Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis

Shared-decision making in pancreatic cancer: A scoping review

PURPOSE

This review aimed to map the current landscape of literature on informed and shared decision-making (SDM) among patients with pancreatic cancer (PC).

METHODS

PubMed, Scopus, Embase, and PsycINFO were queried for studies published before January 2024 that measured SDM or evaluated interventions targeted at SDM among patients with PC. Studies were excluded if they focused on clinician decision-making or the quality of education materials. The included studies were evaluated for interventions, assessment type, and key findings.

RESULTS

Our initial search identified 1194 studies, with 16 studies meeting our inclusion criteria: 4 cross-sectional, 1 mixed method, 8 qualitative, and 3 experimental. Common themes identified across studies included that there was a subset of patients that did not feel involved in their care, patients felt overwhelmed with information during the initial consultation, patients understood that there were limited treatment options, and patients did not always understand treatment decisions. The experimental studies each evaluated a different intervention (i.e., decision aid, clinician training, or combination) with mixed results.

CONCLUSIONS

There is limited data regarding SDM in PC, however, common themes found that PC patients commonly did not feel involved in their care. Future research should focus on role congruence in decision-making, patient empowerment, improving the delivery and comprehension of treatment information, and interventions to improve the SDM process.

Are We There Yet? Co-Production in Recovery Colleges

INTRODUCTION

Recovery Colleges (RCs) are educational hubs offering a unique approach to enhance mental health and wellbeing by fostering inclusive learning opportunities. Co-production, integrating lived and learned knowledge and experience, is central to RCs. However, in Australia, there is limited understanding of how co-production is defined and implemented. This study explored the definition, interpretation, and practice of co-production in Australian RCs.

METHODS

Seventeen stakeholders were interviewed to examine their perspectives on co-production in RCs. Using inductive reflexive thematic analysis, we constructed four superordinate and eight subordinate themes exploring co-production's relational and contextual dynamics.

RESULTS

Superordinate themes were: (1) Conceptual Fluidity and Experiential Integration; (2) Enacting co-production; (3) Navigating power and relationships; (4) Resources for success.

CONCLUSION

Co-production practices in Australian RCs are highly complex and variable. Developing consistent definitions, practical guides, and consistent strategies may support a more adaptable and context-sensitive approach for individual RCs. Further research could explore how different RCs manage co-production stages, involve stakeholders over time, and identify metrics to evaluate impact. SO WHAT?: Addressing contextual nuance is critical to strengthen co-production practices. Doing so could enhance the transformative potential of RCs to foster meaningful health and social outcomes and inform other programs applying co-production principles.

Online Resources for Robin Sequence; an Analysis of Readability

ObjectiveThe objective was to evaluate the readability of easily accessible parent-directed information concerning Robin Sequence (RS) online, compared to the American Medical Association (AMA)-recommended sixth grade (age 11-12) readability level.DesignA Google search of the term "Pierre Robin Sequence information" was performed. The first ten websites were evaluated using six commonly used readability formulas. Sample texts from three websites were 'translated' by the authors, with the aim of achieving a sixth grade readability level.Main outcome measuresThe following outcomes were used: Automated Readability Index (ARI), Coleman Liau Index (CLI), Gunning Fog Score, Simple Measure of Gobbledygook (SMOG), Flesch Kincaid Grade Level (FKGL), and Flesch Reading Ease (FRE) score.ResultsThe mean pooled grade level of the top 10 included websites was 12.1 (age 17-18). The overall FRE Index was 45.8, which is equivalent to a College-grade reading level. The mean grade level by each test used was: Flesch-Kincaid Grade Level 11.6 (age 16-17), Gunning Fog Score 13.3 (age 18+), SMOG 10.0 (age 14-15), Coleman-Liau Index 13.8 (age 18+), and ARI 12.0 (age 17-18). The author-translated resources achieved pooled mean grade levels of 6.3-6.5.ConclusionsParent-directed online materials concerning RS have a readability in excess of the AMA-recommended sixth grade reading level. Even though the condition is complex, more readable resources are achievable. Coproduction of parent-directed resources in association with public an patient involvement (PPI) contributors is encouraged.

Patient experiences with person-centred and integrated chronic care, focusing on patients with low socioeconomic status: a qualitative study

BACKGROUND

The effectiveness of single disease management programmes in general practice may be limited for patients with low socioeconomic status (SES), as these programmes insufficiently take into account the specific problems and needs of this population. A person-centred integrated care (PC-IC) approach focusing on individual patient's needs and concerns could address these problems.

AIM

To explore experiences of patients with (multiple) chronic diseases with regard to the acceptability of a general practice-based PC-IC approach, with a focus on patients with low SES, and to establish which modifications are needed to tailor the approach to this group.

DESIGN AND SETTING

In 2021, a feasibility study in seven general practices in the Netherlands was carried out. The healthcare professionals provided care based on a PC-IC approach for patients with diabetes, chronic respiratory diseases and/or cardiovascular disorders. Patients were followed for 6 months.

METHOD

This was a qualitative study using focus group discussions, in-depth interviews, and semi-structured telephone interviews in a total of 46 patients with chronic diseases and multimorbidity, including 31 patients with low SES.

RESULTS

An overall positive experience of participants with the PC-IC approach was observed. Discussing their health made patients feel they were being taken more seriously and seen as a unique individual, and it provided the opportunity to discuss their life and health concerns. Recommended adaptations of the PC-IC approach for patients with low SES include creating materials that are clear and easy to understand and offering communication training for healthcare professionals.

CONCLUSION

The PC-IC approach seems helpful for patients with chronic diseases, provided that it is tailored to their skills and abilities. Several modifications for patients with low SES were suggested.

Black US military veterans respond favourably to a booklet using narratives to normalise shared decision-making

Background

Black Americans, including military veterans, experience worse health outcomes. In the United States, Black men have the highest lung cancer mortality and are less likely to undergo lung cancer screening (LCS). Mistrust caused by systemic racism can inhibit their participation in clinical conversations like shared decision-making (SDM). We sought to empower Black veterans to participate in SDM for LCS by normalising patients advocating for what matters most to them in clinical care decisions. We evaluated the impact of a booklet co-designed with veterans that includes four veteran narratives. They describe how each veteran began to trust their providers and engage in clinical conversations like SDM for LCS.

Study design

Pre-post intervention pilot study using surveys to evaluate the impact of the booklet and reactions to the narratives.

Methods

The survey was mailed to a random national sample of 450 Black veterans eligible for LCS but not yet screened. Respondents to the baseline survey were mailed the booklet and a follow-up survey.

Results

Thirty-nine veterans completed baseline and follow-up surveys. Mean agreement was above 3.0 (on a Likert scale of 1-5) for five statements about the booklet, with "Veterans eligible for screening should read" being the highest (mean 4.3). Information about LCS was rated most engaging (mean 3.2 on a scale of 1-4) and informative (3.3). The mean rating for veteran stories was 3.1 (engaging) and 2.9 (informative). Reactions to the narratives varied, including whether characters were relatable, likable, or influential. One narrative, describing a veteran slowly developing a trusting relationship with his provider, was particularly influential in encouraging respondents to talk with their doctor.

Conclusions

The positive reaction to the booklet supports the need to raise LCS awareness among LCS-eligible populations, and suggests that narratives may be a promising tool to increase engagement in care among Black veterans.

Evaluating the co-creation process in public health interventions: the PROSECO framework

OBJECTIVES

To date, there is a lack of evaluation frameworks to guide the planning and conducting of the evaluation of co-creation in public health. This study aims to identify and set the components of the PROSECO framework (PROcesS Evaluation framework for CO-creation) to support the evaluation of co-creation processes in public health interventions.

STUDY DESIGN

A multi-step, iterative approach combining the outcomes of two scoping reviews, expert validation, and design refinement.

METHODS

The PROSECO framework was developed in three steps. Firstly, collecting results from two scoping reviews on process evaluation for co-creation and evaluation of co-creation methods. The scoping review results were analysed and refined by a selected group of experts and through a three-round anonymous survey. Based on those findings, the framework visualisation was developed and designed through multiple design iterations.

RESULTS

The PROcesS Evaluation framework for CO-creation, called the PROSECO framework, was developed to assist researchers and stakeholders in evaluating a co-creation process. The framework comprises a list of 37 components grouped under the five dimensions of Delivery, Participation, Experiential, Context, and Impact.

CONCLUSIONS

PROSECO is the first framework to offer a systematic approach to evaluating co-creation. By integrating a diverse set of evaluation components, encompassing delivery, participation, experiential, impact, and context, it offers a flexible and comprehensive approach to address the complex nature of co-creation.

Perspectives of clinicians and screening candidates on shared decision-making in prostate cancer screening with the prostate-specific antigen (PSA) test: a qualitative study (PROSHADE study)

OBJECTIVE

The objective of this study is to analyse the perspectives of screening candidates and healthcare professionals on shared decision-making (SDM) in prostate cancer (PCa) screening using the prostate-specific antigen (PSA) test.

DESIGN

Descriptive qualitative study (May-December 2022): six face-to-face focus groups and four semistructured interviews were conducted, transcribed verbatim and thematically analysed using ATLAS.ti software.

SETTING

Data were obtained as part of the project PROSHADE (Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer) to develop a tool for SDM in PCa screening with PSA testing in Spain.

