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Valentine KD, Leavitt L, Sepucha KR, Atlas SJ, Simmons L, Siegel L, Richter JM, Han PKJ. Uncertainty tolerance among primary care physicians: Relationship to shared decision making-related perceptions, practices, and physician characteristics. Patient Educ Couns 2024; 123:108232. [PMID: 38458091 PMCID: PMC10997439 DOI: 10.1016/j.pec.2024.108232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Understand how physicians' uncertainty tolerance (UT) in clinical care relates to their personal characteristics, perceptions and practices regarding shared decision making (SDM). METHODS As part of a trial of SDM training about colorectal cancer screening, primary care physicians (n = 67) completed measures of their uncertainty tolerance in medical practice (Anxiety subscale of the Physician's Reactions to Uncertainty Scale, PRUS-A), and their SDM self-efficacy (confidence in SDM skills). Patients (N = 466) completed measures of SDM (SDM Process scale) after a clinical visit. Bivariate regression analyses and multilevel regression analyses examined relationships. RESULTS Higher UT was associated with greater physician age (p = .01) and years in practice (p = 0.015), but not sex or race. Higher UT was associated with greater SDM self-efficacy (p < 0.001), but not patient-reported SDM. CONCLUSION Greater age and practice experience predict greater physician UT, suggesting that UT might be improved through training, while UT is associated with greater confidence in SDM, suggesting that improving UT might improve SDM. However, UT was unassociated with patient-reported SDM, raising the need for further studies of these relationships. PRACTICE IMPLICATIONS Developing and implementing training interventions aimed at increasing physician UT may be a promising way to promote SDM in clinical care.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Leigh Simmons
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lydia Siegel
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James M Richter
- Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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Valentine KD, Lipstein EA, Vo H, Cosenza C, Barry MJ, Mancini B, Brinkman WB, Sepucha K. Measure of Caregiver Attention-Deficit/Hyperactivity Disorder Knowledge Is Responsive to Decision Aid on Treatment for Attention-Deficit/Hyperactivity Disorder. Acad Pediatr 2024; 24:417-423. [PMID: 37536452 DOI: 10.1016/j.acap.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Adapt and test a measure of knowledge for caregivers of children with attention-deficit/hyperactivity disorder (ADHD) and evaluate the impact of the information component of a decision aid (DA) on participant knowledge. METHODS A set of seven knowledge items were created based on prior knowledge measures and clinical guidelines. As part of a larger cross-sectional survey study of caregivers of children diagnosed with ADHD, caregivers were randomized to one of two arms: 1) a DA arm, where participants reviewed the information component of the Cincinnati Children's Hospital's DA, and 2) a control arm, where participants were not shown a DA. All participants completed the seven knowledge items. Knowledge items were assessed for difficulty, quality of distractors, acceptability, and redundancy. Total knowledge scores (0-100) for the DA and control arm were compared. RESULTS Caregivers were assigned to the DA arm (n = 243) or the control arm (n = 260). All 7 knowledge items were retained as no items were too difficult or too easy, all response options were used, there were little missing data, and no items were redundant. The overall knowledge score was normally distributed, and almost covered the full range of scores (5-100). Those who received the DA component had higher knowledge scores (M=68, SD=23) than those who did not receive the DA component (M=60, SD=19, P < .01, d=0.4). CONCLUSIONS The Caregiver ADHD Knowledge (CAKe) measure was acceptable and demonstrated construct validity as those who were assigned to review the DA component demonstrated greater knowledge than those who were not assigned to review the DA component.
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Affiliation(s)
- Kathrene Diane Valentine
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass.
| | - Ellen A Lipstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (EA Lipstein and WB Brinkman), Cincinnati, Ohio; Department of Pediatrics (EA Lipstein and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ha Vo
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston
| | - Carol Cosenza
- Center for Survey Research (C Cosenza), University of Massachusetts Boston
| | - Michael J Barry
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass
| | - Brittney Mancini
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston
| | - William B Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (EA Lipstein and WB Brinkman), Cincinnati, Ohio; Department of Pediatrics (EA Lipstein and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen Sepucha
- Department of General Internal Medicine, Massachusetts General Hospital (KD Valentine, H Vo, MJ Barry, B Mancini, and K Sepucha), Boston; Department of Medicine, Harvard Medical School (KD Valentine, MJ Barry, and K Sepucha), Boston, Mass
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Gore Moses R, Nieters A, Valentine KD, Wooters M, Wynn J, Wardyn A, Amendola L, Sepucha KR, Shannon KM. Performance of the shared decision-making process scale for use in evaluation of hereditary cancer genetic testing decisions. J Genet Couns 2023; 32:957-964. [PMID: 37069832 DOI: 10.1002/jgc4.1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/18/2023] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
This study aimed to evaluate feasibility, acceptability, reliability, and validity of the existing four-item Shared Decision Making (SDM) Process Scale for use in evaluating genetic testing decisions. Patients from a large hereditary cancer genetics practice were invited to participate in a two-part survey after completing pre-test genetic counseling. The online survey included the SDM Process Scale and the SURE scale, a measure of decisional conflict. SDM Process scores were compared to SURE scores to test convergent validity, and respondents were sent a second survey 1 week later to assess retest reliability. The response rate was 65% (n = 259/398) and missing data was low (<1%). SDM scores ranged from zero to four with a mean of 2.3 (SD = 1.1). Retest reliability was good, with intraclass correlation of 0.84, 95% confidence interval (0.79, 0.88). No relationship was found between SDM Process scores and decisional conflict (p = 0.46), likely because 85% of participants reported no decisional conflict. The four-item SDM Process Scale demonstrated feasibility, acceptability, and retest reliability, but not convergent validity with decisional conflict. These findings provide initial evidence for use of this scale to measure patient perceptions of SDM in pre-test counseling for hereditary cancer genetic testing.
