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Ayre J, Kumarage R, Jenkins H, McCaffery KJ, Maher CG, Hancock MJ. A Decision Aid for Patients Considering Surgery for Sciatica: Codesign and User-Testing With Patients and Clinicians. Health Expect 2024; 27:e14111. [PMID: 38896009 PMCID: PMC11186058 DOI: 10.1111/hex.14111] [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: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Surgery can help patients with leg pain caused by sciatica recover faster, but by 12 months outcomes are similar to nonsurgical management. For many the decision to have surgery may require reflection, and patient decision aids are an evidence-based clinical tool that can help guide patients through this decision. OBJECTIVE The aim of this study was to develop and refine a decision aid for patients with sciatica who are deciding whether to have surgery or 'wait and see' (i.e., try nonsurgical management first). DESIGN Semistructured interviews with think-aloud user-testing protocol. PARTICIPANTS Twenty clinicians and 20 patients with lived experience of low back pain or sciatica. OUTCOME MEASURES Items from Technology Acceptance Model, Preparation for Decision Making Scale and Decision Quality Instrument for Herniated Disc 2.0 (knowledge instrument). METHODS The prototype integrated relevant research with working group perspectives, decision aid standards and health literacy guidelines. The research team refined the prototype through seven rounds of user-testing, which involved discussing user-testing feedback and implementing changes before progressing to the next round. RESULTS As a result of working group feedback, the decision aid was divided into sections: before, during and after a visit to the surgeon. Across all rounds of user-testing, clinicians rated the resource 5.9/7 (SD = 1.0) for perceived usefulness, and 6.0/7 for perceived ease of use (SD = 0.8). Patients reported the decision aid was easy to understand, on average correctly answering 3.4/5 knowledge questions (SD = 1.2) about surgery for sciatica. The grade reading score for the website was 9.0. Patients scored highly on preparation for decision-making (4.4/5, SD = 0.7), suggesting strong potential to empower patients. Interview feedback showed that patients and clinicians felt the decision aid would encourage question-asking and help patients reflect on personal values. CONCLUSIONS Clinicians found the decision aid acceptable, patients found it was easy to understand and both groups felt it would empower patients to actively engage in their care and come to an informed decision that aligned with personal values. Input from the working group and user-testing was crucial for ensuring that the decision aid met patient and clinician needs. PATIENT OR PUBLIC CONTRIBUTION Patients and clinicians contributed to prototype development via the working group.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Richie Kumarage
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Hazel Jenkins
- Department of Chiropractic, Faculty of Medicine, Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Kirsten J. McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Christopher G. Maher
- Institute of Musculoskeletal Health, Faculty of Medicine and HealthThe University of Sydney and Sydney Local Health DistrictSydneyNew South WalesAustralia
| | - Mark J. Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
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Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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Baird TA, Wright DR, Britto MT, Lipstein EA, Trout AT, Hayatghaibi SE. Patient Preferences in Diagnostic Imaging: A Scoping Review. THE PATIENT 2023; 16:579-591. [PMID: 37667148 DOI: 10.1007/s40271-023-00646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND As new diagnostic imaging technologies are adopted, decisions surrounding diagnostic imaging become increasingly complex. As such, understanding patient preferences in imaging decision making is imperative. OBJECTIVES We aimed to review quantitative patient preference studies in imaging-related decision making, including characteristics of the literature and the quality of the evidence. METHODS The Pubmed, Embase, EconLit, and CINAHL databases were searched to identify studies involving diagnostic imaging and quantitative patient preference measures from January 2000 to June 2022. Study characteristics that were extracted included the preference elicitation method, disease focus, and sample size. We employed the PREFS (Purpose, Respondents, Explanation, Findings, Significance) checklist as our quality assessment tool. RESULTS A total of 54 articles were included. The following methods were used to elicit preferences: conjoint analysis/discrete choice experiment methods (n = 27), contingent valuation (n = 16), time trade-off (n = 4), best-worst scaling (n = 3), multicriteria decision analysis (n = 3), and a standard gamble approach (n = 1). Half of the studies were published after 2016 (52%, 28/54). The most common scenario (n = 39) for eliciting patient preferences was cancer screening. Computed tomography, the most frequently studied imaging modality, was included in 20 studies, and sample sizes ranged from 30 to 3469 participants (mean 552). The mean PREFS score was 3.5 (standard deviation 0.8) for the included studies. CONCLUSIONS This review highlights that a variety of quantitative preference methods are being used, as diagnostic imaging technologies continue to evolve. While the number of preference studies in diagnostic imaging has increased with time, most examine preventative care/screening, leaving a gap in knowledge regarding imaging for disease characterization and management.