PARTICIPANTS

A total of 27 screening candidates (three groups of men: 40-50 years old; 51-60 years old and 61-80 years old), 25 primary care professionals (one group of eight nurses and two groups of physicians: one with more and one with less than 10 years of experience), and four urologists. Focus groups for patients and healthcare professionals were conducted separately.

MAIN OUTCOME MEASURES

Participants' perceptions of shared decision-making related to PSA opportunistic screening, including their understanding, preferences, and attitudes.

RESULTS

Three themes were generated: (1) perceptions of SDM, (2) perceptions of PSA testing and (3) perceptions of SDM regarding PCa screening. Theme 1: screening candidates valued SDM when it included clear information and empowered them. There was consensus with primary care health professionals on this point, although their knowledge and implementation of SDM varied. Theme 2: candidates were divided on PSA testing; some trusted it for early detection, while others expressed scepticism due to concerns about false positives and invasive procedures, reflecting gaps in accessible information. Theme 3: professionals across primary and specialised care stressed the need for standardised SDM protocols. Primary care physicians were particularly concerned that PSA decisions align with scientific evidence and urologists recognised SDM as valuable in PSA testing only if it was adequately explained to each patient. Barriers to implementing SDM included insufficient coordination across care levels, lack of consensus-driven protocols and limited clinical time.

CONCLUSIONS

While patients expect comprehensive information, primarily based on practice to achieve empowerment, healthcare professionals face obstacles such as limited time and insufficient coordination between primary care and urology. All stakeholders agree on the importance of evidence-based tools to reinforce effective SDM and enhance collaboration across urologists and primary care in the context of PSA testing.

Impact of a Web-Based Decision Aid on Socioeconomically Disadvantaged Patients' Engagement in Breast Surgery Decision-Making: Stepped-Wedge Clinical Trial (Alliance-A231701CD)

BACKGROUND

Decision aids (DAs) may increase engagement in decision-making by addressing barriers that disproportionately impact socioeconomically disadvantaged patients. The impact of a breast cancer surgery DA on increasing patient engagement in decision-making was tested in clinics serving a high proportion of socioeconomically disadvantaged patients.

METHODS

A stepped-wedge trial was conducted with 10 National Cancer Institute Community Oncology Research Program clinics (Alliance for Clinical Trials in Oncology, June 2019 to December 2021). The clinics were randomized to time of transition from usual care (UC) to delivery of a web-based DA. Patients with stages 0-3 breast cancer eligible for surgery provided consent before a surgical consultation. Engagement was measured by Patient's Self-Efficacy in Patient-Physician Interactions (PEPPI-5, follow-up survey) and count of Active Patient Behaviors (audio-recorded consultation). Intervention effects were tested with linear mixed-effects models, accounting for surgeon and clinic-level clustering, time, and enrollment after COVID. Heterogeneity of treatment effect by socioeconomic disadvantage (using the Area Deprivation Index) was assessed with an interaction term.

RESULTS

The study enrolled 576 patients, and 44 % (136/309) of the patients reviewed the DA. No significant difference in engagement was observed between DA and UC for PEPPI-5 (- 0.8; 95 % CI, - 2.1-0.6; p = 0.260) or Active Patient Behaviors (2.5; 95 % CI, - 4.1-9.2; p = 0.456). No heterogeneity of treatment effect was observed. Socioeconomic disadvantage was associated with fewer Active Patient Behaviors (- 5.9; 95 % CI, - 0.6-- 1.2; p = 0.013).

CONCLUSION

This trial conducted in clinics that serve diverse populations, observed no significant relationship between a web-based DA and patient engagement. Future analyses will explore DA implementation, characteristics of patients who reviewed the DA, and persistent barriers to engagement.

Racial and Ethnic Differences in Shared Decision Making Among Patients With Hypertension: Results From the RICH LIFE Project

BACKGROUND

Racial and ethnic disparities in hypertension care persist. Shared decision making (SDM) is promoted in hypertension guidelines. However, evidence is lacking on how race, ethnicity, and SDM relate, and the effect of SDM on hypertension control in diverse groups. We aimed to explore the relationships among SDM, blood pressure (BP), race and ethnicity, and other decision-making factors in patients with hypertension.

METHODS AND RESULTS

Longitudinal analysis of data from the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) project's participants (n=1426) with uncontrolled hypertension was performed using descriptive statistics, linear regression, and generalized estimating equations. Participants were middle-aged (mean age 60±11.6 years), predominantly women (59.4%, 847), non-Latino Black (59%, 844), and high school graduates or below (65%, 931). The mean SDM score was 7.2±2.6 out of 9, and the mean baseline systolic and diastolic BP were 152.2±12.0 and 85.3±12.1 mm Hg. Non-Latino Black people had 0.14 points higher mean SDM score (P<0.001) than non-Latino White people. Systolic BP reduction over 12 months was greater with a higher SDM mean score (β=-0.42, P=0.035). Baseline characteristics associated with SDM included more than high school education (β=-0.08, P=0.045), hypertension knowledge (β=-0.05, P=0.046), considering taking BP medication as very important (β=0.06, P=0.022), and patient activation (β=0.09, P=0.001).

CONCLUSIONS

There was greater BP reduction for patients with higher SDM score at follow-up, and associations between SDM and race and ethnicity, education, hypertension knowledge and attitude, and patient activation. Future research should further explore SDM differences among racial and ethnic groups to better align hypertension care with patients' needs.

A mixed methods realist analysis of telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand: contexts, mechanisms, and outcomes

PURPOSE

This study examined telehealth delivery of complex wheelchair assessment in Aotearoa New Zealand, specifically: what works, for whom, and in which contexts, with exploration of culturally specific factors for indigenous Māori.

MATERIALS AND METHODS

A mixed methods realist evaluation was conducted with remote specialist assessors (physiotherapists and occupational therapists), on-site assistants, and wheelchair users. Interviews/focus groups, mobility goal achievement, satisfaction, and fidelity of tele-delivered assessment of wheelchair and seating (tAWS) contributed to Context-Mechanism-Outcome configurations (CMOc).

RESULTS

Four remote specialist assessors delivered tAWS, but it was declined by on-site assistants in 78% of cases in which specialist assessors perceived it could work. When tAWS was delivered to wheelchair users (N = 5), the majority of goals were achieved, with high service satisfaction. CMOc's highlight the influence of system design in the uptake of telehealth by health professionals.

CONCLUSIONS

While therapists can navigate complexity for successful tAWS, therapist and system barriers limit its uptake, particularly confidence in conducting assessment and use of technology among the non-adopters. Telehealth specific training in culturally-responsive rehabilitation is recommended. This evaluation contributes to telehealth program theory and the mechanisms to be addressed for telehealth to meet its potential to enhance equity in health outcomes.

Efficacy of Educational Presentations in the Pediatric Orthopaedics Clinic

BACKGROUND

The patient education process is an important part of healthcare, and tools including handouts, videos, and webpage suggestions have been used to aid this process. Although educational slide presentations are commonly used for teaching in academic settings and have been used in certain specialty clinics, their use for educating families and improving the shared decision-making process has, to our knowledge, not been described in the orthopaedic surgery clinic.

QUESTIONS/PURPOSES

(1) How effective were educational PowerPoint presentations in the pediatric orthopaedics clinic as assessed by scores on a validated shared decision-making scale? (2) What were the families' preferred ways of learning about healthcare conditions?

METHODS

This prospective case series was conducted at an outpatient pediatric orthopaedic surgery clinic. Between May 2024 to January 2025, all new patients whose clinic visit was the initial visit for a single problem received an educational PowerPoint presentation specific to their diagnosis, delivered by the senior author (EDS) from a laptop. These presentations were developed for the top 10 most common diagnoses seen in the pediatric orthopaedic clinic. The presentation took on average 4 minutes to complete and outlined details of the diagnosis, natural history of the condition, treatment plan, and answers to frequently asked questions. Fifty-six patients with mean ± age of 11 ± 5 years were included in this study. The most common condition was scoliosis (52% [29 of 56]). After the clinic visit, the parents or guardians were given the Shared Medical Decision Making Satisfaction Scale, a validated tool that assessed their understanding of the diagnosis, ability to participate in shared decision-making, and perception of the visit. This survey included nine questions scored 1 to 5 or "not applicable" for a maximum score of 45. Higher scores indicated better understanding of the diagnosis and treatment options. Parents or guardians also ranked their preferred ways of learning from a list of four options, with options including educational presentation, verbal explanation, handout, or webpage suggestion. They were asked to draw from past experiences with the different modalities to compare to their experience with the provided educational PowerPoint. Fifty-six families completed the Shared Medical Decision Making Satisfaction Survey; 71% (40) of those families completed the ranking of preferred ways of learning, while the others left it blank for unknown reasons. A chi-square goodness-of-fit test was performed to determine which method of learning was preferred among parents or guardians.

RESULTS

Parents or guardians of the children treated generally gave the educational tool (the brief PowerPoint presentation about the child's condition) very high scores on the Shared Medical Decision Making Satisfaction Scale (mean ± SD 43 ± 4 of a possible 45 points, with higher scores representing the perception of a more engaging and satisfying process). Mean scores on all of the subscales of that tool exceeded 4.5 of a possible 5 points. When asked to compare their experience with the educational PowerPoint presentation to earlier experiences with verbal explanations, printed handouts, or web-based resources, the presentation was the preferred mode of receiving information; 60% (24 of 40) ranked this as the preferred approach, compared with verbal explanation (23% [9 of 40]), webpage suggestion (10% [4 of 40]), and printed materials (8% [3 of 40]) (p < 0.001).

