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Dams L, Van der Gucht E, Devoogdt N, Smeets A, Bernar K, Morlion B, Godderis L, Haenen V, De Vrieze T, Fieuws S, Moloney N, Van Wilgen P, Meeus M, De Groef A. Effect of pain neuroscience education after breast cancer surgery on pain, physical, and emotional functioning: a double-blinded randomized controlled trial (EduCan trial). Pain 2023; 164:1489-1501. [PMID: 36637138 DOI: 10.1097/j.pain.0000000000002838] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
ABSTRACT Pain is one of the most common and long-lasting side effects reported by women surgically treated for breast cancer. Educational interventions may optimize the current physical therapy modalities for pain prevention or relief in this population. Pain neuroscience education (PNE) is an educational intervention that explains the pain experience not only from a biomedical perspective but also the psychological and social factors that contribute to it. Through a double-blinded randomized controlled trial (EduCan trial) it was investigated if PNE, in addition to the standard physiotherapy program immediately after breast cancer surgery, was more effective over the course of 18 months postoperatively than providing a biomedical explanation for pain. Primary outcome was the change in pain-related disability (Pain Disability Index, 0-70) over 12 months. Secondary outcomes included change in pain intensity, upper limb function, physical activity level, and emotional functioning over 4, 6, 8, 12, and 18 months postoperatively. Multivariate linear models for repeated (longitudinal) measures were used to compare changes. Preoperative and postoperative moderators of the change in pain-related disability were also explored. Of 184 participants randomized, the mean (SD) age in the PNE and biomedical education group was 55.4 (11.5) and 55.2 (11.4) years, respectively. The change in pain-related disability from baseline to 12 months postoperatively did not differ between the 2 groups (PNE 4.22 [95% confidence interval [CI]: 1.40-7.03], biomedical 5.53 [95% CI: 2.74-8.32], difference in change -1.31 [95% CI: -5.28 to 2.65], P = 0.516). Similar results were observed for all secondary outcomes. Future research should explore whether a more patient-tailored intervention would yield better results.
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Affiliation(s)
- Lore Dams
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Elien Van der Gucht
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Bart Morlion
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Section Anaesthesiology and Algology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, University of Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Vincent Haenen
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Center for Biostatistics and Statistical Bioinformatics, University of Leuven and University of Hasselt, Leuven, Belgium
| | - Niamh Moloney
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Paul Van Wilgen
- Pain in Motion International Research Group, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Transcare, Transdisciplinary Pain Management Centre, Groningen, the Netherlands
| | - Mira Meeus
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - An De Groef
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
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Anderson CB, Fatone S, Mañago MM, Swink LA, Hager ER, Kittelson AJ, Christiansen CL, Magnusson DM. Improving shared decision-making for prosthetic care: A qualitative needs assessment of prosthetists and new lower-limb prosthesis users. Prosthet Orthot Int 2023; 47:26-42. [PMID: 35622457 PMCID: PMC9691789 DOI: 10.1097/pxr.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prosthesis design is complex and multiple appropriate options exist for any individual with lower-limb amputation. However, there is insufficient evidence for guiding decision-making. Shared decision-making (SDM) offers an opportunity to incorporate patient-specific values and preferences where evidence is lacking for prosthesis design decisions. To develop resources to facilitate SDM, and consistent with the International Patient Decision Aid Standards, it is necessary to identify the decisional needs of prosthetists and prosthesis users for prosthesis design decisions. OBJECTIVES To assess the needs of prosthetists and new prosthesis users for SDM about the first prosthesis design. STUDY DESIGN Qualitative descriptive design. METHODS Six focus groups were conducted with 38 prosthetists. Individual semistructured interviews were conducted with 17 new prosthesis users. Transcripts were analyzed using directed content analysis, with codes defined a priori using existing frameworks for SDM: the Three Talk Model for SDM and the Ottawa Decision Support Framework. RESULTS Four main themes were identified among prosthetists and prosthesis users: acknowledging complexity in communication, clarifying values, recognizing the role of experience to inform preferences , and understanding the prosthetic journey . CONCLUSIONS Resources that support SDM for the first prosthesis design should consider methods for identifying individual communication needs, support with clarifying values, and resources such as experience for achieving informed preferences, within the context of the overall course of rehabilitation and recovery following lower-limb amputation. The themes identified in this work can inform SDM to promote collaborative discussion between prosthetists and new prosthesis users when making prosthesis design decisions.