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Affiliation(s)
- Rachel Gore Moses
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda Nieters
- Massachusetts General Hospital Center for Cancer Risk Assessment, Boston, Massachusetts, USA
| | - K D Valentine
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mackenzie Wooters
- Massachusetts General Hospital Center for Cancer Risk Assessment, Boston, Massachusetts, USA
| | - Julia Wynn
- Billion to One, Inc., Menlo Park, California, USA
| | - Amy Wardyn
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | | | - Karen R Sepucha
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen M Shannon
- Massachusetts General Hospital Center for Cancer Risk Assessment, Boston, Massachusetts, USA
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Valentine KD, Shaffer VA, Hauber B. Eliciting preferences for cancer screening tests: Comparison of a discrete choice experiment and the threshold technique. Patient Educ Couns 2023; 115:107898. [PMID: 37467593 DOI: 10.1016/j.pec.2023.107898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare results of three preference elicitation methods for a cancer screening test. METHODS Participants (undergraduate students) completed a discrete choice experiment (DCE) and a threshold technique (TT) task. Accuracy (false positives, false negatives), benefits (lives saved), and cost for a cancer screening test were used as attributes in the DCE and branching logic for the TT. Participants were also asked a direct elicitation question regarding a hypothetical screening test for breast (women) or prostate (men) cancer without mortality benefit. Correlations assessed the relationship between DCE and TT thresholds. Thresholds were standardized and ranked for both methods to compare. A logistic regression used the thresholds to predict results of the direct elicitation. RESULTS DCE and TT estimates were not meaningfully correlated (max ρ = 0.17). Participant rankings of attributes matched only 20% of the time (58/292). Neither method predicted preference for being screened (ps > 0.21). CONCLUSIONS The DCE and TT yielded different preference estimates (and rank orderings) for the same participant. Neither method predicted patients' desires for a screening test. PRACTICE IMPLICATIONS Clinicians, patients, policy makers, and researchers should be aware that patient preference results may be sensitive to the method of eliciting preferences.
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Affiliation(s)
- K D Valentine
- Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | | | - Brett Hauber
- Pfizer, Inc., New York, NY 10017, USA; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA 98107, USA
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Valentine KD, Vo H, Mancini B, Urman RD, Arias F, Barry MJ, Sepucha KR. Shared Decision Making for Elective Surgical Procedures in Older Adults with and without Cognitive Insufficiencies. Med Decis Making 2023; 43:656-666. [PMID: 37427547 PMCID: PMC10526885 DOI: 10.1177/0272989x231182436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE Older adults are prone to cognitive impairment, which may affect their ability to engage in aspects of shared decision making (SDM) and their ability to complete surveys about the SDM process. This study examined the surgical decision-making processes of older adults with and without cognitive insufficiencies and evaluated the psychometric properties of the SDM Process scale. METHODS Eligible patients were 65 y or older and scheduled for a preoperative appointment before elective surgery (e.g., arthroplasty). One week before the visit, staff contacted patients via phone to administer the baseline survey, including the SDM Process scale (range 0-4), SURE scale (top scored), and the Montreal Cognitive Assessment Test version 8.1 BLIND English (MoCA-blind; score range 0-22; scores < 19 indicate cognitive insufficiency). Patients completed a follow-up survey 3 mo after their visit to assess decision regret (top scored) and retest reliability for the SDM Process scale. RESULTS Twenty-six percent (127/488) of eligible patients completed the survey; 121 were included in the analytic data set, and 85 provided sufficient follow-up data. Forty percent of patients (n = 49/121) had MoCA-blind scores indicating cognitive insufficiencies. Overall SDM Process scores did not differ by cognitive status (intact cognition x ¯ = 2.5, s = 1.0 v. cognitive insufficiencies x ¯ = 2.5, s = 1.0; P = 0.80). SURE top scores were similar across groups (83% intact cognition v. 90% cognitive insufficiencies; P = 0.43). While patients with intact cognition had less regret, the difference was not statistically significant (92% intact cognition v. 79% cognitive insufficiencies; P = 0.10). SDM Process scores had low missing data and good retest reliability (intraclass correlation coefficient = 0.7). CONCLUSIONS Reported SDM, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The SDM Process scale was an acceptable, reliable, and valid measure of SDM in patients with and without cognitive insufficiencies. HIGHLIGHTS Forty percent of patients 65 y or older who were scheduled for elective surgery had scores indicative of cognitive insufficiencies.Patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies.The Shared Decision Making Process scale was an acceptable, reliable, and valid measure of shared decision making in patients with and without cognitive insufficiencies.
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Affiliation(s)
- K D Valentine
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ha Vo
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Franchesca Arias
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael J Barry
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Vo H, Valentine KD, Barry MJ, Sepucha KR. Evaluation of the shared decision-making process scale in cancer screening and medication decisions. Patient Educ Couns 2023; 108:107617. [PMID: 36593166 DOI: 10.1016/j.pec.2022.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Examine reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. METHODS Secondary data analysis from 6174 participants who made decisions about cancer screening (breast, colon or prostate) or medication (menopause, depression, hypertension or high cholesterol). Key measures included the SDM Process scale, decisional conflict, decision regret, and decision quality. Construct validity was examined by testing whether higher SDM Process scores were associated with lower regret, lower decisional conflict and higher decision quality. Meta-analyses summarized data across studies. Some studies assessed the scale's reliability. RESULTS Average SDM Process scores ranged from 1.2 to 2.5. There was a moderate-to-large, positive association between scores and lack of decisional conflict (cancer screening: d=0.61, CI(0.38, 0.84), p < .001; medications: d=0.36, CI(0.29, 0.44), p < .001). High scores were associated with lower decision regret (cancer screening: d=-0.24, CI(-0.37, -0.11), p < .001; medications: d=-0.30, CI(-0.40,-0.20), p < .001). There was no relationship with decision quality. Retest reliability was acceptable (ICC>0.7) for seven of eight clinical samples. CONCLUSIONS The SDM Process scale demonstrated construct validity and retest reliability in cancer screening and medication decisions. PRACTICE IMPLICATIONS The validated SDM Process scale is a short, patient reported metric to evaluate the current state of SDM.