CONCLUSION

Educational PowerPoint presentations seemed useful in delivering information to patients and families and in the facilitating of the shared decision-making process. Creating presentations for every diagnosis encountered in clinic is not feasible; however, presentations for the most common diagnoses may help to create a more effective practice. Further studies are warranted to investigate which slides are most effective, which healthcare information is best conveyed over PowerPoint for each diagnosis, and how reading level affects the ability of patients to understand the presentations.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Engaging Parents of Children With Sickle Cell Disease in Shared Decision-Making for Hydroxyurea: The ENGAGE-HU Study

BACKGROUND

Guidelines recommend that hydroxyurea be offered to children with sickle cell disease (SCD) as early as 9 months of age using shared decision-making. To help clinicians implement shared decision-making with parents, we developed the Hydroxyurea Shared Decision-Making (H-SDM) toolkit. We evaluated its effectiveness on parent decisional uncertainty, perceptions of shared decision-making, hydroxyurea knowledge, and the likelihood of being offered and prescribed hydroxyurea.

PROCEDURE

Sites began in the usual care condition (clinician pocket guide) before crossing over to the H-SDM toolkit condition between 2018 and 2022. Caregivers of children with SCD (birth to 5 years) eligible for hydroxyurea completed assessments at baseline, immediately after discussing hydroxyurea with their clinician, and 3-7 months later.

RESULTS

Participants included 176 caregivers (93.2% female, 89% Black); most toolkit participants were enrolled during the pandemic (n = 81). There were no statistically significant differences between conditions on parent decisional uncertainty, perceptions of shared decision-making, or hydroxyurea knowledge (p-values >0.05). However, there was a clinically important difference in certainty, with higher decisional uncertainty in the usual care group. A greater proportion of participants enrolled during usual care were offered (80.7%) and prescribed hydroxyurea (48.2%), compared to 58.7% offered and 39.7% prescribed during the toolkit condition (p-values ≤0.01).

CONCLUSIONS

Findings suggest the toolkit may help parents feel more confident in deciding about hydroxyurea. Given the significant impacts of the COVID-19 pandemic on study implementation, the impact on hydroxyurea uptake requires additional exploration. Ultimately, the H-SDM toolkit may be most beneficial for clinics that do not routinely use a shared decision-making process for those considering hydroxyurea.

Exploring Shared Decision-Making Training in Pediatrics: A Scoping Review

BACKGROUND

Shared decision-making (SDM) is crucial in pediatric care, but its implementation poses unique challenges. Training health care professionals in pediatric SDM is essential, yet little is known about the current state of these training programs.

OBJECTIVE

Review existing pediatric-specific SDM training programs to understand the current state of training and identify areas for improvement.

DATA SOURCES

Medline, PsycINFO, CINAHL, Education Research Complete, and LILACS.

ELIGIBILITY CRITERIA

We included original research publications in English, Spanish, and German that focused on SDM training involving pediatric health care professionals or evaluated SDM training within pediatric settings.

DATA EXTRACTION

We used a custom Covidence template to extract data on publication year, author, SDM focus, participants, curriculum design, teaching strategies, evaluated outcomes, and how the curriculum incorporated children's participation.

RESULTS

Nineteen studies met the inclusion criteria. Most programs were from North America and published after 2018. Training approaches varied widely, with many focusing on specific clinical contexts. Only 2 curricula explicitly considered children as participants in the SDM process. Evaluation methods and outcomes varied across Kirkpatrick levels, with most programs reporting positive results in participant satisfaction, skill improvement, and patient outcomes.

LIMITATIONS

Only papers in English, Spanish, and German were included in the search.

CONCLUSIONS

While progress has been made in developing pediatric SDM training programs, there is a need for more consistency in content and evaluation methods. Future pediatric SDM training programs should prepare health care professionals with the skills necessary to involve children in the SDM process when appropriate.

Conditional adherence after medical recommendation and the attraction of additional information

OBJECTIVE

This study introduces conditional adherence (CA) as the patients' inclination toward additional information sources instead of unconditionally adhering to treatment. The study examined how medical decision-making practices are associated with CA and the intention to turn to various information sources.

METHODS

Scenario survey data (N = 1935) were used to analyse the association between decision-making practices and patients' intentions to seek additional information from either formal or informal sources.

RESULTS

Additional information was preferably acquired from the attending physician without the intention to seek additional information elsewhere. Shared decision-making (SDM) decreased the likelihood of CA and especially the need to consult other formal sources. Other kind of decision-making practices were associated with a higher likelihood of CA. Decisional conflicts from previous medical appointments associated with seeking information from informal sources.

CONCLUSIONS

Turning to additional formal information sources associates with appointments lacking the element of SDM. However, turning to informal information sources is more significantly associated with prior experiences of contradictory treatment recommendations.

IMPLICATIONS

SDM and open communication between the physician and the patient are underscored in the objective of treatment adherence. CA may be prevented by participating patients to decision-making and identifying possible trust issues concerning also prior medical decisions.

Preventing smoking initiation in adolescents living in vulnerable socioeconomic conditions: Study protocol of the KickAsh!-intervention

AIMS

Adolescents living in vulnerable socioeconomic conditions are confronted with tobacco-related health disparities. As school-based interventions appear to be less effective among these youngsters, other approaches are necessary. One promising avenue is youth social work settings that offer sport and recreational activities (SR-settings). SR-settings have been examined as a levering context for health promotion, but evidence regarding smoking prevention is currently lacking.

METHODS

This study describes the protocol of a non-randomised cluster controlled trial evaluating a smoking prevention intervention for adolescents. At least 24 SR-settings are needed for the intervention and control group. A mixed-method design will be used. Quantitative measures will be used to assess effectiveness, involving validated questionnaires on smoking initiation behaviour and influencing factors (i.e. attitude, self-efficacy, social influence and risk perception). In addition, feasibility will be assessed with regard to intervention fidelity, dose and reach. Data will be collected at baseline, three and nine months following the intervention. To gain deeper understanding on the impact and underlying processes of the intervention, we will conduct qualitative interviews with users (adolescents) and implementers (youth workers within the SR-settings) of the intervention.

CONCLUSIONS

Conducting this trial will offer novel insights into the effectiveness of a smoking prevention intervention designed for adolescents living in vulnerable socioeconomic conditions. A mixed-method design will enable to measure impact, implementation and underlying processes of the intervention. Overall, this design will enhance our understanding on the suitability of SR-settings as contexts for smoking prevention initiatives targeting hard-to-reach youth. This trial is registered on Clinicaltrials.gov: NCT05920772.

Decision aid for pediatric sleep disordered breathing: A randomized trial

OBJECTIVE

The objective of this study was to assess whether a decision aid (DA) can increase parental perceptions of shared decision making and reduce decisional conflict.

STUDY DESIGN

Prospective randomized controlled trial.

SETTING

January 2017-June 2018 Single-Center Tertiary Pediatric Otolaryngology Practice in Halifax Nova Scotia, Canada.

METHODS

English-speaking parents of children younger than 6 years with mild to moderate SDB were included. Parents were randomized to the intervention, with in-person consultation using the DA or the control group, without the DA. Outcomes measured were the decisional conflict scale (DCS), shared decision-making questionnaire (SDM-Q-9) and the OPTION instrument. Descriptive, parametric and non-parametric analyses were performed where appropriate. Spearman's r correlations were used to examine the relation between outcome measures.

RESULTS

101 parents were included (n = 50 DA/51 control). Parents who used the DA reported lower median DCS scores (6.50 vs. 19.25; p = 0.005) and higher SDM-Q-9 scores (93.59 vs. 80.74; p = 0.035). The DCS scores were significantly negatively correlated to SDM-Q-9 scores (Spearman's r = -0.680; p < 0.001). No significant differences were found in mean OPTION scores between groups. SDM-Q-9 and OPTION scores were positively correlated (Spearman's r = 0.590; p < 0.010).

CONCLUSION

Parents using our DA reported lower levels of decisional conflict and greater perceived involvement in the decision-making process for their children with SDB.

A Quantitative Study Exploring and Comparing Key Factors in Medication Management in the Irish Healthcare Setting

BACKGROUND

Shared decision-making in the context of medication management has been shown to be contingent on information-seeking behaviours such as patient knowledge, self-efficacy and engagement.

OBJECTIVE

The aim of this study was to: (i) compare differences in perceptions of patients' knowledge, capabilities and engagement across healthcare professionals (HCPs) and patients and family caregivers and (ii) investigate associations between these factors and patients' medication beliefs using a cross-sectional survey study of patients, family caregivers and community and hospital HCPs in Ireland.

METHODS

Two cross-sectional surveys measuring key factors in medication management were distributed to patients and family caregivers taking three or more medicines and HCPs involved in medicines management. χ2 tests were used to investigate differences between HCPs and patients and family caregivers. Multivariable linear regression with adjustment for the socio-demographic covariates was used to examine key factors in medication management and beliefs about medicine (BMQ-General) in patients and family caregivers.