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Affiliation(s)
- Trey A Baird
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Davene R Wright
- Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Maria T Britto
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ellen A Lipstein
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shireen E Hayatghaibi
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Marziliano A, Miller SM, Fleisher LG, Ropka ME, Stanton AL, Wen KY, Cornelius T, Lapitan E, Diefenbach MA. Examining the impact of a multimedia intervention on decisional conflict and psychological distress among early-stage breast cancer patients: results from a nationwide RCT. Transl Behav Med 2023; 13:727-735. [PMID: 37379519 PMCID: PMC10538468 DOI: 10.1093/tbm/ibad037] [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] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
We conducted a nationwide, randomized controlled trial to evaluate the impact of Healing Choices, a novel interactive education and treatment decision program rooted in the self-regulation theory framework, on decisional conflict and psychological distress at 2-month post-intervention in women with early-stage breast cancer. Patients were randomized to receive the National Cancer Institute's standard print material (control) or standard print material plus Healing Choices (the intervention). The final sample at 2-month post-intervention consisted of N = 388 participants (intervention: n = 197; control: n = 191). There were no significant differences in decisional conflict or its subscales; however, psychological distress was higher in the intervention group (16.09 ± 10.25) than in the control group (14.37 ± 8.73) at follow-up, B = 1.88, 95% CI [-0.03, 3.80], t(383) = 1.94, p = .05. Upon further examination, we found that engagement with the intervention was low-41%-prompting as-treated analyses, which showed no difference in distress between users and nonusers and a positive impact of Healing Choices on decisional conflict: decisional support subscale: users (35.36 ± 15.50) versus nonusers (39.67 ± 15.99), B = -4.31 (s.e. = 2.09), p = .04. Multiple recommendations for moving ahead stem from this work: (i) intent-to-treat analyses appeared to cause distress, cautioning against interventions that may lead to information overload; (ii) engagement with the intervention is low and future work needs to focus on increasing engagement and monitoring it throughout the study; and (iii) in studies with low engagement, as-treated analyses are critical.
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Affiliation(s)
- Allison Marziliano
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Linda G Fleisher
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Mary E Ropka
- Public Health Sciences, University of Virginia School of Medicine, Emeritus, Charlottesville, VA, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kuang-Yi Wen
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Talea Cornelius
- Division of General Medicine, Department of Medicine, Columbia University, New York, NY, USA
| | - Emmanuel Lapitan
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Michael A Diefenbach
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Berrigan D, Dean D, Senft Everson N, D’Angelo H, Boyd P, Klein WMP, Han PKJ. Uncertainty: a neglected determinant of health behavior? Front Psychol 2023; 14:1145879. [PMID: 37251060 PMCID: PMC10213393 DOI: 10.3389/fpsyg.2023.1145879] [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: 01/16/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Health behaviors are critical determinants of the well-being of individuals and populations, and understanding the determinants of these behaviors has been a major focus of research. One important determinant that has received little direct attention in past health research is uncertainty: a complex phenomenon that pertains not only to scientific issues regarding the diagnosis, prognosis, prevention, and treatment of health problems, but also to personal issues regarding other important health-related concerns. Here, we make the case for greater attention to uncertainty in health behavior theory and research, and especially to personal uncertainties. We discuss three exemplary types of personal uncertainty-value uncertainty, capacity uncertainty, and motive uncertainty-which relate, respectively, to moral values, capacities to enact or change behaviors, and the motives and intentions of other persons or institutions. We argue that that personal uncertainties such as these influence health behaviors, but their influence has historically been obscured by a focus on other constructs such as self-efficacy and trust. Reconceptualizing and investigating health behavior as a problem of uncertainty can advance both our understanding of the determinants of healthy behaviors and our ability to promote them.