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Affiliation(s)
- Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Sepucha K, Han PKJ, Chang Y, Atlas SJ, Korsen N, Leavitt L, Lee V, Percac-Lima S, Mancini B, Richter J, Scharnetzki E, Siegel LC, Valentine KD, Fairfield KM, Simmons LH. Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED Study): a Physician Cluster Randomized Trial. J Gen Intern Med 2023; 38:406-413. [PMID: 35931908 PMCID: PMC9362387 DOI: 10.1007/s11606-022-07738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND For adults aged 76-85, guidelines recommend individualizing decision-making about whether to continue colorectal cancer (CRC) testing. These conversations can be challenging as they need to consider a patient's CRC risk, life expectancy, and preferences. OBJECTIVE To promote shared decision-making (SDM) for CRC testing decisions for older adults. DESIGN Two-arm, multi-site cluster randomized trial, assigning physicians to Intervention and Comparator arms. Patients were surveyed shortly after the visit to assess outcomes. Analyses were intention-to-treat. PARTICIPANTS AND SETTING Primary care physicians affiliated with 5 academic and community hospital networks and their patients aged 76-85 who were due for CRC testing and had a visit during the study period. INTERVENTIONS Intervention arm physicians completed a 2-h online course in SDM communication skills and received an electronic reminder of patients eligible for CRC testing shortly before the visit. Comparator arm received reminders only. MAIN MEASURES The primary outcome was patient-reported SDM Process score (range 0-4 with higher scores indicating more SDM); secondary outcomes included patient-reported discussion of CRC screening, knowledge, intention, and satisfaction with the visit. KEY RESULTS Sixty-seven physicians (Intervention n=34 and Comparator n=33) enrolled. Patient participants (n=466) were on average 79 years old, 50% with excellent or very good self-rated overall health, and 66% had one or more prior colonoscopies. Patients in the Intervention arm had higher SDM Process scores (adjusted mean difference 0.36 (95%CI (0.08, 0.64), p=0.01) than in the Comparator arm. More patients in the Intervention arm reported discussing CRC screening during the visit (72% vs. 60%, p=0.03) and had higher intention to follow through with their preferred approach (58.0% vs. 47.1, p=0.03). Knowledge scores and visit satisfaction did not differ significantly between arms. CONCLUSION Physician training plus reminders were effective in increasing SDM and frequency of CRC testing discussions in an age group where SDM is essential. TRIAL REGISTRATION The trial is registered on clinicaltrials.gov (NCT03959696).
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Affiliation(s)
- Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Paul K J Han
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Neil Korsen
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - Vivian Lee
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brittney Mancini
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
| | - James Richter
- Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Scharnetzki
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Lydia C Siegel
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kathleen M Fairfield
- Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA
| | - Leigh H Simmons
- Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Valentine KD, Brodney S, Sepucha K, Barry MJ. Predictors of Informed People's Preferences for Statin Therapy to Reduce Cardiovascular Disease Risk: an Internet Survey Study. J Gen Intern Med 2023; 38:36-41. [PMID: 35230620 PMCID: PMC9849500 DOI: 10.1007/s11606-022-07440-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/25/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Guidelines suggest clinicians inform patients about their 10-year cardiovascular disease (CVD) risk; however, little is known about how the risk estimate influences patients' preferences for statin therapy for primary prevention. OBJECTIVE To define predictors of preference for statin therapy after participants were informed about their individualized benefits and harms. DESIGN Cross-sectional survey in 2020. SETTING Online US survey panel. PARTICIPANTS A national sample of 304 respondents aged 40 to 75 who had not previously taken a statin and who knew their cholesterol levels and blood pressure measurements. INTERVENTION Participants entered their risk factors into a calculator which estimated their 10-year CVD risk. They were then provided with an estimate of their absolute risk reduction with a statin and the chance of side effects from meta-analyses. MAIN MEASUREMENTS We used a hierarchical model to predict participants' preferences for statin therapy according to their 10-year CVD risk, perceptions of the magnitude of statin benefit (large, medium, small, or almost no benefit), worry about side effects (very worried, somewhat worried, a little worried, not worried at all), and other variables. KEY RESULTS Participants had a mean age of 55 years (SD = 9.9); 50% were female, 44% were non-white, and 16% had a high school degree or less education. After reviewing their benefits and side effects, 45% of the participants reported they probably or definitely wanted to take a statin. In the full hierarchical model, only perceived benefits of taking a statin was a significant independent predictor of wanting a statin (OR 7.3, 95% CI 4.7, 12.2). LIMITATIONS Participants were from an internet survey panel and making hypothetical decisions. CONCLUSIONS Participants' perceptions of their benefit from statin therapy predicted wanting to take a statin for primary prevention; neither estimated CVD risk nor worries about statin side effects were independent predictors.
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Affiliation(s)
- K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, USA
| | - Suzanne Brodney
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, USA
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, USA
| | - Michael J Barry
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, USA.
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA.