RESULTS

Overall, 636 responses were received; patients and family caregivers (N = 134, 21%), community (N = 313, 49%) and hospital HCPs (N = 189, 30%). A higher proportion of patients and family caregivers self-reported as 'knowledgeable' about medications (N = 76; 56.7%) than community (N = 75, 24%) and hospital HCPs (N = 44, 23.3%) (p < 0.01). The majority of patients and family caregivers were 'fairly/very confident' they could maintain an accurate medication list without assistance (N = 78; 58.2%), compared to the majority of the community (N = 213, 68.1%) and hospital HCPs (N = 114, 60.3%) who were 'not at all/somewhat confident' (p < 0.01.) These patients and family caregivers also had significantly lower overall beliefs in medication harm (β = -1.23, 95% CI: -2.34, -0.13). Patient and family caregivers who asked HCPs about their medication frequently (> 7 times per year) had higher overall beliefs in medication overuse (β = 1.88, 95% CI: 0.06, 3.69) and medication harm (β = 2.65, 95% CI: 1.10, 4.20), compared to those who never asked.

CONCLUSION

There was divergence between HCPs and patients and family caregivers in their assessments of patients' medication knowledge and capabilities. Engagement between HCPs and patients around medication should be purposeful rather than frequent, to alleviate fears about overuse and harm.

PATIENT OR PUBLIC CONTRIBUTION

The patient and family caregiver survey was developed in partnership with members of the Patient and Public Involvement (PPI) group. Feedback was provided by the group to increase accessibility of survey and maximise distribution. In addition, the survey was piloted among members of the public involved in medication management.

Experiences with a co-creation process to adapt a healthy sleep intervention with adolescents: A Health CASCADE process evaluation

OBJECTIVES

Co-adaptation is a collaborative process to adapt existing interventions to new contexts and offers a promising way to scale (co-created) public health interventions. However, there is limited understanding of how co-adaptation processes are experienced. This study examined whether a robust co-creation process can be maintained when adapting a previously co-created intervention to promote adolescents' healthy sleep. Adolescents' experiences during this co-adaptation process were explored, using five key dimensions of co-creation (1) multistakeholder collaborative action, 2) co-learning towards innovation, 3) contextual knowledge production, 4) generating meaning, 5) open, trustful, and inclusive dialogue) as the guiding framework.

STUDY DESIGN

Qualitative observational study.

METHODS

Qualitative data were collected from a co-adaptation process with an action group of adolescents (n = 8) and researchers (n = 2). Over eleven sessions (50 min) following Intervention Mapping, a needs assessment was conducted, and the original intervention's goals and materials were adapted. Data sources included session transcripts, facilitator reflections, adolescent evaluations (n = 5), and focus group transcripts (n = 3), elaborating on adolescents' experiences during sessions, and were analysed using Qualitative Content Analysis (QCA).

RESULTS

All five dimensions of co-creation were reflected in adolescents' experiences of co-adapting the healthy sleep intervention. They enjoyed collaborating, committed to the project, reported ongoing possibilities for learning, and produced contextual knowledge from their lived experiences. The process felt meaningful, with a respectful atmosphere. However, challenges like the exclusion of students outside the group and time constraints were also encountered.

CONCLUSIONS

The presence of the five dimensions of co-creation in this study demonstrates that robust co-creation research can be maintained also when co-adapting a previously co-created intervention to a new context with a new group of stakeholders.

Participatory Research in Clinical Studies: An Innovative Approach to Co-creating Nutritional and Physical Activity Recommendations for Older Adults With Sarcopenia (FOOP-Sarc Project)

BACKGROUND

Participating in co-creation processes can improve the knowledge, satisfaction and healthcare outcomes of volunteers. However, this methodology is still underused in nutritional clinical studies.

OBJECTIVE

This study aimed to use participatory research as an innovative approach to co-creating nutritional and physical activity (PA) recommendations for the FOOP-Sarc project and to assess their usability and volunteers' satisfaction and engagement experience (SEE) during the co-creation process.

DESIGN

The co-creation process was based on four stages: (s1) co-ideation, (s2) co-design, (s3) co-implementation and (s4) co-evaluation (Ref.: NCT05485402).

SETTING AND PARTICIPANTS

Thirteen volunteers with sarcopenia were included (stages 1-2 [n = 7], stage 3 [n = 3 intervention, n = 3 control] and stage 4 [n = 13]).

MEASURES

The co-ideation (s1) and co-design (s2) stages focused on designing recommendations adapted to the volunteers' preferences; the co-implementation (s3) stage included the implementation and comparison of the co-created or standard recommendations for 3 weeks to test the recommendations' acceptance; and the co-evaluation (s4) stage focused on usability, SEE, and adherence.

RESULTS

The volunteers co-created recommendations for improving sarcopenia according to the barriers identified related to diet and PA. The recommendations' usability and the SEE of volunteers were high in all cases.

CONCLUSIONS

The participatory research approach used in this nutritional intervention study, demonstrates a high usability of the co-created recommendations for sarcopenia and high SEE of the volunteers, particularly in the volunteers who participated in co-ideation (s1) and co-design (s2), the most key stages of the co-creation process.

PATIENT OR PUBLIC CONTRIBUTION

The volunteers in this study participated in the co-creation of nutritional and PA recommendations to improve sarcopenia, which they must subsequently follow.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05485402.

Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse

OBJECTIVE

To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care.

METHODS

Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign.

MAIN OUTCOME MEASURES

Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM.

PARTICIPANTS

1439 Australian adults, recruited online.

RESULTS

The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (χ2 (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy.

CONCLUSION

Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.

Shared decision making in routine oncology appointments with Black patients with lung cancer

PURPOSE

Poor clinician-patient communication may contribute to racialized inequities in cancer symptom burden. Shared decision-making (SDM) enhances clinician-patient communication, and could contribute to health equity for Black patients with cancer. However, research on SDM is limited for Black patients with cancer.

METHODS

This multi-method longitudinal observational study examined SDM during routine oncology follow-ups for patients with advanced lung cancer. We analyzed SDM reported by clinicians (n = 6), self-identified Black patients with lung cancer (n = 30), and coded from patient visit recordings (n = 20). We described the symptom management conversations, and examined how SDM related to patient satisfaction and symptom severity with two-sided correlations.

RESULTS

Most patients (85.0%) asked questions during appointments and discussed cancer-related symptoms (95.0%), most commonly pain/neuropathy (65.0%). Though coded SDM during symptom discussions was low, providers and patients reported high levels of SDM. Coded SDM did not statistically significantly correlate with post-appointment satisfaction (r = -.01, p > .10) or symptom burden (r = .04, p > .10). However, patient-reported SDM did relate to post-appointment satisfaction (r = .72, p = .08) and symptom burden (r = .35, p = .08) one month later.

CONCLUSIONS

Through detailed multi-method analysis, we found that coded SDM did not correspond to patient and physician-reported SDM during routine oncology appointments. Patient-reported SDM correlated to several better physical and mental health outcomes as well as overall satisfaction a month later. Our findings highlight the complexities of clinician-patient communication and the importance of studying these processes for Black patients with cancer. Future research should develop culturally-relevant methods of assessing SDM with Black patients and understand Black patients' communication needs.

Practical applications of methods to incorporate patient preferences into medical decision models: a scoping review

BACKGROUND

Algorithms and models increasingly support clinical and shared decision-making. However, they may be limited in effectiveness, accuracy, acceptance, and comprehensibility if they fail to consider patient preferences. Addressing this gap requires exploring methods to integrate patient preferences into model-based clinical decision-making.

OBJECTIVES

This scoping review aimed to identify and map applications of computational methods for incorporating patient preferences into individualized medical decision models and to report on the types of models where these methods are applied.

INCLUSION CRITERIA

This review includes articles without restriction on publication date or language, focusing on practical applications. It examines the integration of patient preferences in models for individualized clinical decision-making, drawing on diverse sources, including both white and gray literature, for comprehensive insights.

METHODS

Following the Joanna Briggs Institute (JBI) methodology, a comprehensive search was conducted across databases such as PubMed, Web of Science, ACM Digital Library, IEEE Xplore, Cochrane Library, OpenGrey, National Technical Reports Library, and the first 20 pages of Google Scholar. Keywords related to patient preferences, medical models, decision-making, and software tools guided the search strategy. Data extraction and analysis followed the JBI framework, with an explorative analysis.

RESULTS

From 7074 identified and 7023 screened articles, 45 publications on specific applications were reviewed, revealing significant heterogeneity in incorporating patient preferences into decision-making tools. Clinical applications primarily target neoplasms and circulatory diseases, using methods like Multi-Criteria Decision Analysis (MCDA) and statistical models, often combining approaches. Studies show that incorporating patient preferences can significantly impact treatment decisions, underscoring the need for shared and personalized decision-making.

CONCLUSION

This scoping review highlights a wide range of approaches for integrating patient preferences into medical decision models, underscoring a critical gap in the use of cohesive frameworks that could enhance consistency and clinician acceptance. While the flexibility of current methods supports tailored applications, the limited use of existing frameworks constrains their potential. This gap, coupled with minimal focus on clinician and patient engagement, hinders the real-world utility of these tools. Future research should prioritize co-design with clinicians, real-world testing, and impact evaluation to close this gap and improve patient-centered care.

Exploring co-adaptation for public health interventions: insights from a rapid review and interviews

BACKGROUND

Adapting co-creation research processes and/or public health interventions improves the fit between the intervention and population of interest, potentially resulting in more relevant and effective interventions. Mode 2 research approaches (e.g., co-creation, co-production, co-design, community-based participatory research, and participatory action research) can ensure that adaptations fit the socio-cultural and economic contexts. However, an overview of existing practices and how to co-adapt is lacking. This study aimed to provide an overview of the use of co-adaptation in co-creation processes and/or public health interventions.