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Andersen SK, Butler RA, Chang CCH, Arnold R, Angus DC, White DB. Prevalence of long-term decision regret and associated risk factors in a large cohort of ICU surrogate decision makers. Crit Care 2023; 27:61. [PMID: 36797793 PMCID: PMC9933411 DOI: 10.1186/s13054-023-04332-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Whether surrogate decision makers regret decisions about the use of life support for incapacitated, critically ill patients remain uncertain. We sought to determine the prevalence of decision regret among surrogates of adult ICU patients and identify factors that influence regret. METHODS We conducted a secondary analysis of data from the PARTNER 2 trial, which tested a family support intervention for surrogates of critically ill adults. At 6-month follow-up, surrogates rated their regret about life support decisions using the Decision Regret Scale (DRS), scored from 0 to 100, with higher scores indicating more regret. We used multiple linear regression to identify covariates associated with decision regret based on a psychological construct of regret. We constructed two models using the full cohort; model 1 included patient outcomes; model 2 focused on covariates known at the time of ICU decision-making. Subgroup analyses were also conducted based on patient survival status at hospital discharge and 6-month follow-up. RESULTS 748 of 848 surrogates had complete DRS data. The median (IQR) DRS score was 15 (0, 25). Overall, 54% reported mild regret (DRS 5-25), 19% moderate-strong regret (DRS 30-100), and 27% no regret (DRS 0). Poor patient outcome at 6 months (death or severe functional dependence) was associated with more regret in model 1 (β 10.1; 95% C.I. 3.2, 17.0). In model 2, palliative care consultation (3.0; 0.1, 5.9), limitations in life support (LS) prior to death (6.3; 3.1, 9.4) and surrogate black race (6.3; 0.3, 12.3) were associated with more regret. Other modulators of regret in subgroup analyses included surrogate age and education level, surrogate-patient relationship, death in hospital (compared to the post-discharge period), and code status at time of ICU admission. CONCLUSIONS One in five ICU surrogate decision makers experience moderate to strong regret about life support decisions in ICU. Poor patient outcomes are linked to more regret. Decisions to limit life support prior to patient death may also increase regret. Future studies are needed to understand how regret relates to decision quality and how to lessen lasting regret.
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Affiliation(s)
- Sarah K Andersen
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA.
| | - Rachel A Butler
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas B White
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA, USA
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Debrabander J, Mertes H. Watson, autonomy and value flexibility: revisiting the debate. JOURNAL OF MEDICAL ETHICS 2022; 48:1043-1047. [PMID: 34526369 DOI: 10.1136/medethics-2021-107513] [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: 04/16/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Many ethical concerns have been voiced about Clinical Decision Support Systems (CDSSs). Special attention has been paid to the effect of CDSSs on autonomy, responsibility, fairness and transparency. This journal has featured a discussion between Rosalind McDougall and Ezio Di Nucci that focused on the impact of IBM's Watson for Oncology (Watson) on autonomy. The present article elaborates on this discussion in three ways. First, using Jonathan Pugh's account of rational autonomy we show that how Watson presents its results might impact decisional autonomy, while how Watson produces knowledge might affect practical autonomy. Second, by drawing an analogy with patient decision aids we identify an empirical way of estimating Watson's impact on autonomy (ie, value-congruence). Lastly, McDougall introduced the notion of value-flexible design as a way to account for the diverging preferences patients hold. We will clarify its relation with the established domain of value-sensitive design. In terms of the tripartite methodology of value-sensitive design, we offer a conceptual clarification using Pugh's account of rational autonomy, an empirical tool to evaluate Watson's impact on autonomy and situate a group of technical options to incorporate autonomy in Watson's design.