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Affiliation(s)
- Chelsey B. Anderson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Stefania Fatone
- Department of Rehabilitation Medicine, Division of Prosthetics and Orthotics, University of Washington, Seattle, WA, USA
| | - Mark M. Mañago
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Laura A. Swink
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Emily R. Hager
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Andrew J. Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Dawn M. Magnusson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
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Razmjou H, Christakis M, Nam D, Drosdowech D, Sheth U, Wainwright A, Richards R. Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process. J Shoulder Elb Arthroplast 2023; 7:24715492231167104. [PMID: 37008201 PMCID: PMC10064165 DOI: 10.1177/24715492231167104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were “ready” and those who were “not-ready” to have surgery. Gender ( P = 0.037), overall health ( P = .024), strength in external rotation ( P = .002), pain severity ( P = .001), ASES score ( P < .0001), and expectations ( P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Helen Razmjou, Holland Orthopedic and Arthritic Centre, 43 Wellesley Street East, Toronto, Ontario, Canada M4Y 1H1.
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Diane Nam
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Darren Drosdowech
- Roth | McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Western University, London, Canada
| | - Ujash Sheth
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amy Wainwright
- Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robin Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
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Bosman CE, van der Sluis CK, Geertzen JHB, Kerver N, Vrieling AH. User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results. PLoS One 2023; 18:e0276874. [PMID: 36649233 PMCID: PMC9844830 DOI: 10.1371/journal.pone.0276874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Persons with a transfemoral amputation or knee-disarticulation are heavily reliant on an adequate set of components for their prosthesis. To improve the process of adjusting the specific prosthetic properties to the expectations of the prosthesis users, it is of importance to first identify which factors have an influence on prosthesis use. Therefore, we aimed to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. METHODS A qualitative meta-synthesis was conducted by searching five databases (last update January 20th 2022). Studies were considered eligible if they contained qualitative data about adult persons with a transfemoral amputation or knee-disarticulation with experience in using a prosthesis and focused on the users' opinions. All eligible studies were independently screened by two reviewers. The results sections of the included studies were entered in Atlas.ti software (v8) and coded using the framework approach. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) qualitative research checklist. Results of the meta-synthesis were validated with prosthesis users (n = 8) in a focus group. RESULTS Out of 5757 articles, 14 studies were included. An overview of seven themes ('prosthesis related'; 'rehabilitation, costs and prosthetist'; 'mental'; 'physical'; 'social'; 'activities and participation' and 'walking') containing 84 factors was created. Ten factors were added during the focus group, resulting in an overview of 94 factors that may influence the prosthesis use of lower-limb prosthesis users. Participants would like more user-involvement from the rehabilitation team. The development of a patient decision aid could help this process in the future. CONCLUSION The large number of factors demonstrates that there is a great variety between prosthesis users and the factors that influence their prosthesis use. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.
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Affiliation(s)
- Charlotte E. Bosman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aline H. Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Surgery for Osteoarthritis. Clin Geriatr Med 2022; 38:385-396. [DOI: 10.1016/j.cger.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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6
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Huibers CJA, Sallevelt BTGM, Heij JMJO, O'Mahony D, Rodondi N, Dalleur O, van Marum RJ, Egberts ACG, Wilting I, Knol W. Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting. Eur Geriatr Med 2022; 13:541-552. [PMID: 35291025 PMCID: PMC9151543 DOI: 10.1007/s41999-022-00633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
Aim To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START based medication optimisation recommendations from a pharmacotherapy team. Findings In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement (74%) was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors. Message Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations. Objective To evaluate the agreement of hospital physicians and older patients with individualised STOPP/START-based medication optimisation recommendations from a pharmacotherapy team. Methods This study was embedded within a large European, multicentre, cluster randomised controlled trial examining the effect of a structured medication review on drug-related hospital admissions in multimorbid (≥ 3 chronic conditions) older people (≥ 70 years) with polypharmacy (≥ 5 chronic medications), called OPERAM. Data from the Dutch intervention arm of this trial were used for this study. Medication review was performed jointly by a physician and pharmacist (i.e. pharmacotherapy team) supported by a Clinical Decision Support System with integrated STOPP/START criteria. Individualised STOPP/START-based medication optimisation recommendations were discussed with patients and attending hospital physicians. Results 139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9–14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30–50 ml/min/1.73 m2; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients’ reluctance to discontinue or initiate medication. Conclusion Better patient and physician education regarding the benefit/risk balance of pharmacotherapy, in addition to more precise and up-to-date medical records to avoid irrelevant recommendations, will likely result in higher adherence with future pharmacotherapy optimisation recommendations. Clinical trial registration Trial Registration Number NCT02986425.