METHODS

We conducted a rapid review search on the Health CASCADE co-creation database. Relevant peer-reviewed studies reporting on co-adaptation of public health interventions were identified. A call for case studies via social media and co-authors' snowballing was issued to perform interviews with co-creation researchers gaining insights into how co-adaptation was applied from unpublished studies and practice. Interviews were analysed using template analysis.

RESULTS

Fourteen studies addressed various public health issues by co-adapting co-creation processes, intervention activities, communication platforms, monitoring strategies, training components, and materials' language and tone. Most studies lacked detailed reporting on the co-adaptation process, though some provided information on group composition and number, duration, and methods applied. Two out of 14 studies used a framework (i.e., Intervention Mapping Adapt), seven described their adaptation procedure without naming a specific framework, and five did not report any procedures or frameworks. Five of seven case studies used adaptation frameworks (e.g., ADAPT guidance). Interviews provided insights into the co-adaptation process emphasising the importance of contextual fit, integrating prior knowledge, and logging adaptations.

CONCLUSIONS

This study is the first introducing the concept of and exploring co-adaptation of co-creation processes and/or public health interventions. It provides details regarding adaptations made, whether and which frameworks were used, and procedures applied to adapt. The findings highlight the need for tailored frameworks for co-adaptation and better reporting of co-adaptation processes.

[Point of view on shared decision making: A territorial survey of healthcare professionals]

BACKGROUND AND OBJECTIVES

$ Shared Decision-Making (SDM) is an intuitive approach among healthcare professionals, but one that is still little formalized or taught in practice in France. In 2022, we carried out a qualitative study on the perception of the PDP concept among a multi-professional panel. Several themes emerged, notably around knowledge of the concept, its implementation in practice and the need for training. The aim of this study is to compare the results obtained in our qualitative study with a larger number of professionals, using a questionnaire.

METHODS

Territorial distribution of a questionnaire to medical, paramedical and non-medical professionals and students during the second half of 2022. Quantitative variables are described in headcount proportions. Results from open-ended questions were analyzed by axial coding of verbatims, grouped into categories, themes and sub-themes.

RESULTS

A total of 381 responses were collected from 10 professions (including 41% doctors, 17% pharmacists, 15% nurses, 8% midwives and 8% physiotherapists). Less than a third of respondents (28%) claimed to be trained in therapeutic patient education (TPE). Only 6% of respondents claim to be fully familiar with PDP, while 53% are unfamiliar with the concept. When asked to define PDP, the answer was appropriate in 33% of cases. The majority (81%) of respondents would like to have specific training, and 84% believe there is a link between PDP and ETP. As for the limitations of the concept, 75% of respondents cited the urgency of decision-making, 72% the lack of time, 49% organizational difficulties and lack of knowledge of the concept, and 42% lack of knowledge of the available support tools. Among the levers mentioned by respondents were: strengthening the therapeutic alliance (67%), patient demand (60%), inter-professional support (56%), team motivation (53%) and improving the patient pathway (44%). From the 130 free responses on needs for implementing PDP, 6 themes emerged: needs oriented towards professionals and towards patients, deployment of material resources, adaptation to certain specialties, institutional responsibility and difficulty in finding downstream solutions.

CONCLUSION

The construction of this questionnaire from the qualitative study allows us to continue our reflection. Implementation of the concept in practice still seems to be in the minority. The limitations and levers identified in the qualitative analysis are confirmed. The development of specific and adapted training seems necessary and desirable for the implementation of the PDP process, even among people trained in ETP.

Decision aid for surgical management of benign prostatic hyperplasia - Assessing acceptability of the French version

INTRODUCTION

Exploring all surgical interventions for benign prostatic hyperplasia (BPH) can be time-consuming. We developed the first online CUA-endorsed BPH surgical Patient Decision Aid (PtDA), including all guideline-approved surgical modalities. Our study assesses the acceptability of the tool's French version (FRv) among patients and urologists.

MATERIAL

A PtDA was developed including 9 surgical modalities: monopolar transurethral resection of the prostate (TURP), bipolar TURP, GreenLight photovaporization, endoscopic enucleation of the prostate, Rezum, Urolift, Aquablation, open retropubic prostatectomy, and robotic simple prostatectomy. Ten urologists who perform BPH surgery and 21 patients with a history of BPH surgery were recruited. Alpha-testing was performed for the FRv and compared to the English version (ENv).

RESULTS

In both versions of the PtDA, the language was considered clear (urologists FRv 78%; ENv 92%, patients FRv 91%; ENv 100%) and outcomes correctly reported (urologists FRv 71%; ENv 82%) and well explained (patients FRv 91%; ENv 90%). Most patients believed the PtDA would have been useful during their consultation (FRv=86%, ENv=89%), and all recommended it for future patients. A higher proportion of patients, versus urologists, found the PtDA of appropriate duration (urologists FRv 46%; ENv 64%, patients FRv 90%; ENv 84%) and length (urologists FRv 54%; ENv 64%, patients FRv 57%; ENv 84%). Urologists mainly recommended text lightening and integrating illustrations.

CONCLUSION

While the FRv was found to be acceptable, it underperformed the ENv among urologists due to its information overload. The FRv will be rendered more concise to facilitate its integration into clinical practice.

EVIDENCE GRADE

4.

How Inclusive Are Patient Decision Aids for People with Limited Health Literacy? An Analysis of Understandability Criteria and the Communication about Options and Probabilities

OBJECTIVE

Patient decision aids (PtDAs) can support shared decision making. We aimed to explore how inclusive PtDAs are for people with limited health literacy (LHL) by analyzing 1) the understandability of PtDAs using established criteria, 2) how options and probabilities of outcomes are communicated, and 3) the extent to which risk communication (RC) guidelines are followed.

METHODS

In a descriptive document analysis, we analyzed Dutch PtDAs available in 2021 that met the International Patient Decision Aid Standards. We developed and pilot tested a data extraction form based on key RC and health literacy literature.

RESULTS

Most PtDAs (151/198) met most of the understandability criteria on layout (7-8 out of 8 items) such as font size but not on content aspects (121/198 PtDAs scored 5-7 out of 12 items) such as defining medical terms. Only 31 of 198 PtDAs used a short and simple sentence structure. Most PtDAs presented 2 to 4 treatment options. Many followed RC recommendations such as the use of numerical RC strategies such as percentages or natural frequencies (160/198) and visual formats such as icon arrays (91/198). Only 10 used neutral framing (10/198). When presented, uncertainty was presented verbally (134/198) or in ranges (58/198). Four PtDAs were co-created together with patients with LHL and used only verbal RC or no RC.

CONCLUSION

Most PtDAs met most of the understandability criteria on layout, but content aspects and adherence to RC strategies can be improved. Many PtDAs used long sentences and mostly verbal RC and are therefore likely to be inappropriate for patients with LHL. Further research is needed on PtDA characteristics and RC strategies suitable for people with LHL.

HIGHLIGHTS

Despite meeting most criteria for understandability, many of the Dutch PtDAs use long sentences, which likely impede comprehension for patients with LHL.Most of the Dutch PtDAs follow established recommendations for risk communication, with room for improvement for some strategies such as framing and a clear reference to the time frame.Overall, more research is needed to tailor PtDAs to the needs of people with LHL.

The perceptions and experiences of community nurses and patients towards shared decision-making in the home setting: An integrative review

AIM

To explore patients' and community nurses' perceptions and experiences of shared decision-making in the home.

DESIGN

Integrative review.

DATA SOURCES

CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023.

REVIEW METHODS

A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed.

RESULTS

Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described tension in managing patients' involvement in decision-making.

CONCLUSION

The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled.

IMPACT

This paper demonstrates how the idea of shared decision-making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision-making in theory and how it plays out in practice.

REPORTING METHOD

The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021).

PATIENT OR PUBLIC CONTRIBUTION

This review was carried out as part of a wider study for which service users have been consulted.

Pharmacoequity measurement framework: A tool to reduce health disparities

Pharmacoequity is a health system and policy goal of ensuring equitable access to high-quality medications for all individuals, regardless of factors such as race, ethnicity, socioeconomic status, or resource availability to reduce health disparities. Although measurement frameworks have been widely used in health equity contexts, a focused framework for pharmacoequity remains a critical gap. In this article, we introduce a novel pharmacoequity measurement framework anchored in the patient medication-use journey. The framework includes the following domains: (1) access to health care services, (2) prescription generation, (3) primary medication nonadherence, (4) secondary medication nonadherence, and (5) medication monitoring. For each domain, we provide examples of outcome measures and potential data sources that can be used for evaluation. We also outline an implementation workflow of the pharmacoequity measurement framework that population health stakeholders can use across various settings (eg, health systems, health plans). The framework provides a structured approach to identify existing gaps in the path toward achieving pharmacoequity and lay the foundation for targeted interventions. Additionally, it enables ongoing monitoring of progress toward achieving pharmacoequity while identifying interventions that are effective, scalable, and sustainable.

Development and evaluation of a decision aid for HPV vaccination among adults aged 27-45 years old in the United States

OBJECTIVE

To design, develop, and field test the HPV Decide decision tool to facilitate shared clinical decision-making recommendation for mid-adult HPV vaccination.

METHODS

The 'HPV Decide' online tool was developed through a 6-step process, involving community and provider advisory boards, usability testing with 10 end users (unvaccinated adults aged 27-45), field testing interviews with another 10, and interviews with 18 healthcare providers. The process incorporated both inductive and deductive qualitative data analyses.