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Valentine KD, Lipstein EA, Vo H, Cosenza C, Barry MJ, Sepucha K. Pediatric Caregiver Version of the Shared Decision Making Process Scale: Validity and Reliability for ADHD Treatment Decisions. Acad Pediatr 2022; 22:1503-1509. [PMID: 35907446 DOI: 10.1016/j.acap.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended for common pediatric conditions; however, there are limited data on measures of SDM in pediatrics. This study adapted the SDM Process scale and examined validity and reliability of the scale for attention-deficit/hyperactivity disorder (ADHD) treatment decisions. METHODS Cross-sectional survey of caregivers (n = 498) of children (aged 5-13) diagnosed with ADHD, who had made a decision about ADHD medication in the last 2 years. Surveys included the adapted SDM Process scale (scores range 0-4, higher scores indicate more SDM), decisional conflict, decision regret, and decision involvement. Validity was assessed by testing hypothesized relationships between these constructs. A subset of participants was surveyed a week later to assess retest reliability. RESULTS Pediatric Caregiver version of the SDM Process scale (M = 2.8, SD = 1.05) showed no evidence of floor or ceiling effects. The scale was found to be acceptable (<1% missing data) and reliable (intraclass correlation coefficient = 0.74). Scores demonstrated convergent validity, as they were higher for those without decisional conflict than those with decisional conflict (2.93 vs 2.46, P < .001, d = 0.46), and higher for caregivers who stated they made the decision with the provider than those who made the decision themselves (3.0 vs 2.7; P = .003). Higher scores were related to less regret (r = -0.15, P < .001), though the magnitude of the relationship was small. CONCLUSIONS The adapted Pediatric Caregiver version of the SDM Process scale demonstrated acceptability, validity and reliability in the context of ADHD medication decisions made by caregivers of children 5-13. Scores indicate pediatricians generally involve caregivers in decision making about ADHD medication.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine (KD Valentine, H Vo, MJ Barry, and K Sepucha), Massachusetts General Hospital, Boston; Harvard Medical School (KD Valentine and K Sepucha), Boston, Mass.
| | - Ellen A Lipstein
- James M. Anderson Center for Healthy Systems Excellence (EA Lipstein), Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics (EA Lipstein), University of Cincinnati College of Medicine, Ohio
| | - Ha Vo
- Division of General Internal Medicine (KD Valentine, H Vo, MJ Barry, and K Sepucha), Massachusetts General Hospital, Boston
| | - Carol Cosenza
- Center for Survey Research (Carol Cosenza), University of Massachusetts, Boston
| | - Michael J Barry
- Division of General Internal Medicine (KD Valentine, H Vo, MJ Barry, and K Sepucha), Massachusetts General Hospital, Boston
| | - Karen Sepucha
- Division of General Internal Medicine (KD Valentine, H Vo, MJ Barry, and K Sepucha), Massachusetts General Hospital, Boston; Harvard Medical School (KD Valentine and K Sepucha), Boston, Mass
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Brodney S, Valentine KD, Vo HA, Cosenza C, Barry MJ, Sepucha KR. Measuring shared decision-making in younger and older adults with depression. Int J Qual Health Care 2022; 34:6717540. [PMID: 36161492 DOI: 10.1093/intqhc/mzac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study examined the performance of the shared decision-making (SDM) Process scale in patients with depression, compared alternative wording of two items in the scale and explored performance in younger adults. METHODS A web-based non-probability panel of respondents with depression aged 18-39 (younger) or 40-75 (older) who talked with a health-care provider about starting or stopping treatment for depression in the past year were surveyed. Respondents completed one of two versions of the SDM Process scale that differed in the wording of pros and cons items and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider or together). A subset of respondents completed a retest survey by 1 week. We examined how version and age group impacted SDM Process scores and calculated construct validity and retest reliability. We hypothesized that patients with higher SDM Process scores would show less decisional conflict using the SURE scale (range = 0-4); top score = no conflict versus other and less regret (range 1-4; higher scores indicated more regret). RESULTS The sample (N = 494) was majority White, non-Hispanic (82%) and female (72%), 48% were younger and 23% had a high school education or less. SDM Process scores did not differ by version (P = 0.09). SDM Process scores were higher for younger respondents (M = 2.6, SD = 1.0) than older respondents (M = 2.3, SD = 1.1; P = 0.001). Higher SDM Process scores were also associated with no decisional conflict (M = 2.6, SD = 0.99 vs. M = 2.1, SD = 1.2; P < 0.001) and less decision regret (r = -0.18, P < 0.001). Retest reliability was intraclass correlation coefficient = 0.81. CONCLUSIONS The SDM Process scale demonstrated validity and retest reliability in younger adults, and changes to item wording did not impact scores. Although younger respondents reported more SDM, there is room for improvement in SDM for depression treatment decisions.
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Affiliation(s)
- Suzanne Brodney
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - H A Vo
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts, Boston - 100 Morrissey Blvd, Boston, MA 02125, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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11
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Shaffer VA, Wegier P, Valentine KD, Duan S, Canfield SM, Belden JL, Steege LM, Popescu M, Koopman RJ. Patient judgments about hypertension control: the role of patient numeracy and graph literacy. J Am Med Inform Assoc 2022; 29:1829-1837. [PMID: 35927964 PMCID: PMC9552283 DOI: 10.1093/jamia/ocac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the impact of patient health literacy, numeracy, and graph literacy on perceptions of hypertension control using different forms of data visualization. MATERIALS AND METHODS Participants (Internet sample of 1079 patients with hypertension) reviewed 12 brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure (BP) data. We examined how variations in mean systolic blood pressure, BP standard deviation, and form of visualization (eg, data table, graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change. We also measured patient's health literacy, subjective and objective numeracy, and graph literacy. RESULTS Judgments about hypertension data presented as a smoothed graph were significantly more positive (ie, hypertension deemed to be better controlled) then judgments about the same data presented as either a data table or an unsmoothed graph. Hypertension data viewed in tabular form was perceived more positively than graphs of the raw data. Data visualization had the greatest impact on participants with high graph literacy. DISCUSSION Data visualization can direct patients to attend to more clinically meaningful information, thereby improving their judgments of hypertension control. However, patients with lower graph literacy may still have difficulty accessing important information from data visualizations. CONCLUSION Addressing uncertainty inherent in the variability between BP measurements is an important consideration in visualization design. Well-designed data visualization could help to alleviate clinical uncertainty, one of the key drivers of clinical inertia and uncontrolled hypertension.
