007/s10803-023-06033-3. [PMID: 37480434 DOI: 10.1007/s10803-023-06033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/24/2023]
Abstract
Autistic adults experience stark health disparities and difficulties accessing health care. Their realities of managing complex health conditions are unknown. Our research explored the experience of Autistic adults self-managing diabetes. Interviews with Autistic adults with diabetes and their support people were thematically analysed to identify three key themes. The Autistic experience influenced diabetes self-management, including autism-unique challenges and strengths. Participants prioritised avoiding Autistic burnout over diabetes self-management; mitigating the psychosocial pressures of neurotypical systems took precedence. Health professionals often separated autism and diabetes subsequently overlooking key factors impacting diabetes self-management. To better meet the needs of Autistic adults, diabetes care and health management more broadly should be considered within the context of autism, including supports for self-management during Autistic burnout.
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Affiliation(s)
- Ritwika Vinayagam
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-UQ, The University of Queensland, Level 2, 39 Annerley Rd, South Brisbane, QLD, 4101, Australia.
- The Cooperative Research Centre for Living with Autism (Autism CRC), Level 3, Foxtail Building UQ Long Pocket Campus, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
| | - Christopher Tanner
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-UQ, The University of Queensland, Level 2, 39 Annerley Rd, South Brisbane, QLD, 4101, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Level 3, Foxtail Building UQ Long Pocket Campus, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia
| | - David Harley
- UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital Campus, Building 71/918, Herston, QLD, 4029, Australia
| | - Shamshad Karatella
- School of Pharmacy, The University of Queensland, Level 4/20 Cornwall St, Woolloongabba, QLD, 4102, Australia
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Building 48 1 James Cook Drive, Douglas, QLD, 4811, Australia
| | - Katie Brooker
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-UQ, The University of Queensland, Level 2, 39 Annerley Rd, South Brisbane, QLD, 4101, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Level 3, Foxtail Building UQ Long Pocket Campus, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia
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Büdenbender B, Köther AK, Kriegmair MC, Grüne B, Michel MS, Alpers GW. Getting specific: participation preference in urooncological decision-making. BMC Med Inform Decis Mak 2023; 23:114. [PMID: 37407999 DOI: 10.1186/s12911-023-02201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Shared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference. METHODS In Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed. RESULTS Study 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001. CONCLUSIONS The desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany.
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Turnbull S, Walsh NE, Moore AJ. Adaptation and Implementation of a Shared Decision-Making Tool From One Health Context to Another: Partnership Approach Using Mixed Methods. J Med Internet Res 2023; 25:e42551. [PMID: 37405845 DOI: 10.2196/42551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/04/2023] [Accepted: 05/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Osteoarthritis is a leading cause of pain and disability. Knee osteoarthritis accounts for nearly four-fifths of the burden of osteoarthritis internationally, and 10% of adults in the United Kingdom have the condition. Shared decision-making (SDM) supports patients to make more informed choices about treatment and care while reducing inequities in access to treatment. We evaluated the experience of a team adapting an SDM tool for knee osteoarthritis and the tool's implementation potential within a local clinical commissioning group (CCG) area in southwest England. The tool aims to prepare patients and clinicians for SDM by providing evidence-based information about treatment options relevant to disease stage. OBJECTIVE This study aimed to explore the experiences of a team adapting an SDM tool from one health context to another and the implementation potential of the tool in the local CCG area. METHODS A partnership approach using mixed methods was used to respond to recruitment challenges and ensure that study aims could be addressed within time restrictions. A web-based survey was used to obtain clinicians' feedback on experiences of using the SDM tool. Qualitative interviews were conducted by telephone or video call with a sample of stakeholders involved in adapting and implementing the tool in the local CCG area. Survey findings were summarized as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data were mapped directly to the Theoretical Domains Framework (TDF). RESULTS Overall, 23 clinicians completed the survey, including first-contact physiotherapists (11/23, 48%), physiotherapists (7/23, 30%), specialist physiotherapists (4/23, 17%), and a general practitioner (1/23, 4%). Eight stakeholders involved in commissioning, adapting, and implementing the SDM tool were interviewed. Participants described barriers and facilitators to the adaptation, implementation, and use of the tool. Barriers included a lack of organizational culture that supported and resourced SDM, lack of clinician buy-in and awareness of the tool, challenges with accessibility and usability, and lack of adaptation for underserved communities. Facilitators included the influence of clinical leaders' belief that SDM tools can improve patient outcomes and National Health Service resource use, clinicians' positive experiences of using the tool, and improving awareness of the tool. Themes were mapped to 13 of the 14 TDF domains. Usability issues were described, which did not map to the TDF domains. CONCLUSIONS This study highlights barriers and facilitators to adapting and implementing tools from one health context to another. We recommend that tools selected for adaptation should have a strong evidence base, including evidence of effectiveness and acceptability in the original context. Legal advice should be sought regarding intellectual property early in the project. Existing guidance for developing and adapting interventions should be used. Co-design methods should be applied to improve adapted tools' accessibility and acceptability.