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Affiliation(s)
- C J A Huibers
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - B T G M Sallevelt
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M J Op Heij
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D O'Mahony
- Department of Medicine (Geriatrics), University College Cork and Cork University Hospital, Cork, Ireland
| | - N Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Dalleur
- Pharmacy Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Louvain, Belgium.,Louvain Drug Research Institute-Clinical Pharmacy, Université catholique de Louvain, Louvain, Belgium
| | - R J van Marum
- Department of Elderly Care Medicine, Amsterdam, UMC, Location VUmc, Amsterdam, The Netherlands.,Departments of Geriatrics and Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - A C G Egberts
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - I Wilting
- Clinical Pharmacy Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Knol
- Geriatric Medicine Department, University Medical Center Utrecht, Utrecht, The Netherlands
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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Hoffmann TC, Jones M, Glasziou P, Beller E, Trevena L, Mar CD. A Brief Shared Decision-Making Intervention for Acute Respiratory Infections on Antibiotic Dispensing Rates in Primary Care: A Cluster Randomized Trial. Ann Fam Med 2022; 20:35-41. [PMID: 35074766 PMCID: PMC8786416 DOI: 10.1370/afm.2755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether acute respiratory infection (ARI) decision aids and a general practitioner (GP) training package reduces antibiotic dispensing rate and improves GPs' knowledge of antibiotic benefit-harm evidence. METHODS A cluster randomized trial of 27 Australian general practices (13 intervention, 14 control) involving 122 GPs. Intervention group GPs were given brief decision aids for 3 ARIs (acute otitis media, acute sore throat, acute bronchitis) and video-delivered training. Primary outcome was dispensing rate of target antibiotic classes (routinely used for ARIs), extracted for 12 months before, and following, randomization. Secondary outcomes were GPs' knowledge of antibiotic benefit-harm evidence; prescribing influences; acceptability, usefulness, and self-reported resource use; and dispensing rate of all antibiotics. RESULTS The baseline mean dispensing rate of ARI-related antibiotics was 3.5% (intervention GPs) and 3.2% (control GPs) of consultations. After 12 months, mean rates decreased (to 2.9% intervention; 2.6% control): an 18% relative reduction from baseline but similar in both groups (rate ratio 1.01; 95% CI, 0.89-1.15). Greater increases in knowledge were seen in the intervention group than control; a significant increase (average 3.6; 95% CI, 2.4-4.7, P <.001) in the number of correct responses to the 22 knowledge questions. There were no between-group differences for other secondary outcomes. The intervention was well received, perceived as useful, and reported as used by about two-thirds of intervention GPs. CONCLUSIONS A brief shared decision-making intervention provided to GPs did not reduce antibiotic dispensing more than usual care, although GPs' knowledge of relevant benefit-harm evidence increased significantly.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Elaine Beller
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
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Ferreira LL, Sampaio DL, Chagas ACP, Guimarães HP, Hajjar LA, Lobo SMA, Abdo CHN, Bonamigo Filho JL, Bacha HA, Moura RFD, Bernardo WM. AMB Guidelines: COVID –19. Rev Assoc Med Bras (1992) 2020; 66Suppl 2:17-21. [DOI: 10.1590/1806-9282.66.s2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Hélio Penna Guimarães
- Associação Brasileira de Medicina de Emergência, Brasil; Hospital Israelita Albert Einstein, Brasil; Hospital do Coração, Brasil; Universidade Federal de São Paulo, Brasil
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FitzPatrick MA, Hess AC, Sudbury-Riley L, Schulz PJ. A Typology of Patients Based on Decision-Making Styles: Cross-Sectional Survey Study. J Med Internet Res 2019; 21:e15332. [PMID: 31746770 PMCID: PMC6893560 DOI: 10.2196/15332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