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Affiliation(s)
- Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Pete Wegier
- Institute of Health Policy, Management, and Evaluation, Humber River Hospital & University of Toronto, Toronto, Ontario, Canada
| | - K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sean Duan
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Shannon M Canfield
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jeffery L Belden
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mihail Popescu
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
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12
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Valentine KD, Scherer LD. Interpersonal (mis)perceptions and (mis)predictions in patient-clinician interactions. Curr Opin Psychol 2022; 43:244-248. [PMID: 34461604 PMCID: PMC8801540 DOI: 10.1016/j.copsyc.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
Patient-clinician interactions require an interpersonal exchange of information, preferences, expectations, values, and priorities. Given the brief interaction patients and clinicians are allowed, many barriers to effective communication exist, resulting in patients and clinicians leaving an interaction with discordant perceptions of what has occurred and what is to come. We review literature on concordance and lack thereof, between patient and clinician perceptions, reasons why discordance may occur, how to decrease discordance as well as how dischordance impacts patient care and outcomes.
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Affiliation(s)
- KD Valentine
- Massachusetts General Hospital,Harvard Medical School
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13
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Fowler FJ, Sepucha KR, Stringfellow V, Valentine KD. Validation of the SDM Process Scale to Evaluate Shared Decision-Making at Clinical Sites. J Patient Exp 2021; 8:23743735211060811. [PMID: 34869847 PMCID: PMC8640277 DOI: 10.1177/23743735211060811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Shared Decision-Making (SDM) Process scale (scored 0-4) uses 4 questions about decision-making behaviors: discussion of options, pros, cons, and preferences. We use data from mail surveys of patients who made surgical decisions at 9 clinical sites and a national web survey to assess the reliability and validity of the measure to assess shared decision-making at clinical sites. Patients at sites using decision aids to promote shared decision-making for hip, knee, back, or breast cancer surgery had significantly higher scores than national cross-section samples of surgical patients for 3 of 4 comparisons and significantly higher scores for both comparisons with “usual care sites.” Reliability was supported by an intra-class correlation at the clinical site level of 0.93 and an average correlation of SDM scores for knee and hip surgery patients treated at the same sites of 0.56. The results document the reliability and validity of the measure to assess the degree of shared decision-making for surgical decisions at clinical sites.
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Affiliation(s)
- Floyd J Fowler
- Center for Survey Research, University of Massachusetts Boston, Boston, USA
| | - Karen R Sepucha
- Harvard University School of Medicine, Cambridge, MA, USA.,Health Decisions Sciences Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - K D Valentine
- Health Decisions Sciences Center, Massachusetts General Hospital, Boston, MA, USA
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14
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Valentine KD, Cha T, Giardina JC, Marques F, Atlas SJ, Bedair H, Chen AF, Doorly T, Kang J, Leavitt L, Licurse A, O'Brien T, Sequist T, Sepucha K. Assessing the quality of shared decision making for elective orthopedic surgery across a large healthcare system: cross-sectional survey study. BMC Musculoskelet Disord 2021; 22:967. [PMID: 34798866 PMCID: PMC8605511 DOI: 10.1186/s12891-021-04853-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals. Methods A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected. Patients were mailed a survey including measures of Shared Decision Making (SDMP scale) and Informed, Patient-Centered (IPC) decisions. We examined decision-making across sites, surgeons, and conditions, and whether the decision-making measures were associated with better health outcomes. Analyses were adjusted for clustering of patients within surgeons. Results Six hundred forty-six surveys (74% response rate) were returned with sufficient responses for analysis. Patients who had TJR reported lower SDMP scores than patients who had spine surgery (2.2 vs. 2.8; p < 0.001). Patients who had TJR were more likely to make IPC decisions (OA = 70%, Spine = 41%; p < 0.001). SDMP and IPC scores varied widely across surgeons, but the site was not predictive of SDMP scores or IPC decisions (all p > 0.09). Higher SDMP scores and IPC decisions were associated with larger improvements in global health outcomes for patients who had TJR, but not patients who had spine surgery. Conclusions Measures of shared decision making and decision quality varied among patients undergoing common elective orthopedic procedures. Routine measurement of shared decision making provides insight into areas of strength across these different orthopedic conditions as well as areas in need of improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04853-x.
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Affiliation(s)
- K D Valentine
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA. .,Harvard Medical School (HMS), Boston, MA, USA.