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Affiliation(s)
- Sophie Turnbull
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Nicola E Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom
| | - Andrew J Moore
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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McCurry P, Cadogan AA, Hubinger G, Paramour S, Tan S, Minhoto Arid de Lima V, Menon R, Albano D. Understanding information (in)equity: influencing factors and medical information's role in bridging the gap. Curr Med Res Opin 2023; 39:1007-1011. [PMID: 37314382 DOI: 10.1080/03007995.2023.2225300] [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: 11/30/2022] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/15/2023]
Abstract
Medical Information in the pharmaceutical industry involves the creation and dissemination of evidence-based scientific medical content in response to questions about medicines and therapy areas for patients and healthcare professionals. Health information equity can be broadly defined as the distribution of health information in a way that is accessible and understandable to all users, allowing them to benefit and reach their full potential for health. Ideally, this information would be made available to all those in need across the globe. However, as demonstrated by the COVID-19 pandemic, widespread health discrepancies exist. The World Health Organization defines health inequity as differences in health status or in the distribution of health resources between different population groups. Health inequities are influenced by the social conditions in which people are born, grow, live, work and age. This article explains select key factors influencing health information inequity and addresses opportunities where Medical Information departments can make a difference to improve global public health.
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Affiliation(s)
- Patrick McCurry
- Global Medical Information, Pfizer Inc., New York, NY, USA
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | | | - Gudrun Hubinger
- Global Medical Information, Pfizer Gulf FZ LLC, Dubai, United Arab Emirates
| | - Sarah Paramour
- Global Medical Information, Pfizer Ltd., Tadworth, United Kingdom
| | - Shu Tan
- Global Medical Information, Pfizer Inc., Beijing, China
| | | | - Roopa Menon
- Global Medical Information, Pfizer Limited, Mumbai, India
| | - Dominick Albano
- Global Medical Information, Pfizer Inc., New York, NY, USA
- Board of Directors, Pharma Collaboration for Transparent Medical Information, West Point, PA, USA
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Phillips S, Schlenz AM, D'Alton S, Johnson M, Kanter J. Patient and Family Opioid Decision-Making for Pain Management in Sickle Cell Disease: A Qualitative Study. THE JOURNAL OF PAIN 2023; 24:1240-1250. [PMID: 36863679 PMCID: PMC10329994 DOI: 10.1016/j.jpain.2023.02.022] [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: 10/21/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
Pain is a significant symptom experienced frequently by individuals with sickle cell disease (SCD). Pain management includes strategies such as oral rehydration, non-pharmacological therapies (eg, massage, relaxation), and oral analgesics and opioids. Shared decision-making around pain management is emphasized repeatedly in recent guidelines; however, research is sparse regarding factors to be considered in shared decision-making approaches including the perceived risks and benefits of opioids. This qualitative descriptive study was conducted to explore perspectives of decision-making for opioid medications in SCD. We conducted 20 in-depth interviews with caregivers of children with SCD and individuals with SCD to elucidate the decision-making processes around home use of opioid therapy for pain management at a single center. Themes were identified in the domains of the Decision Problem (Alternatives and Choices; Outcomes and Consequences; Complexity), the Context (Multilevel Stressors and Supports; Information; Patient-Provider Interactions), and the Patient (Decision-Making Approaches; Developmental Status; Personal and Life Values; Psychological State). Key findings indicated opioid management for pain in SCD is important yet complex and requires collaboration among patients, families, and providers. Elements of patient and caregiver decision-making identified in this study may be applied to shared decision-making strategies in the clinical setting and future study. PERSPECTIVE: This study illustrates the factors involved in decision-making around home opioid use for pain management in children and young adults with SCD. These findings can be applied to determining shared decision-making approaches around pain management between providers and patients, in accordance with recent SCD pain management guidelines.