Background Although previous research shows broad differences in the impact of online health information on patient-practitioner decision making, specific research is required to identify and conceptualize patient decision-making styles related to the use of online health information and to differentiate segments according to the influence of online information on patient decision making and interactions with health professionals. Objective This study aimed to investigate patients’ decision making in relation to online health information and interactions with health care practitioners. We also aimed to present a typology of patients based on significant differences in their decision making. Methods We applied a large-scale cross-sectional research design using a survey. Data, generated using a questionnaire that was administered by companies specializing in providing online panels, were collected from random samples of baby boomers in the United Kingdom, the United States, and New Zealand. The total sample comprised 996 baby boomers born between 1946 and 1964, who had used the internet in the previous 6 months to search for and share health-related information. Data were analyzed using hierarchical cluster analysis and confirmatory factor analysis, as well as one-way analysis of variance, chi-square tests, and paired sample t tests. Results Analyses identified 3 key decision-making styles that served as the base for 4 unique and stable segments of patients with distinctive decision-making styles: the Collaborators (229/996, 23.0%), the Autonomous-Collaborators (385/996, 38.7%), the Assertive-Collaborators (111/996, 11.1%), and the Passives (271/996, 27.2%). Profiles were further developed for these segments according to key differences in the online health information behavior, demographics, and interactional behaviors of patients. The typology demonstrates that collaborative decision making is dominant among patients either in its pure form or in combination with autonomous or assertive decision making. In other words, most patients (725/996, 72.8%) show significant collaboration in their decision making with health care professionals. However, at times, patients in the combination Autonomous-Collaborative segment prefer to exercise individual autonomy in their decision making, and those in the combination Assertive-Collaborative segment prefer to be assertive with health professionals. Finally, this study shows that a substantial number of patients adopt a distinctly passive decision-making style (271/996, 27.2%). Conclusions The patient typology provides a framework for distinguishing practice-relevant and addressable segments with important implications for health care practitioners, including better-targeted communication programs for patients and more successful outcomes for health care services in the long term.
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Affiliation(s)
- Mary Anne FitzPatrick
- School of Management and Marketing, Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Alexandra Claudia Hess
- School of Communication, Journalism and Marketing, Massey University, Auckland, New Zealand
| | | | - Peter Johannes Schulz
- Institute of Communication and Health, Faculty of Communication Science, University of Lugano, Lugano, Switzerland
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Bailes AF, Gannotti M, Bellows DM, Shusterman M, Lyman J, Horn SD. Caregiver knowledge and preferences for gross motor function information in cerebral palsy. Dev Med Child Neurol 2018; 60:1264-1270. [PMID: 30132848 DOI: 10.1111/dmcn.13994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine caregiver knowledge and preferences for gross motor information and examine differences across Gross Motor Function Classification System (GMFCS) levels. METHOD A questionnaire was developed. Respondents reported GMFCS knowledge, preference for knowledge, and experience with GMFCS and motor curve information. RESULTS In total, 303 caregivers of children with cerebral palsy (CP) (GMFCS level I: 22%; GMFCS level II: 16%; GMFCS level III: 15%; GMFCS level IV: 23%; GMFCS level V: 24%) completed the questionnaire. Forty-five per cent of caregivers knew the GMFCS level at survey, and only 31% knew how their child's motor development compared with others of similar age and level. Caregiver education level was associated with knowledge (p<0.001). Most prefer discussing motor development with a therapist. Of caregivers who knew their child's GMFCS level at survey, 83% reported it would be helpful to revisit the topic over time. Compared with GMFCS level IV and V, caregivers of children in GMFCS levels I to III preferred to learn at the same time as CP diagnosis, (p=0.04) and were more likely to report having received visual aids (p=0.04). Caregivers of children in GMFCS levels IV and V found it more difficult to learn their child's level (p<0.001) versus those caring for children of GMFCS levels I to III, and reported seeing pictures with descriptions more informative (p=0.03). INTERPRETATION Caregivers of children with CP may not know GMFCS and motor curve information, and vary in experience and preferences for this information. WHAT THIS PAPER ADDS Fewer than half of caregivers of children with cerebral palsy (CP) know their child's Gross Motor Function Classification System level. Most want to know how their child's function compares to other children with CP. The majority of caregivers would like to revisit the topic over time. Caregivers want to discuss gross motor information with the therapist and doctor.