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Affiliation(s)
- Jasper Debrabander
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
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8
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Golden SE, Disher N, Dieckmann NF, Eden KB, Matlock D, Vranas KC, Slatore CG, Sullivan DR. Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making. PEC INNOVATION 2022; 1:100094. [PMID: 37213736 PMCID: PMC10194168 DOI: 10.1016/j.pecinn.2022.100094] [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: 05/09/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 05/23/2023]
Abstract
Objective Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM). Methods We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content. We used an integrated approach of deductive and inductive thematic analysis. Results Twenty-seven patients with NSCLC participated. Participants with prior cancer experiences or those with family members with prior cancer experiences reported better preparedness for cancer treatment decision-making. All participants agreed the conversation tool would be helpful to clarify their thinking about values, comparisons, and goals of treatment, and to help patients communicate more effectively with their clinicians. Conclusion Participants reported that the tool may empower them with confidence and agency to actively participate in cancer treatment SDM. The conversation tool was acceptable, comprehensible, and usable. Next steps will test effectiveness on patient-centered and decisional outcomes. Innovation A personalized conversation tool using consequence tables and core SDM components is novel in that it can encourage a tailored, conversational dynamic and includes patient-centered values along with traditional decisional outcomes.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Corresponding author at: 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA.
| | - Natalie Disher
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
| | - Nathan F. Dieckmann
- School of Nursing, Oregon Health and Science University (OHSU), Portland, OR, USA
- Division of Psychology, School of Medicine, OHSU, Portland, OR, USA
| | - Karen B. Eden
- Department of Medical Informatics and Clinic Epidemiology, OHSU, Portland, OR, USA
| | - Daniel Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
- Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, Portland, OR, USA
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A Protocol of a Pilot Experimental Study Using Social Network Interventions to Examine the Social Contagion of Attitudes Towards Childhood Vaccination in Parental Social Networks. HEALTH PSYCHOLOGY BULLETIN 2022. [DOI: 10.5334/hpb.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pozzar RA, Xiong N, Hong F, Filson CP, Chang P, Halpenny B, Berry DL. Concordance between influential adverse treatment outcomes and localized prostate cancer treatment decisions. BMC Med Inform Decis Mak 2022; 22:223. [PMID: 36002847 PMCID: PMC9404592 DOI: 10.1186/s12911-022-01972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although treatment decisions for localized prostate cancer (LPC) are preference-sensitive, the extent to which individuals with LPC receive preference-concordant treatment is unclear. In a sample of individuals with LPC, the purpose of this study was to (a) assess concordance between the influence of potential adverse treatment outcomes and treatment choice; (b) determine whether receipt of a decision aid predicts higher odds of concordance; and (c) identify predictors of concordance from a set of participant characteristics and influential personal factors. Methods Participants reported the influence of potential adverse treatment outcomes and personal factors on treatment decisions at baseline. Preference-concordant treatment was defined as (a) any treatment if risk of adverse outcomes did not have a lot of influence, (b) active surveillance if risk of adverse outcomes had a lot of influence, or (c) radical prostatectomy or active surveillance if risk of adverse bowel outcomes had a lot of influence and risk of other adverse outcomes did not have a lot of influence. Data were analyzed using descriptive statistics and logistic regression. Results Of 224 participants, 137 (61%) pursued treatment concordant with preferences related to adverse treatment outcomes. Receipt of a decision aid did not predict higher odds of concordance. Low tumor risk and age ≥ 60 years predicted higher odds of concordance, while attributing a lot of influence to the impact of treatment on recreation predicted lower odds of concordance. Conclusions Risk of potential adverse treatment outcomes may not be the foremost consideration of some patients with LPC. Assessment of the relative importance of patients’ stated values and preferences is warranted in the setting of LPC treatment decision making. Clinical trial registration: NCT01844999 (www.clinicaltrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01972-w.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | | | - Peter Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