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Affiliation(s)
- Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon D'Alton
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Johnson
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Kanter
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Koehler A, Strauss B, Briken P, Fisch M, Soave A, Riechardt S, Nieder TO. Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty. Healthcare (Basel) 2023; 11:1746. [PMID: 37372864 DOI: 10.3390/healthcare11121746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, University Hospital Jena, Stoystrasse 3, 07740 Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Margit Fisch
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Armin Soave
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Silke Riechardt
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Stewart SJF, Moon Z, Horne R. Medication nonadherence: health impact, prevalence, correlates and interventions. Psychol Health 2023; 38:726-765. [PMID: 36448201 DOI: 10.1080/08870446.2022.2144923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
Nonadherence to medicines is a global problem compromising health and economic outcomes for individuals and society. This article outlines how adherence is defined and measured, and examines the impact, prevalence and determinants of nonadherence. It also discusses how a psychosocial perspective can inform the development of interventions to optimise adherence and presents a series of recommendations for future research to overcome common limitations associated with the medication nonadherence literature. Nonadherence is best understood in terms of the interactions between an individual and a specific disease/treatment, within a social and environmental context. Adherence is a product of motivation and ability. Motivation comprises conscious decision-making processes but also from more 'instinctive', intuitive and habitual processes. Ability comprises the physical and psychological skills needed to adhere. Both motivation and ability are influenced by environmental and social factors which influence the opportunity to adhere as well as triggers or cues to actions which may be internal (e.g. experiencing symptoms) or external (e.g. receiving a reminder). Systematic reviews of adherence interventions show that effective solutions are elusive, partly because few have a strong theoretical basis. Adherence support targeted at the level of individuals will be more effective if it is tailored to address the specific perceptions (e.g. beliefs about illness and treatment) and practicalities (e.g. capability and resources) influencing individuals' motivation and ability to adhere.
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Affiliation(s)
- Sarah-Jane F Stewart
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Rob Horne
- Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
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Machin M, Van Herzeele I, Ubbink D, Powell JT. Shared Decision Making and the Management of Intact Abdominal Aortic Aneurysm: A Scoping Review of the Literature. Eur J Vasc Endovasc Surg 2023; 65:839-849. [PMID: 36720426 DOI: 10.1016/j.ejvs.2023.01.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/19/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to summarise the current knowledge of shared decision making (SDM) in patients facing a treatment decision about an intact abdominal aortic aneurysm (AAA), and to identify where further evidence is needed. DATA SOURCES MEDLINE, Embase, and the Cochrane Library were searched on 18 July 2021. An updated search was run on 31 May 2022 for relevant studies published from 1 January 2000 to 31 May 2022. REVIEW METHODS This scoping review was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines following a pre-defined protocol, retrieving studies reporting on aspects of SDM in those with intact AAAs. Qualitative synthesis of the articles was performed, and the results grouped according to theme. RESULTS Fifteen articles reporting on a total of 1 344 participants (age range 62-74 years) from hospital vascular surgery clinics with intact AAAs were included. Studies were observational (n = 9), non-randomised studies of an intervention (n = 3), and randomised clinical trials (n = 3). The first theme was the preferences and practice of SDM. The proportion of patients preferring SDM ranged from 58% to 95% (three studies), although objective rating of SDM practice was consistently < 50% (three studies). Clinician training improved SDM practice. The second theme was poor provision of information. Fewer than half of patients (0 - 46%) surveyed were informed about all available treatment options (three studies). Publicly available information sources were rated as poor. The third theme concerned the utility of decision making support tools (DSTs). Two randomised trials demonstrated that the provision of DSTs improves patient knowledge and agreement between patient preference and repair type received but not objective measures of SDM for patients with AAAs. CONCLUSION SDM for patients with an intact AAA appears to be in its infancy. Most patients with an AAA want SDM, but this is not commonly applied. Most patients with an AAA do not receive adequate information for SDM, although the use of bespoke DSTs leaves patients better informed to facilitate SDM.