RESULTS

The logic model, based on the Ottawa Decision Support Framework, highlighted the importance of objective knowledge and managing decisional conflict. Iterative modifications were informed by the advisory boards, alpha testing, and usability testing. Field testing showed utility to end users, highlighting the straightforward design, and lack of medical jargon. Many expressed a desire to access the tool before doctor appointments, emphasizing its value in a healthcare context and in partnership with providers. Lastly, healthcare provider feedback highlighted information quality, structure, acceptability, and future implementation.

DISCUSSION

While users recognized the tool's information quality and user-centric design, full evaluation focused on changes in informed decision making and clinic-based implementation are needed.

PRACTICAL VALUE

The HPV Decide decision tool demonstrates promise in supporting informed decisions about HPV vaccination among mid-adults.

Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis

OBJECTIVES

To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF.

STUDY DESIGN

Systematic review and meta-analysis.

ELIGIBILITY CRITERIA

Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF.

INFORMATION SOURCES

We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies.

SYNTHESIS OF RESULTS

We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge.

RESULTS

13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery.

CONCLUSIONS

In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted.

PROSPERO REGISTRATION NUMBER

CRD42020218025.

Substituting confidence for competence in health literacy: a review of studies, citations, and trial registrations

Patient health literacy is crucial for effective patient-physician communication, and interventions targeting health literacy can use measures based on either actual performance (competence) or self-ratings (confidence). This paper analyzed the development of these measures through three studies. Study 1 reviewed articles describing the development of novel measures; Study 2 examined the citations of these studies, and Study 3 evaluated data from clinical trials registries. The literature search was conducted from 14 April 2023 to 27 April 2023. PubMed was used as the main database in which studies on health literacy measures were searched for the systematic review (Study 1). We then used Google Scholar and the OpenCitations database to describe citation patterns of the included health literacy measures (Study 2). Finally, we evaluated confidence- or competence-based health literacy measures by extracting and analyzing trial data from ClinicalTrials.gov (Study 3). Our review included 55 health literacy measures, among which 23 (42%) were competence-based, 28 (51%) confidence-based, and 4 (7%) assessed both. Recent trends show a shift toward developing more confidence-based measures and a decline in creating new competence-based measures. Confidence-based measures were increasingly cited, whereas citations for competence-based measures have plateaued. Lastly, our findings showed a steady increase in the use of confidence-based measures in recent clinical trials and a decrease in the use of competence-based measures when controlling for sample size. This shift may be problematic because confidence-based measures do not improve our limited knowledge about patients' actual ability to meet demands of shared decision-making, especially regarding new technologies like artificial intelligence in healthcare.

Implementing High-Risk Human Papillomavirus Self-Sampling for Cervical Cancer Screening in Ghana: A Study (CarciSCAN) Protocol

Background: The World Health Organization (WHO) aims to eliminate cervical cancer by 2030 through a global strategy, centred on high-risk Human papillomavirus (hrHPV)-based screening and treatment. Implementing these strategies in low-resource settings remains challenging, due to barriers associated with limited healthcare infrastructure and patient awareness. Self-sampling for hrHPV has shown higher acceptability and similar diagnostic accuracy compared to clinician-taken samples. This study proposes a protocol to evaluate the clinical efficacy of a cervical cancer screening program utilising hrHPV self-sampling in Ghana.Methods and Analysis: 1000 non-pregnant women aged 30-65 years will be invited to self-collect hrHPV samples. Those testing hrHPV positive will undergo visual inspection with acetic acid. Those diagnosed with high-grade squamous intraepithelial lesions will be offered ablation. In any case where there is a suspicion of invasion, or equivocal diagnosis, biopsies will be taken. Follow-up for women who are test positive for hrHPV and/or undergo treatment, will involve hrHPV self-sampling after 6 months. HrHPV-negative women will rescreen after 3 years. Biopsies will be taken where immediate treatment is not suitable, and women with confirmed or suspected invasive cervical carcinoma will be referred for surgical and/or oncological care. The primary outcome will be the proportion of women successfully screened, defined as the proportion of women with a valid HPV test result out of those invited to attend cervical screening. Secondary outcomes include screening uptake, disease detection rate, hrHPV genotype prevalence, treatment acceptance rate, successful treatment response, missed disease during treatment, number lost to follow-up, and disease recurrence.Discussion: In low-resource settings, hrHPV self-sampling offers an accessible method to increase screening uptake. This study will inform strategies for broader implementation of cervical cancer screening and contribute to achieving the WHO's goal of elimination by 2030.Trial Registration: Ethical approval for this study was obtained from the Kintampo Health Research Centre Institutional Ethics Committee (IEC), Bono East, Ghana, West Africa, on 24 May 2024 (IEC IRB Registration No. 0004854; Study ID: KHRCIEC/2024-03).

Intersectional inequities in colorectal cancer screening attendance in Sweden: Using decision trees for intersectional matrix reduction

Colorectal cancer (CRC) represents a significant health burden worldwide, with existing inequities in incidence and mortality. In Sweden, CRC screening programmes have varied regionally since the mid-2000s, but the significance of organised screening for counteracting complex inequities in screening attendance has not been investigated. This study aimed to assess patterns of inequities in lifetime CRC screening attendance in the Swedish population aged 60-69 years by identifying intersectional strata at higher risk of never attending CRC screening. The research question is answered using decision trees to reduce the complexity of a full intersectional matrix into a reduced intersectional matrix for risk estimation. Participants were drawn from the cross-sectional 2019 European Health Interview Survey (N = 9,757, response rate: 32.52%). The Conditional Inference Tree (CIT) (AUC = 0.7489, F-score = 0.7912, depth = 4, significance level = 0.05) identified region of residence (opportunistic vs organised screening), country of origin, gender, age and income as relevant variables in explaining lifetime CRC screening attendance in Sweden. Then, Poisson regression with robust standard errors estimated that EU-born women living in opportunistic screening regions belonging to the 2nd income quintile had the highest risk of never attending CRC screening (PR = 8.54, p < 0.001), followed by EU-born men living in opportunistic screening regions (PR = 7.41, p < 0.001) compared to the reference category (i.e. people aged 65-69 living in organised screening regions). In contrast, only age-related differences in attendance were found in regions with organised screening (i.e. people aged 60-64 living in regions with organised screening (PR = 2.01, p < 0.05)). The AUC of the reduced intersectional matrix model (0.7489) was higher than the full intersectional matrix model (0.6959) and slightly higher than the main effects model (0.7483), demonstrating intersectional effects of the reduced intersectional matrix compared with the main effects model and better discriminatory accuracy than the full intersectional matrix. In conclusion, regions with long-established organised CRC screening programmes display more limited socio-demographic inequities than regions with opportunistic CRC screening. This suggests that organised screening may be a crucial policy instrument to improve equity in CRC screening, which, in the long run, has the potential to prevent inequities in colorectal cancer mortality. Moreover, decision trees appear to be valuable statistical tools for efficient data-driven simplification of the analytical and empirical complexity that epidemiological intersectional analysis conventionally entails.

Pharmacoequity measurement framework: A tool to reduce health disparities

Pharmacoequity is a health system and policy goal of ensuring equitable access to high-quality medications for all individuals, regardless of factors such as race, ethnicity, socioeconomic status, or resource availability to reduce health disparities. Although measurement frameworks have been widely used in health equity contexts, a focused framework for pharmacoequity remains a critical gap. In this article, we introduce a novel pharmacoequity measurement framework anchored in the patient medication-use journey. The framework includes the following domains: (1) access to health care services, (2) prescription generation, (3) primary medication nonadherence, (4) secondary medication nonadherence, and (5) medication monitoring. For each domain, we provide examples of outcome measures and potential data sources that can be used for evaluation. We also outline an implementation workflow of the pharmacoequity measurement framework that population health stakeholders can use across various settings (eg, health systems, health plans). The framework provides a structured approach to identify existing gaps in the path toward achieving pharmacoequity and lay the foundation for targeted interventions. Additionally, it enables ongoing monitoring of progress toward achieving pharmacoequity while identifying interventions that are effective, scalable, and sustainable.

Development and pilot testing of the Population And ContExt adaption of decision aids (PACE) framework

Objective

This study aimed to develop and pilot test a new framework for the adaptation of patient decision aids (PtDAs) using a specific case example of contraceptive method PtDAs for Chinese-speaking migrant women.

Methods

We developed a novel approach for adaptation - the PACE (Population And ContExt adaption of decision aids) framework - that incorporated both existing models and frameworks and innovative elements. It involves six stages: selection and appraisal; review by content experts; content validity and usability pre-testing; translation; decisional needs assessment; and perceived acceptability, usability and feasibility testing. We then followed the framework to pilot and adapt a suite of PtDAs on contraceptive methods for Chinese-speaking migrant women in Australia. Twenty healthcare providers and 22 Chinese migrant women participated during the stages five and six.

Results

The pilot resulted in adapted PtDAs that were acceptable to end users. For future research, we proposed further recommendations and considerations based on lessons learnt, which include flexibility in applying the framework and considering an additional real-world evaluation step.

Conclusion

Adaptation of PtDAs required a multi-stage and multidisciplinary team-based and pragmatic approach as exemplified in the application of the PACE framework.

Innovation

The PACE framework developed and piloted in this study fills a crucial gap in knowledge about how to adapt PtDAs for new populations and contexts and provides an innovative and systemic approach to guide the adaptation process.