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Gültzow T, Smit ES, Crutzen R, Jolani S, Hoving C, Dirksen CD. Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial. J Med Internet Res 2022; 24:e34246. [PMID: 35838773 PMCID: PMC9338418 DOI: 10.2196/34246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist; however, their use is limited. The choice between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial; however, insights into their effective elements are lacking. OBJECTIVE This study tested the added value of an effective element (ie, an "explicit value clarification method" paired with computer-tailored advice indicating the most fitting cessation assistance) of a web-based smoking cessation DA. METHODS A web-based randomized controlled trial was conducted among smokers motivated to stop smoking within 6 months. The intervention group received a DA with the aforementioned elements, and the control group received the same DA without these elements. The primary outcome measure was 7-day point prevalence abstinence 6 months after baseline (time point 3 [t=3]). Secondary outcome measures were 7-day point prevalence of abstinence 1 month after baseline (time point 2 [t=2]), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately after DA; time point 1). Logistic and linear regression analyses were performed to assess the outcomes. Analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation) outcome scenarios: complete cases, worst-case scenario (assuming that dropouts still smoked), and multiple imputations. A priori sample size calculation indicated that 796 participants were needed. The participants were mainly recruited on the web (eg, social media). All the data were self-reported. RESULTS Overall, 2375 participants were randomized (intervention n=1164, 49.01%), of whom 599 (25.22%; intervention n=275, 45.91%) completed the DAs, and 276 (11.62%; intervention n=143, 51.81%), 97 (4.08%; intervention n=54, 55.67%), and 103 (4.34%; intervention n=56, 54.37%) completed time point 1, t=2, and t=3, respectively. More participants stopped smoking in the intervention group (23/63, 37%) than in the control group (14/52, 27%) after 6 months; however, this was only statistically significant in the worst-case scenario (crude P=.02; adjusted P=.04). Effects on the secondary outcomes were only observed for smoking abstinence after 1 month (15/55, 27%, compared with 7/46, 15%, in the crude and adjusted models, respectively; P=.02) and for cessation assistance uptake after 1 month (26/56, 46% compared with 18/47, 38% only in the crude model; P=.04) and 6 months (38/61, 62% compared with 26/50, 52%; crude P=.01; adjusted P=.02) but only in the worst-case scenario. Nonuse attrition was 34.19% higher in the intervention group than in the control group (P<.001). CONCLUSIONS Currently, we cannot confidently recommend the inclusion of explicit value clarification methods and computer-tailored advice. However, they might result in higher nonuse attrition rates, thereby limiting their potential. As a lack of statistical power may have influenced the outcomes, we recommend replicating this study with some adaptations based on the lessons learned. TRIAL REGISTRATION Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/21772.
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Affiliation(s)
- Thomas Gültzow
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Eline Suzanne Smit
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
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12
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Butler AE, Chapman GB. Don't Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated. Med Decis Making 2021; 42:341-351. [PMID: 34605713 DOI: 10.1177/0272989x211038941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Publicly available report cards for transplant centers emphasize posttransplant survival and obscure the fact that some centers reject many of the donor organs they are offered (reflecting a conservative donor acceptance strategy), while others accept a broader range of donor offers (reflecting an open donor acceptance strategy). OBJECTIVE We assessed how the provision of salient information about donor acceptance practices and waitlist survival rates affected evaluation judgments of hospital report cards given by laypeople and medical trainees. METHODS We tested 5 different report card formats across 4 online randomized experiments (n1 = 1,003, n2 = 105, n3 = 123, n4 = 807) in the same hypothetical decision. The primary outcome variable was a binary choice between transplant hospitals (one with an open donor acceptance strategy and the other with a conservative donor acceptance strategy). RESULTS Report cards featuring salient information about donor organ utilization rates (transplant outcomes categorized by quality of donor offers accepted) or overall survival rates (outcomes from both waitlist and transplanted patients) led lay participants (studies 1, 3, and 4) and medical trainees (study 2) to evaluate transplant centers with open donor acceptance strategies more favorably than centers with conservative strategies. LIMITATIONS Due to the nature of the decision, a hypothetical scenario was necessary for both ethical and practical reasons. Results may not generalize to transplant clinicians or patients faced with the decision of where to join the transplant waitlist. CONCLUSIONS These findings suggest that performance evaluations for transplant centers may vary significantly based not only on what outcome information is presented in report cards but also how the information is displayed.