| | - Tom Cha
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.,Harvard Medical School (HMS), Boston, MA, USA
| | | | - Felisha Marques
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
| | - Steven J Atlas
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.,Harvard Medical School (HMS), Boston, MA, USA
| | - Hany Bedair
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.,North Shore Medical Center, MA, Salem, USA
| | - Antonia F Chen
- Harvard Medical School (HMS), Boston, MA, USA.,Newton Wellesley Hospital, MA, Newton, USA
| | | | - James Kang
- Harvard Medical School (HMS), Boston, MA, USA.,Newton Wellesley Hospital, MA, Newton, USA
| | - Lauren Leavitt
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
| | - Adam Licurse
- Harvard Medical School (HMS), Boston, MA, USA.,Newton Wellesley Hospital, MA, Newton, USA
| | - Todd O'Brien
- Harvard Medical School (HMS), Boston, MA, USA.,Brigham and Women's Hospital (BWH), MA, Boston, USA
| | - Thomas Sequist
- Harvard Medical School (HMS), Boston, MA, USA.,Department of Quality and Patient Experience, Mass General Brigham Health System, Boston, MA, USA
| | - Karen Sepucha
- Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.,Harvard Medical School (HMS), Boston, MA, USA
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15
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Van den Akker OR, Weston S, Campbell L, Chopik B, Damian R, Davis-Kean P, Hall A, Kosie J, Kruse E, Olsen J, Ritchie S, Valentine KD, Van 't Veer A, Bakker M. Preregistration of secondary data analysis: A template and tutorial. MP 2021. [DOI: 10.15626/mp.2020.2625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Preregistration has been lauded as one of the solutions to the so-called ‘crisis of confidence’ in the social sciences and has therefore gained popularity in recent years. However, the current guidelines for preregistration have been developed primarily for studies where new data will be collected. Yet, preregistering secondary data analyses--- where new analyses are proposed for existing data---is just as important, given that researchers’ hypotheses and analyses may be biased by their prior knowledge of the data. The need for proper guidance in this area is especially desirable now that data is increasingly shared publicly. In this tutorial, we present a template specifically designed for the preregistration of secondary data analyses and provide comments and a worked example that may help with using the template effectively. Through this illustration, we show that completing such a template is feasible, helps limit researcher degrees of freedom, and may make researchers more deliberate in their data selection and analysis efforts.
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16
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Wegier P, Belden JL, Canfield SM, Shaffer VA, Patil SJ, LeFevre ML, Valentine KD, Popescu M, Steege LM, Jain A, Koopman RJ. Home blood pressure data visualization for the management of hypertension: using human factors and design principles. BMC Med Inform Decis Mak 2021; 21:235. [PMID: 34353322 PMCID: PMC8340525 DOI: 10.1186/s12911-021-01598-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/28/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension. METHODS We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States. RESULTS A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements. CONCLUSIONS We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension.
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Affiliation(s)
- Pete Wegier
- Humber River Hospital, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Jeffery L Belden
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Shannon M Canfield
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Sonal J Patil
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Michael L LeFevre
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mihail Popescu
- Department of Health Management and Informatics, University of Missouri-Columbia, Columbia, MO, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Akshay Jain
- Department of Electrical and Computer Engineering, University of Missouri-Columbia, Columbia, MO, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
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17
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Valentine KD, Mancini B, Vo H, Brodney S, Cosenza C, Barry MJ, Sepucha KR. Using Standardized Videos to Examine the Validity of the Shared Decision Making Process Scale: Results of a Randomized Online Experiment. Med Decis Making 2021; 42:105-113. [PMID: 34344233 DOI: 10.1177/0272989x211029267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Shared Decision Making (SDM) Process scale is a brief, patient-reported measure of SDM with demonstrated validity in surgical decision making studies. Herein we examine the validity of the scores in assessing SDM for cancer screening and medication decisions through standardized videos of good-quality and poor-quality SDM consultations. METHOD An online sample was randomized to a clinical decision-colon cancer screening or high cholesterol-and a viewing order-good-quality video first or poor-quality video first. Participants watched both videos, completing a survey after each video. Surveys included the SDM Process scale and the 9-item SDM Questionnaire (SDM-Q-9); higher scores indicated greater SDM. Multilevel linear regressions identified if video, order, or their interaction predicted SDM Process scores. To identify how the SDM Process score classified videos, area under the curve (AUC) was calculated. The correlation between SDM Process score and SDM-Q-9 assessed construct validity. Heterogeneity analyses were conducted. RESULTS In the sample of 388 participants (68% white, 70% female, average age 45 years) good-quality videos received higher SDM Process scores than poor-quality videos (Ps < 0.001), and those who viewed the good-quality high cholesterol video first tended to rate the videos higher. SDM Process scores were related to SDM-Q-9 scores (rs > 0.58; Ps < 0.001). AUC was poor (0.69) for the high cholesterol model and fair (0.79) for the colorectal cancer model. Heterogeneity analyses suggested individual differences were predictive of SDM Process scores. CONCLUSION SDM Process scores showed good evidence of validity in a hypothetical scenario but were lacking in ability to classify good-quality or poor-quality videos accurately. Considerable heterogeneity of scoring existed, suggesting that individual differences played a role in evaluating good- or poor-quality SDM conversations.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Brittney Mancini
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne Brodney
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts, Boston, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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18
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Valentine KD, Brodney S, Vo H, Sepucha K, Fowler FJ, Barry MJ. Validation of the Impact Index: can we measure disease effects on quality of life in patients with hip and knee osteoarthritis? Qual Life Res 2021; 30:1191-1198. [PMID: 33387288 DOI: 10.1007/s11136-020-02728-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To validate the Impact Index, a short, publicly available scale that measures the extent to which a respondent's health problem adversely impacts their quality of life. METHODS Secondary analysis of patients with hip or knee osteoarthritis surveyed after visiting a surgeon at baseline (N = 322) and about 6 months after the visit (N = 283). Patients responded to the Impact Index and previously validated questionnaires about overall health, pain, and function. The Impact Index includes four questions that ask how much the respondent is bothered, worried, limited, or in pain due to their health condition over the past 30 days. Total scores range from 0 to 12; higher scores indicate more deleterious impact. RESULTS Patients were mostly female (55%), majority white (95%), had an average age of 65 (SD = 9), and most had surgery (64%). The baseline Impact Index score was 9.48 (SD = 2.63); at follow up 4.75 (SD = 3.54). Impact Index was related to overall health at baseline (r = - 0.49). For knee patients at baseline, Impact Index was negatively related to their knee symptoms (r = - 0.49) and knee pain (r = - 0.67). For hip patients at baseline, Impact Index was negatively related to the Harris Hip score (r = - 0.62). Scale directions varied; however, the signs of all correlations were as hypothesized. The Impact Index was predictive of surgical choice (p < .001, OR = 1.45), however, overall health (p = .88) and comorbidity (p = .24) measures were not. Reliability was acceptable (α = 0.85). Responsiveness statistics suggested overall health, pain, function, and Impact Index measures reflected improvement patients experienced from surgery. The Impact Index had the largest effect sizes (> - 3.4) and Guyatt Responsiveness Statistics (> - 2.3). CONCLUSIONS The Impact Index demonstrated strong evidence of validity, reliability, and responsiveness in hip or knee osteoarthritis patients.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | - S Brodney
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA
| | - Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | - Floyd J Fowler
- Center for Survey Research, University of Massachusetts, Boston, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
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19
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Koopman RJ, Canfield SM, Belden JL, Wegier P, Shaffer VA, Valentine KD, Jain A, Steege LM, Patil SJ, Popescu M, LeFevre ML. Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs. BMC Med Inform Decis Mak 2020; 20:195. [PMID: 32811489 PMCID: PMC7432548 DOI: 10.1186/s12911-020-01194-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023] Open
Abstract
Background Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness. Methods A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management. Results Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure ‘story’ and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care. Conclusions Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users’ needs, and addressing additional stakeholders’ needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.