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Affiliation(s)
- Matthew Machin
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Ubbink
- Amsterdam University Medical Centres, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands
| | - Janet T Powell
- Department of Surgery and Cancer, Imperial College London, London, UK
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Sullivan DR, Wisnivesky JP, Nugent SM, Stone K, Farris MK, Kern JA, Swanson S, Smith CB, Rosenzweig K, Slatore CG. Decision Regret among Patients with Early-stage Lung Cancer Undergoing Radiation Therapy or Surgical Resection. Clin Oncol (R Coll Radiol) 2023; 35:e352-e361. [PMID: 37031075 PMCID: PMC10241560 DOI: 10.1016/j.clon.2023.03.015] [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: 04/20/2022] [Revised: 12/30/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
AIMS Clinical equipoise exists regarding early-stage lung cancer treatment among patients as trials comparing stereotactic body radiation therapy (SBRT) and surgical resection are unavailable. Given the potential differences in treatment effectiveness and side-effects, we sought to determine the associations between treatment type, decision regret and depression. MATERIALS AND METHODS A multicentre, prospective study of patients with stage IA-IIA non-small cell lung cancer (NSCLC) with planned treatment with SBRT or surgical resection was conducted. Decision regret and depression were measured using the Decision Regret Scale (DRS) and Patient Health Questionnaire-4 (PHQ-4) at 3, 6 and 12 months post-treatment, respectively. Mixed linear regression modelling examined associations between treatment and decision regret adjusting for patient sociodemographics. RESULTS Among 211 study participants with early-stage lung cancer, 128 (61%) patients received SBRT and 83 (39%) received surgical resection. The mean age was 73 years (standard deviation = 8); 57% were female; 79% were White non-Hispanic. In the entire cohort at 3 months post-treatment, 72 (34%) and 57 (27%) patients had mild and severe decision regret, respectively. Among patients who received SBRT or surgery, 71% and 46% of patients experienced at least mild decision regret at 3 months, respectively. DRS scores increased at 6 months and decreased slightly at 12 months of follow-up in both groups. Higher DRS scores were associated with SBRT treatment (adjusted mean difference = 4.18, 95% confidence interval 0.82 to 7.54) and depression (adjusted mean difference = 3.49, 95% confidence interval 0.52 to 6.47). Neither patient satisfaction with their provider nor decision-making role concordance was associated with DRS scores. CONCLUSIONS Most early-stage lung cancer patients experienced at least mild decision regret, which was associated with SBRT treatment and depression symptoms. Findings suggest patients with early-stage lung cancer may not be receiving optimal treatment decision-making support. Therefore, opportunities for improved patient-clinician communication probably exist.
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Affiliation(s)
- D R Sullivan
- Division of Pulmonary & Critical Care Medicine (PCCM), OHSU, Portland, OR, USA; Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA.
| | - J P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Division of PCCM Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - S M Nugent
- Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA
| | - K Stone
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Division of PCCM Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - M K Farris
- Department of Radiation Oncology, Wake Forest Baptist Atrium Health, Winston-Salem, NC, USA
| | - J A Kern
- Division of Oncology, National Jewish Health, Denver, CO, USA
| | - S Swanson
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Division of Surgical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - C B Smith
- Division of Hematology and Medical Oncology, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - K Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - C G Slatore
- Division of Pulmonary & Critical Care Medicine (PCCM), OHSU, Portland, OR, USA; Center to Improve Veteran Involvement in Care (CIVIC), VA-Portland Health Care System (VAPORHCS), Portland, OR, USA; Knight Cancer Institute, OHSU, Portland, OR, USA; Section of PCCM, VAPORHCS, Portland, OR, USA
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Mayer TK, Becker-Hebly I, Elaut E, Heylens G, Kreukels BPC, Nieder TO. Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study. J Sex Med 2023; 20:893-904. [PMID: 37037786 DOI: 10.1093/jsxmed/qdad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people's desired decision-making role within TRMI and factors that influence these desires. AIMS The study investigated trans people's desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment. METHODS Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care. OUTCOMES Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth. RESULTS The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery. CLINICAL IMPLICATIONS A desired decision-making role cannot be predicted based on the trans person's sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth. STRENGTHS AND LIMITATIONS This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth. CONCLUSION This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.
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Affiliation(s)
- Toby K Mayer
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Els Elaut
- Department of Experimental, Clinical and Health Psychology, Ghent University, 9000 Ghent, Oost-Vlaanderen, Belgium
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Gunter Heylens
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Timo O Nieder
- Interdisciplinary Transgender Health Care Center Hamburg, Department for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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50
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Lee YK, Kim YH, Kim DH, Kim JH, Lee JH, Park JH, Ko GJ, Hwang WM, Gil HW, Kang YS, Jin KB, Do JY, Kim SJ, Kim BS, Shin HS. Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5. Medicine (Baltimore) 2023; 102:e33695. [PMID: 37171361 PMCID: PMC10174414 DOI: 10.1097/md.0000000000033695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients' physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients' options for dialysis. METHODS SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method. RESULTS The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). CONCLUSIONS Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients' best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
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Affiliation(s)
- Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yang-Hyeon Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Do-Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jin-Heog Kim
- Department of Bigdata and Applied Statistics, College of Science and Technology, Dongguk University, Gyeongju, Republic of Korea
| | - Jeong-Hwan Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyeon Park
- Department of Internal Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won-Min Hwang
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hyo-Wook Gil
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | | | - Kyu-Bok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University Kidney Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | | | - Se-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | | | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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