Multimorbidity and person-centred care in a socioeconomically deprived community: a qualitative study

BACKGROUND

People with multimorbidity (>2 long-term conditions) have poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality person-centred care (PCC) is important in those with multimorbidity, but socially vulnerable populations have not, to our knowledge, informed current PCC models.

AIM

To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management.

DESIGN AND SETTING

Ethnographically informed case study in a community experiencing high SED in Scotland.

METHOD

Participant observation (138 h) was undertaken within four community groups who also took part in two participatory workshops. There were 25 in-depth interviews with people with multimorbidity, recruited from local general practices; emerging findings were discussed with interviewees in one focus group. Field notes/transcripts were analysed using inductive thematic analysis.

RESULTS

Key aspects of PCC were 'patient as person', 'strong therapeutic relationship', 'coordination of care', and 'power sharing'; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of 'being known', 'stigma', and 'none of the systems working' influenced how people approached health services and healthcare decisions. High-quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences.

CONCLUSION

In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with health care in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policymakers should prioritise and resource PCC.

The American Cancer Society National Lung Cancer Roundtable strategic plan: Current challenges and future directions for shared decision making for lung cancer screening

Shared decision making (SDM) between health care professionals and patients is essential to help patients make well informed choices about lung cancer screening (LCS). Patients who participate in SDM have greater LCS knowledge, reduced decisional conflict, and improved adherence to annual screening compared with patients who do not participate in SDM. SDM tools are acceptable to patients and clinicians. The importance of SDM in LCS is emphasized in recommendations from professional organizations and highlighted as a priority in the 2022 President's Cancer Panel Report. The updated 2022 national coverage determination from the Centers for Medicare & Medicaid Services reaffirms the value of SDM in offering LCS to eligible beneficiaries. The Shared Decision-Making Task Group of the American Cancer Society National Lung Cancer Roundtable undertook a group consensus process to identify priorities for research and implementation related to SDM for LCS and then evaluated current knowledge in these areas. Priority areas included: (1) developing feasible, adaptable SDM training programs for health care professionals; (2) understanding the impact of alternative health system LCS models on SDM practice and outcomes; (3) developing and evaluating new patient decision aids for use with diverse populations and in varied settings; (4) offering conceptual clarity about what constitutes a high-quality decision and developing appropriate quality measures; and (5) studying the use of prediction-augmented screening to support SDM in practice. Gaps in current research in all areas were observed. The authors conclude with a research and implementation agenda to advance the quality and implementation of SDM for persons who might benefit from LCS.

A rapid review of digital approaches for the participatory development of health-related interventions

Objectives

Using participatory approaches to design health interventions is promising, and the ongoing digitalization has enabled the development of diverse digital formats for this purpose. These digital formats bring forth distinct advantages and challenges that should be carefully considered. This rapid review aims to present an overview of digital formats employed in participatory health intervention development and their reported benefits and barriers.

Design

A qualitative rapid review was conducted, following recommendations by the Cochrane Rapid Reviews Methods Group. The literature search was carried out in October 2022 and encompassed the PubMed, Embase, PsycINFO, and Cochrane CENTRAL databases. Studies were included if they were published in 2010 or later and reported the development of a health-related intervention employing digital formats in the participatory process.

Results

A total of 22 studies were included. We identified three types of digital formats used for participatory health intervention development: web-based participatory formats (n = 14), digital participatory visual formats (n = 5), and digital participatory mapping (n = 3). The reported benefits of applying digital formats included enhanced participant anonymity, increased time and cost efficiency, and more flexibility regarding scheduling and extent of participation. Among the reported barriers were sufficient internet connectivity, required technical skills, and online fatigue.

Conclusion

The review shows a variety of digital formats employed to develop participatory health interventions. Yet, these methods are primarily digital adaptations of pre-existing analog formats. Innovative digital approaches involving, for example, virtual reality devices remain largely unused. The review also revealed a need for establishing shared terminology and reporting standards to facilitate communication, comparison, and synthesis of findings in this evolving area of research.

Fifteen-minute consultation: Empowering children, young people and families through shared decision-making: a practical guide

Shared decision-making (SDM) is a collaborative approach to healthcare decision-making that involves patients and healthcare professionals working together to make decisions that are informed by the best available medical evidence, as well as the patient's values, preferences and goals. The importance of SDM and the intricate interplay among parents, children and young people (CYP), and healthcare professionals are increasingly acknowledged as the crucial aspects of delivering high-quality paediatric care. While there is a substantial evidence base for SDM improving knowledge and reducing decisional conflict, the evidence for long-term measures such as improved health outcomes is limited and mainly inconclusive. To support healthcare teams in implementing SDM, the authors offer a practical guide to enhance decision-making processes and empower CYP and their families.

Impact of patient education by nurse case managers on decision making for out-of-pocket anti-osteoporotic pharmaceutical therapy: a single-center retrospective study

BACKGROUND

Osteoporosis is a common condition that increases the risk of fracture and mortality. In Taiwan, clinical guidelines recommend pharmaceutical therapy for patients with a T-score of ≤ - 2.5; however, Taiwan's National Health Insurance (NHI) only covers these medications for those with a history of fragility fractures. This gap in coverage necessitates a discussion of out-of-pocket treatment options. To address this, we provided an integrated care program with patient education and shared decision-making by nurse case managers specializing in osteoporosis. We evaluated whether education by nurse case managers influences patients with a T-score ≤ - 2.5, who are not covered by the NHI, to choose out-of-pocket pharmaceutical therapy.

METHODS

We retrospectively reviewed medical records of patients who underwent bone density scanning at our hospital between January 2014 and December 2021. We identified 4,462 patients with a T-score of ≤ - 2.5 who were ineligible for NHI-covered anti-osteoporotic therapy and analyzed trends in out-of-pocket medication use. Since the integrated care program began in 2018, we evaluated whether education by nurse case managers between 2018 and 2021 influenced patients' decisions to pay out-of-pocket for therapy. After the implementation of the integrated care program, we identified 2,910 patients with a T-score ≤ -2.5 who were ineligible for NHI-covered anti-osteoporotic therapy. Of these, 640 opted for out-of-pocket treatment, while 2,270 chose conservative care. After a 1:1 propensity score match based on age and sex, logistic regression was used to analyze the impact of nurse case manager education on these decisions.

RESULTS

Between 2014 and 2021, 888 of the 4,462 patients chose out-of-pocket pharmaceutical therapy. Before the implementation of the integrated care program and patient education by nurse case managers (2014-2017), 16% of the patients opted to pay out-of-pocket for anti-osteoporotic therapy. After the program was implemented (2018-2021), the rate increased significantly to 22% (P < 0.001). A multivariate logistic regression model showed that a history of osteoarthritis (adjusted odds ratio = 1.576; P = 0.009) and education provided by the nurse case managers (adjusted odds ratio = 5.044; P < 0.001) were significantly associated with choosing out-of-pocket therapy.

CONCLUSIONS

Education from nurse case managers significantly increased the likelihood of patients choosing out-of-pocket anti-osteoporotic therapy in our hospital, thereby bridging the gap between clinical guidelines and NHI reimbursement criteria.

Do summaries of evidence enable informed decision-making about COVID-19 and influenza vaccination equitably across more and less disadvantaged groups? Study protocol for a multi-centre cluster randomised controlled trial of 'fact boxes' in health and social care in Germany

INTRODUCTION

Evidence summaries on the benefits and harms of treatment options support informed decisions under controlled conditions. However, few studies have investigated how such formats support decision-making across different social groups. There is a risk that only disadvantaged people will be able to make informed health decisions-possibly increasing the health equity gap. It is also unclear whether they support decision-making in the field at all. The aim of our study is to assess whether evidence summaries based on the fact box format can help people from different social groups make informed decisions about COVID-19 and influenza vaccinations, and thus reduce inequity in health communication.

METHODS AND ANALYSIS

In a multi-centre, cluster-randomised, controlled trial, health educators from usual care and outreach work in Germany will be randomised in a 1:1 ratio to provide either usual health communication plus an evidence summary ('fact box') or usual health communication. Health educators provide a flyer about COVID-19 or influenza vaccination which contains a link to an online study either with (intervention) or without (control) fact box on the reverse side. Flyer and online study will be available in Arabic, German, Turkish and Russian language. The primary outcome is informed vaccination intention, based on vaccination knowledge, attitudes, intentions and behaviour. Secondary outcomes include risk perception, decisional conflict and shared decision-making. We will use linear mixed models to analyse the influence of both individual (eg, education status) and cluster level factors and account for the expected cluster variability in realising usual health communication or the intervention. The statistical analysis plan includes the selection of appropriate measures of effect size and power calculation, assuming a sample size of 800 patients.

ETHICS AND DISSEMINATION

The trial has been approved by the Ethics Committee of the University of Potsdam, Germany (application numbers: 34/2021 and 57/2022).Results will be disseminated through peer-reviewed journals, conferences and to relevant stakeholders.

PROTOCOL VERSION

Version 6 (4 October 2024); Preprint available on Research Square: https://doi.org/10.21203/rs.3.rs-3401234/v3 TRIAL REGISTRATION NUMBER: NCT06076421.