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Affiliation(s)
- Richelle J Koopman
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA.
| | - Shannon M Canfield
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Jeffery L Belden
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Pete Wegier
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Akshay Jain
- Department of Electrical & Computer Engineering, University of Missouri-Columbia, Columbia, MO, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Sonal J Patil
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Mihail Popescu
- Department of Health Management & Informatics, University of Missouri-Columbia, Columbia, MO, USA
| | - Michael L LeFevre
- Department of Family & Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
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20
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Shaffer VA, Wegier P, Valentine KD, Belden JL, Canfield SM, Popescu M, Steege LM, Jain A, Koopman RJ. Use of Enhanced Data Visualization to Improve Patient Judgments about Hypertension Control. Med Decis Making 2020; 40:785-796. [PMID: 32696711 DOI: 10.1177/0272989x20940999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support-in the form of enhanced data visualization-could improve judgments about hypertension control. Methods. Participants (Internet sample of patients with hypertension) in 3 studies (N = 209) viewed graphs depicting blood pressure data for fictitious patients. For each graph, participants rated hypertension control, need for medication change, and perceived risk of heart attack and stroke. In study 3, participants also recalled the percentage of blood pressure measurements outside of the goal range. The graphs varied by systolic blood pressure mean and standard deviation, change in blood pressure values over time, and data visualization type. Results. In all 3 studies, data visualization type significantly affected judgments of hypertension control. In studies 1 and 2, perceived hypertension control was lower while perceived need for medication change and subjective perceptions of stroke and heart attack risk were higher for raw data displays compared with enhanced visualization that employed a smoothing function generated by the locally weighted smoothing algorithm. In general, perceptions of hypertension control were more closely aligned with clinical guidelines when data visualization included a smoothing function. However, conclusions were mixed when comparing tabular presentations of data to graphical presentations of data in study 3. Hypertension was perceived to be less well controlled when data were presented in a graph rather than a table, but recall was more accurate. Conclusion. Enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control. More research is needed to determine the contexts in which graphs are superior to data tables.
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Affiliation(s)
- Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Pete Wegier
- Temmy Latner Centre for Palliative Care, Sinai Health System and University of Toronto, Toronto, Ontario, Canada
| | - K D Valentine
- Health Decision Sciences Center, Massachusetts General Hospital and Harvard Medical School, Cambridge, MA, USA
| | - Jeffery L Belden
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Shannon M Canfield
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
| | - Mihail Popescu
- Department of Health Management and Informatics, University of Missouri, Columbia, MO, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Akshay Jain
- Department of Electrical and Computer Engineering, University of Missouri, Columbia, MO, USA
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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Brodney S, Valentine KD, Fowler FJ, Barry MJ. Validation of the 3-item What Engagement Looks Like (WELL) scale in patients with diabetes. J Patient Rep Outcomes 2020; 4:57. [PMID: 32666381 PMCID: PMC7360003 DOI: 10.1186/s41687-020-00225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients' behaviors play a key role in chronic disease management, but how effective they are may depend on how engaged they feel. The objective was to develop a short measure of how much patients felt engaged in self-managing a chronic condition. Online test of a three-question series followed by a survey of physicians and their eligible diabetic patients. Physicians answered: 1) how well the physician thought the patient was managing his/her diabetes, and 2) how much effort the physician thought the patient was putting in. Each patient was mailed a survey that included three questions on self-management. Six hundred six patients from a national online consumer panel with diabetes or obesity, and 35 physicians from 3 primary care practices and a sample of 243 of their diabetic patients. Respondents were asked three questions about how much they thought their behavior could affect their health condition, how confident they were that they could do what was needed, and how involved they were in decisions about managing their condition. These items were summed to create a WELL score. Descriptive statistics and correlation coefficients were used to describe item relationships. Generalized Estimating Equations were used to predict how well the physician thought the patient was managing their diabetes and patient effort. RESULTS Correlations among the three patient-reported items ranged from - 0.01 to 0.45. The WELL score was correlated with an existing measure of patient activation commitment (r = .43, p < 0.001) and found to be a significant predictor of physicians' ratings of how much effort patients devoted to condition management (b = 0.02, p = 0.001, OR = 1.02) after adjusting for confounders. The WELL score didn't predict physicians' ratings of how effective patients were (b = 0.003, p = .526, OR = 1.004) after their A1c score had been taken into account. CONCLUSION Patients' WELL scores predicted physicians' ratings of patient effort in diabetes self-management.