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Affiliation(s)
- Amy F Bailes
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mary Gannotti
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Danielle M Bellows
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA.,Connecticut Children's Medical Center, Hartford, CT, USA
| | | | | | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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Pache DM, Hollingworth SA, van Driel ML, McGuire TM. Does consumer medicines interest reflect medicines use? An observational study comparing medicines call center queries with medicines use. Res Social Adm Pharm 2018; 15:440-447. [PMID: 29935855 DOI: 10.1016/j.sapharm.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/08/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Consumers have questions about their medication but the nature of these concerns and how they reflect medication use is unknown. OBJECTIVES To determine the characteristics and medicines interests of callers to an Australian medicines call center and whether the medicines interest of callers corresponds with medicines utilization. METHODS Data from consumers who contacted a national medicines call center between September 2002 and June 2010 were analyzed. Patterns of consumer medicines interest were described. Medicines were class-matched by Anatomical Therapeutic Classification, and compared with dispensed use (January 2006-June 2010). RESULTS In total 125,951 calls were received between 2002 and 2010. Callers were mainly female (76.8%), median age 48 years, calling for themselves (71.7%). Motivation to call related to safety (34.7%), efficacy (24.1%) and interactions (14.9%). For the comparison with medicines utilization, 85,416 calls with 124,177 individual medicine counts were analyzed (2006 and 2010). There were 976 unique 'medicines of interest'. Half (49.4%) of these questions involved just fifty unique medicines. Nervous system medicines (antiepileptics, psycholeptics, analgesics) and antibacterials consistently ranked highest for interest compared with use. Conversely, agents acting on the renin-angiotensin system, statins and drugs for acid related disorders ranked low for interest despite widespread use. CONCLUSIONS Consumer questions about medicines correlate poorly with overall medicines utilization. To promote quality health outcomes, clinicians should target their education to the relatively small number of medicines of real concern to patients.
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Affiliation(s)
- David M Pache
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Mater Pharmacy Services, Mater Health Services, South Brisbane, QLD, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
| | | | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Mater Pharmacy Services, Mater Health Services, South Brisbane, QLD, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
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Wentlandt K, Weiss A, O'Connor E, Kaya E. Palliative and end of life care in solid organ transplantation. Am J Transplant 2017; 17:3008-3019. [PMID: 28976070 DOI: 10.1111/ajt.14522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
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Affiliation(s)
- K Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - E O'Connor
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Cuevas HE, Brown SA. Self-Management Decision Making of Cuban Americans With Type 2 Diabetes. J Transcult Nurs 2017; 29:222-228. [PMID: 28826301 DOI: 10.1177/1043659617696977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Although researchers have studied how individuals manage type 2 diabetes, none have examined how Cuban Americans do so. This article explores how Cuban Americans make self-management choices and examines whether an empowerment framework is viable for informing interventions. DESIGN A qualitative descriptive study was conducted ( n = 20) with Cuban Americans with type 2 diabetes. Individual interviews were analyzed with content analysis. RESULTS Motivation and temporal factors, such as knowledge of symptoms and the ability to plan ahead, positively affect self-management. Cultural factors, such as access to cultural foods, negatively affect self-management. Empowerment formed a comprehensive lens through which self-management decisions were acted on. CONCLUSION Given the cultural context, empowerment and unique barriers and facilitators can affect diabetes self-management in this population. Strategies to promote healthy decisions must take into account the strengths of this community as well as its challenges.