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Affiliation(s)
- Alison E Butler
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.,Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gretchen B Chapman
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
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13
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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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14
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Gültzow T, Zijlstra DN, Bolman C, de Vries H, Dirksen CD, Muris JWM, Smit ES, Hoving C. Decision aids to facilitate decision making around behavior change in the field of health promotion: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:1266-1285. [PMID: 33531158 DOI: 10.1016/j.pec.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed. METHODS Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively. RESULTS Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA's effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1). CONCLUSIONS This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making. PRACTICE IMPLICATIONS DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking.
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Affiliation(s)
- Thomas Gültzow
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | - Daniëlle N Zijlstra
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, the Netherlands
| | - Hein de Vries
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Carmen D Dirksen
- CAPHRI Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W M Muris
- CAPHRI Care and Public Health Research Institute, Department of General Practice, Maastricht University, Maastricht, the Netherlands
| | - Eline S Smit
- University of Amsterdam, Amsterdam School of Communication Research/ASCoR, Department of Communication Science, Amsterdam, the Netherlands
| | - Ciska Hoving
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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15
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Gültzow T, Smit ES, Hudales R, Knapen V, Rademakers J, Dirksen CD, Hoving C. An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21772. [PMID: 33320096 PMCID: PMC7772073 DOI: 10.2196/21772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/15/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (ie, behavioral support, nicotine replacement therapy, or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. OBJECTIVE We describe the development process of an online DA (called "VISOR") that helps smokers to choose evidence-based cessation assistance. Additionally, we provide a description of the protocol of an ongoing randomized controlled trial in which the DA containing an explicit value clarification method (VCM) and tailored advice is compared with a DA without an explicit VCM and tailored advice. METHODS The development of "VISOR" was based on the International Patient Decision Aid Standards guidelines. Viewpoints of end users (collected through 20 interviews with smokers) and clinical and scientific experts (assessed using 2 Delphi studies with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha-tested in September 2019 and beta-tested for usability in December 2019; feedback was incorporated and resulted in a final version. The final DA contains (1) an information section, (2) an optional knowledge quiz, (3) a brief smoking assessment, (4) intuitive decision, (5) intermediate advice, (6) an explicit VCM, (7) tailored advice, and (8) access information. A randomized controlled trial is currently being conducted to assess the DA's (cost-)effectiveness compared to a DA that does not include the explicit VCM and the tailored advice; specifically, the DA's effect on smoking abstinence, uptake of evidence-based cessation assistance, smoking abstinence mediated through uptake of evidence-based cessation assistance, and decisional conflict are investigated. Participants are randomly allocated to receive access to 1 of the 2 DAs and are asked to complete 5 questionnaires (including the baseline questionnaire) over a period of 12 months. To evaluate the effects of the DA on the outcome measures, logistic and linear regression analyses as well as mediation analyses will be carried out. An economic evaluation will be performed to assess the cost-effectiveness. RESULTS Data regarding the effect of the VISOR DA are currently being collected, and data collection is expected to be concluded in 2021. CONCLUSIONS By making use of an iterative process that integrated different stakeholders' perspectives (including end users), we were able to systematically design an evidence-based DA. The study will contribute to the current knowledge regarding smoking cessation DA application, the added value of explicit VCMs, and the effect of behavioral and informed decision-making outcomes. TRIAL REGISTRATION Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21772.
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Affiliation(s)
- Thomas Gültzow
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eline Suzanne Smit
- Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Raesita Hudales
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vera Knapen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ciska Hoving
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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