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Affiliation(s)
- Suzanne Brodney
- Informed Medical Decisions Program, Massachusetts General Hospital, Health Decisions Science Center, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
| | - K D Valentine
- Health Decisions Science Center, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
| | - Floyd J Fowler
- Center for Survey Research, University of Massachusetts, Boston, 100 William T Morrissey Blvd, Boston, MA, 02025, USA
| | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Health Decisions Science Center, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
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Valentine KD, Marques F, Selberg A, Flannery L, Langer N, Elmariah S, Sepucha K. Abstract 397: Shared Decision Making In Cardiology: Measures Of Shared Decision Making In Patients With Severe Aortic Stenosis Considering Valve Replacement. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
To identify the degree to which shared decision making (SDM) is occurring for patients with severe aortic stenosis (AS) considering aortic valve replacement (AVR) as measured by the Shared Decision Making Process (SDMP) measure.
Methods:
Patient eligibility was ascertained via the electronic medical record. Eligible patients were between 18-85, spoke English, were diagnosed with severe AS, either had no prior AVR or had AVR more than 6 months prior, and were at low to intermediate risk for surgical AVR (SAVR). Patients were ineligible if they had a concomitant disease of the aorta or another heart valve that required intervention. Eligible patients were approached in either the Interventional Cardiology or Cardiac Surgery clinic after the respective visit and asked to complete the Shared Decision Making Process (SDMP) Measure, which includes 6 questions with a total score ranging from 0-4. The questions focus on if options were presented (yes/no), preferences elicited (yes/no), and if the pros and cons of transcatheter AVR (TAVR) and SAVR were discussed (“a lot”, “some”, “a little”, or “not at all”). A higher score indicates greater shared decision making occurred.
Results:
Of 60 enrolled patients, 59 (98%) returned their survey. Most patients were recruited after the visit with an interventional cardiologist (68%, 40 of 59). The average age was 72 years (SD=7 years), all patients were white, 67.8% (40 of 59) were men, and 82.1% (46 of 56) had more than a high school education. There was a trend toward patients reporting higher SDMP scores if patients were recruited in the cardiac surgery clinic (M=3.0, SD=0.7) when compared to those recruited in the interventional cardiology clinic (M=2.6, SD=1.1; t(57)=1.4, p=.164, d=.39). Nearly all (96.6%, 57 of 59) patients stated they were presented with different options to treat their AS and 88.1% (52 of 59) reported discussing the pros of TAVR while 78.0% (46 of 59) discussed SAVR “some” or “a lot.” Conversely, fewer patients stated they discussed the cons of TAVR (57.6%, 34 of 59) or SAVR (49.2%, 29 of 59) “some” or “a lot.” Most patients stated they were asked what they wanted to do to treat their AS (64.4%, 38 of 59).
Conclusions:
One third of patients did not recall being asked for their preference—a key component of shared decision making conversations. Given the importance of patients being well informed in this preference sensitive decision context, future work should seek to understand both how this multidisciplinary approach may benefit patients, and how to ensure the downsides of options and patient preferences are discussed during the visit.
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Shaffer VA, Wegier P, Valentine KD, Belden JL, Canfield SM, Patil SJ, Popescu M, Steege LM, Jain A, Koopman RJ. Patient Judgments About Hypertension Control: The Role of Variability, Trends, and Outliers in Visualized Blood Pressure Data. J Med Internet Res 2019; 21:e11366. [PMID: 30912759 PMCID: PMC6454346 DOI: 10.2196/11366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. Objective As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, we conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data. Methods In 3 Web studies, participants (internet sample of patients with hypertension) reviewed a series of vignettes depicting patients with hypertension; each vignette included a graph of a patient’s BP. We examined how data visualizations that varied by BP mean and SD (Study 1), the pattern of change over time (Study 2), and the presence of extreme values (Study 3) affected patients’ judgments about hypertension control and the need for a medication change. Results Participants’ judgments about hypertension control were significantly influenced by BP mean and SD (Study 1), data trends (whether BP was increasing or decreasing over time—Study 2), and extreme values (ie, outliers—Study 3). Conclusions Patients’ judgment about hypertension control is influenced both by factors that are important predictors of hypertension related-health outcomes (eg, BP mean) and factors that are not (eg, variability and outliers). This study highlights the importance of developing data visualizations that direct attention toward clinically meaningful information.
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Affiliation(s)
- Victoria Anne Shaffer
- University of Missouri, Department of Psychological Sciences, Columbia, MO, United States
| | - Pete Wegier
- Sinai Health System, Temmy Latner Center for Palliative Care, Toronto, ON, Canada.,Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - K D Valentine
- University of Missouri, Department of Psychological Sciences, Columbia, MO, United States
| | - Jeffery L Belden
- University of Missouri, Department of Family & Community Medicine, Columbia, MO, United States
| | - Shannon M Canfield
- University of Missouri, Department of Family & Community Medicine, Columbia, MO, United States
| | - Sonal J Patil
- University of Missouri, Department of Family & Community Medicine, Columbia, MO, United States
| | - Mihail Popescu
- University of Missouri, Department of Health Management & Informatics, Columbia, MO, United States
| | - Linsey M Steege
- University of Wisconsin, School of Nursing, Madison, WI, United States
| | - Akshay Jain
- University of Missouri, Department of Electrical and Computer Engineering, Columbia, MO, United States
| | - Richelle J Koopman
- University of Missouri, Department of Family & Community Medicine, Columbia, MO, United States
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