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Serrano V, Rodriguez-Gutierrez R, Hargraves I, Gionfriddo MR, Tamhane S, Montori VM. Shared decision-making in the care of individuals with diabetes. Diabet Med 2016; 33:742-51. [PMID: 27105298 DOI: 10.1111/dme.13143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
Abstract
People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes. The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.
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Affiliation(s)
- V Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Nutrition, Diabetes and Metabolism, Pontifical Catholic University of Chile, Santiago, Chile
| | - R Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital 'Dr. Jose E. Gonzalez', Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - I Hargraves
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - S Tamhane
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - V M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Avent ML, Hansen MP, Gilks C, Del Mar C, Halton K, Sidjabat H, Hall L, Dobson A, Paterson DL, van Driel ML. General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial. BMC FAMILY PRACTICE 2016; 17:48. [PMID: 27098971 PMCID: PMC4839086 DOI: 10.1186/s12875-016-0446-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/14/2016] [Indexed: 12/13/2022]
Abstract
Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation. Trial registration The GAPS trial is registered under the Australian New Zealand Clinical Trials Register, reference number: ACTRN12615001128583 (registered 26/10/2015).
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Affiliation(s)
- Minyon L Avent
- The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia. .,The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4006, Australia.
| | - Malene Plejdrup Hansen
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia
| | - Charles Gilks
- The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia
| | - Chris Del Mar
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Hanna Sidjabat
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4006, Australia
| | - Lisa Hall
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Annette Dobson
- The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, 4006, Australia
| | - Mieke L van Driel
- The University of Queensland, Discipline of General Practice, School of Medicine, Herston, QLD, 4006, Australia
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Tong A, Brown MA, Winkelmayer WC, Craig JC, Jesudason S. Perspectives on Pregnancy in Women With CKD: A Semistructured Interview Study. Am J Kidney Dis 2015; 66:951-61. [PMID: 26452499 DOI: 10.1053/j.ajkd.2015.08.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/06/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Women with chronic kidney disease (CKD) often have difficulty achieving pregnancy and are at increased risk for adverse pregnancy outcomes. Given the medical, ethical, and emotional complexities of pregnancy in CKD, the clinical approach should involve explicit consideration of women's values, for which there are sparse data. This study aims to describe the beliefs, values, and experiences of pregnancy in women with CKD to inform prepregnancy counseling and pregnancy care. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 41 women (95% response rate) aged 22 to 56 years with CKD stages 3 to 5 (n=5), receiving dialysis (n=5), or received a kidney transplant (n=31) from 2 renal units in Australia. METHODOLOGY Semistructured interviews. ANALYTICAL APPROACH Transcripts were analyzed thematically. RESULTS 6 themes were identified: bodily failure (conscious of fragility, noxious self, critical timing, and suspended in limbo), devastating loss (denied motherhood, disempowered by medical catastrophizing, resolving grief, barriers to parenthood alternatives, and social jealousy), intransigent guilt (disappointing partners, fear of genetic transmission, respecting donor sacrifice, and medical judgment), rationalizing consequential risks (choosing survival, avoiding fetal harm, responding to family protectiveness, compromising health, decisional ownership, and unjustifiable gamble), strengthening resolve (hope and opportunity, medical assurance, resolute determination, and reticent hope), and reorientating focus (valuing life and gratitude in hindsight). LIMITATIONS Only English-speaking women were recruited, which may limit transferability of the findings. CONCLUSIONS Decisions surrounding pregnancy in the context of CKD require women to confront uncertainties about their own survival, disease progression, guilt toward their family and kidney donor, the outcomes of their offspring, and genetic transmission. Communicating the medical risks of pregnancy to women with CKD must be carefully balanced with their values of autonomy, hope, security, and family. Informed and shared decision making that addresses women's priorities as identified in this study may help contribute to improved pregnancy, health, and psychosocial outcomes in this vulnerable population.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
| | - Mark A Brown
- Department of Renal Medicine, St. George Hospital and University of NSW, Kogarah, Sydney, NSW, Australia
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Shilpanjali Jesudason
- Centre for Clinical and Experimental Transplantation, Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
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