Development of the World Federation of Hemophilia Shared Decision-Making Tool

INTRODUCTION

The use of shared decision-making (SDM) in clinical settings is becoming more prevalent. The evolving and increasingly complex treatment landscape of haemophilia management has augmented the need and desire for SDM between patients and their healthcare team. SDM tools have been used in other chronic conditions and can be an effective form of education for patients and clinicians.

AIM

The World Federation of Hemophilia (WFH) partnered with people with haemophilia (PWH), patient advocacy groups, and healthcare practitioners to form an expert working group to develop an educational tool for PWH and their caregivers. The primary objectives included educating PWH on the available prophylactic treatments and facilitating discussion between PWH and their healthcare team.

METHODS

The tool was proposed and developed by the expert working group, workshopped at conference round tables, and evaluated in two focus groups.

RESULTS

The interactive WFH SDM Tool guides users through the SDM treatment journey and provides an opportunity for reflection on current disease impact and treatment preferences, educational fact sheets and videos, and a comparison between treatment classes. Two forms of the SDM Tool are available: an online platform with a summary page that may be printed and shared and a printable workbook. All evidence in the tool is based on the prescribing information or phase III clinical trial publications. The Tool will be updated twice each year.

CONCLUSION

The WFH SDM Tool is the first available resource that translates published guidance on SDM in haemophilia into a practical, user-friendly tool aimed at facilitating patient-centred treatment decisions.

Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women

INTRODUCTION

Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women.

MATERIAL AND METHODS

We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking.

RESULTS

Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (eg at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67).

CONCLUSIONS

Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.

Uncertainty Profiles and Treatment Preferences for Intraductal Papillary Mucinous Neoplasms

INTRODUCTION

Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic premalignant lesions frequently detected incidentally. Choosing between surgery and surveillance for IPMNs is rooted in uncertainty. We characterized patient preferences in IPMN management, and examined associations with patients' uncertainty profiles (risk perception, risk attitude, and uncertainty tolerance).

METHODS

We conducted a cross-sectional survey drawn from a national opt-in panel. We simulated an encounter following an incidental computed tomography scan finding of an IPMN with a 5% cancer risk. We elicited participants' preferred treatment (surgery versus surveillance). Participant cancer risk perception, risk attitude (risk seeking versus risk averse), and uncertainty tolerance (comfort with the unknown) were determined using validated measures. Multivariate regression models assessed for independent predictors of treatment preference and risk perception.

RESULTS

The sample included 520 participants, ages 40-70, racially representative of the US population. Participants preferred surveillance (n = 331, 64%) over surgery (n = 189, 36%). Patients were significantly more likely to prefer surgery as their cancer risk perception increased (absolute difference = 12% from 1.0 standard deviation below to 1.0 standard deviation above the mean, 95% CI 3.5-20.2). Treatment preference was not significantly associated with risk attitude (P = 0.068) or uncertainty tolerance (P = 0.755). However, initial cancer risk perception was significantly associated with both uncertainty tolerance (P = 0.013) and baseline cancer anxiety (risk perception 16.4% versus 65%, not worried at all versus extremely worried, P < 0.001).

CONCLUSIONS

Patient preference varies widely for IPMN and is significantly associated with cancer risk perception, which is, in turn, significantly associated with uncertainty tolerance and cancer anxiety. These findings argue for the preference-sensitive nature of IPMN treatment decisions.

Public deliberation to assess patient views on biosimilar medication switching for the treatment of inflammatory bowel disease

BACKGROUND

Biosimilars are highly similar, but not identical, versions of originator biologic medications. Switching patients to biosimilars presents an opportunity to mitigate rising drug costs and expand patient access to important biologic therapies. However, decreased patient acceptance and adherence to biosimilar medications have been reported, which can lead to loss of treatment response, adverse reactions, and inefficient resource utilization. Understanding patient perceptions of biosimilars and biosimilar switching is needed to inform patient-centered care strategies that promote efficient resource utilization.

METHODS

We used democratic deliberation methods to solicit the informed and considered opinions of patients regarding biosimilar switching. Patients with inflammatory bowel disease (IBD; n = 29) from the Veterans Health Administration (VHA) participated in 5-hour deliberation sessions over two days. Following educational presentations with experts, participants engaged in facilitated small group discussions. Transcripts and facilitators' notes were used to identify key themes. Participants completed surveys pre- and post-deliberation to collect sociodemographic and clinical features as well as to assess IBD treatment knowledge and attitudes toward care and approaches to biosimilar switching.

RESULTS

Five major themes emerged from the small group discussions in the context of biosimilar switching: 1) concerns about adverse consequences and unclear risk-benefit balance; (2) importance of communication and transparency; (3) desire for shared decision making and patient involvement in treatment decisions; (4) balancing cost-saving with competing priorities; and (5) advocating for individualized care and prioritization based on risk levels. These views led participants to favor approaches that prioritize switching the sickest patients last (i.e., those with poorly controlled disease) and that offer patients control and choices around biosimilar switching. Participants also expressed preferences for combining elements of different approaches to maximize fairness.

CONCLUSIONS

Approaches to biosimilar switching should consider patients' desires for transparency and effective communication about biosimilar switching and engagement in their medical decision-making as part of patient-centered care. Incorporating patient preferences around biosimilar switching is critical when navigating the quality and affordability of care in resource constrained settings, both within the VHA and in other healthcare systems.

Exploring the Correlation Between Health Literacy and Knowledge of Cervical Cancer and Radiotherapy Among Japanese Women: A Web-Based Survey

Health literacy (HL) plays a vital role in an individual's ability to make informed health decisions. Japan faces several challenges in cervical cancer control, including low human papillomavirus (HPV) vaccination and screening rates, underutilization of radiotherapy, and limited HL. This study explored the association between HL and knowledge of cervical cancer and radiotherapy, particularly among young Japanese women. We conducted a web-based survey among users of LunaLuna, a popular women's healthcare application, to assess their HL and knowledge about cervical cancer and radiotherapy through a 46-question survey. We compared three groups in terms of HL (inadequate, problematic, and sufficient & excellent). Multiple regression analysis was used to identify factors associated with knowledge. In total, 1468 respondents were included in this study. HL was positively correlated with knowledge scores (inadequate: 51.8%; problematic: 56.3%; sufficient & excellent: 60%). Participants displayed relatively low accuracy for treatment-related questions. Higher HL (β = 0.15, p < 0.01), education (β =  - 0.11, p < 0.01), cervical cancer screening (β =  - 0.11, p < 0.01), income (β = 0.09, p < 0.01), and employment (β =  - 0.06, p = 0.04) were significant factors affecting knowledge of cervical cancer and radiotherapy. Our findings underscore the pivotal role of HL in promoting cervical cancer prevention and providing a better understanding of radiotherapy. Despite factors such as age, education, and history of cervical cancer screening, HL showed the strongest association with knowledge of cervical cancer and radiotherapy. The enhancement of HL and knowledge dissemination may be critical for promoting cervical cancer prevention and radiotherapy in Japan.

Medical Metaphors That May Reinforce Misconceptions Are Associated With Increased Trust in the Clinician

BACKGROUND AND OBJECTIVES

This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral?

METHODS

In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor.

RESULTS

Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort ( P < .05).

CONCLUSION

The observation that metaphors that validate a person's understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions.

Acceptability determinants of a proposal to reduce antiretroviral treatment to an oral two-drug regimen among patients living with HIV and physicians in France

An oral two-drug regimen (O2DR) in the form of a once-a-day single tablet is now recommended for treatment switching and treatment initiation for HIV. In clinical care, the process of treatment change refers to adaptation issues, both individual and within the care relationship. The study aim is to present the determinants involved in the acceptability of switching to O2DR in the PROBI (Patient-Reported Outcomes BItherapy) qualitative study. The study includes 30 interviews: 15 were conducted with doctors caring for people living with HIV, 15 were conducted with patients who had been offered a change of treatment. A double analysis was carried out: lexicometric analysis to highlight the structuring of the discourse around the change in treatment and a thematic analysis to understand the associated issues more precisely. The results highlighted common concerns with respect to switching to O2DR. Also, the caregiver-patient relationship was a central determinant in treatment switching. Information, knowledge and representations of O2DR are also factors facilitating treatment change and should be taken into account for doctors' and patients' adherence.

Using co-design to identify intervention components to address unhealthy dietary and activity behaviours in New Zealand South Asians

There is an urgent need to develop sustainable and impactful interventions to mitigate the high risk of diet-related non-communicable diseases (diet-NCDs) in South Asians living in high-income countries. The current study using a co-design methodology aimed to identify community-led intervention components (solutions) to address barriers and enablers of disease-promoting dietary and physical activity behaviours in New Zealand South Asians. Data were collected from South Asian immigrants aged 25-59 years via three focus group discussions (n = 21) and 10 telephone or face-to-face interviews between 2018 and 2019. The thematic analysis resulted in identifying 22 barrier and enabler codes and 12 solution codes which were summarised under five themes. The key solutions (intervention components) to mitigate the identified target behaviours were providing recipes for using local vegetables in South Asian cuisine, information on the nutritional quality of frozen vegetables and canned lentils, simple home gardening techniques, the saturated fat content of dairy foods, interpreting nutrition labels, optimal portion sizes of foods, and framing low-fat messages positively. Similarly, group-based activities with peer support such as walking, cultural dancing and community sports like cricket, football, and tennis were the identified solutions to increase physical activity levels. The identified solutions for health promoting dietary habits and physical activity levels could be part of any targeted multicomponent health promoting programme to reduce the risk of diet-NCDs in South Asian immigrants.