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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [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: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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Witteman HO, Vaisson G, Provencher T, Chipenda Dansokho S, Colquhoun H, Dugas M, Fagerlin A, Giguere AM, Haslett L, Hoffman A, Ivers NM, Légaré F, Trottier ME, Stacey D, Volk RJ, Renaud JS. An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation. J Med Internet Res 2021; 23:e15032. [PMID: 33724194 PMCID: PMC8074832 DOI: 10.2196/15032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. OBJECTIVE The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. METHODS We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. RESULTS We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. CONCLUSIONS The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools.
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Affiliation(s)
- Holly O Witteman
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Gratianne Vaisson
- Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | | | | | - Michele Dugas
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance, Salt Lake City, UT, United States
| | - Anik Mc Giguere
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Lynne Haslett
- East End Community Health Centre, Toronto, ON, Canada
| | - Aubri Hoffman
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Noah M Ivers
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - France Légaré
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Marie-Eve Trottier
- Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Dawn Stacey
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Sébastien Renaud
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
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Vaisson G, Provencher T, Dugas M, Trottier MÈ, Chipenda Dansokho S, Colquhoun H, Fagerlin A, Giguere AMC, Hakim H, Haslett L, Hoffman AS, Ivers NM, Julien AS, Légaré F, Renaud JS, Stacey D, Volk RJ, Witteman HO. User Involvement in the Design and Development of Patient Decision Aids and Other Personal Health Tools: A Systematic Review. Med Decis Making 2021; 41:261-274. [PMID: 33655791 DOI: 10.1177/0272989x20984134] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND When designing and developing patient decision aids, guidelines recommend involving patients and stakeholders. There are myriad ways to do this. We aimed to describe how such involvement occurs by synthesizing reports of patient decision aid design and development within a user-centered design framework and to provide context by synthesizing reports of user-centered design applied to other personal health tools. METHODS We included articles describing at least one development step of 1) a patient decision aid, 2) user- or human-centered design of another personal health tool, or 3) evaluation of these. We organized data within a user-centered design framework comprising 3 elements in iterative cycles: understanding users, developing/refining prototype, and observing users. RESULTS We included 607 articles describing 325 patient decision aid projects and 65 other personal health tool projects. Fifty percent of patient decision aid projects reported involving users in at least 1 step for understanding users, 35% in at least 1 step for developing/refining the prototype, and 84% in at least 1 step for observing users' interaction with the prototype. In comparison, other personal health tool projects reported 91%, 49%, and 92%, respectively. A total of 74% of patient decision aid projects and 92% of other personal health tool projects reported iterative processes, both with a median of 3 iterative cycles. Preliminary evaluations such as usability or feasibility testing were reported in 66% of patient decision aid projects and 89% of other personal health tool projects. CONCLUSIONS By synthesizing design and development practices, we offer evidence-based portraits of user involvement. Those wishing to further align patient decision aid design and development with user-centered design methods could involve users earlier, design and develop iteratively, and report processes in greater detail.
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Affiliation(s)
| | | | - Michèle Dugas
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | | | | | | | - Angela Fagerlin
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anik M C Giguere
- McMaster University Faculty of Health Sciences, Quebec, QC, Canada
| | - Hina Hakim
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | - Lynne Haslett
- East End Community Health Centre, Toronto, ON, Canada
| | - Aubri S Hoffman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - France Légaré
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | | | - Dawn Stacey
- University of Ottawa Faculty of Health Sciences, Ottawa, ON, Canada
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Provencher T, Charest J, Bastien CH. Non-Invasive Brain Stimulation for Insomnia - A Review of Current Data and Future Implications. ACTA ACUST UNITED AC 2020. [DOI: 10.21926/obm.icm.2001001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Provencher T, Fecteau S, Bastien C. Psychophysiological and paradoxical insomnia: how different is their brain asymmetry? an eeg study. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Provencher T, Lemyre A, Vallières A, Bastien CH. Insomnia in personality disorders and substance use disorders. Curr Opin Psychol 2019; 34:72-76. [PMID: 31778972 DOI: 10.1016/j.copsyc.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/05/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use polysomnography to diagnose insomnia, objective measures have shown sleep abnormalities in individuals with a personality disorder and insomnia. Interestingly, there is increasing evidence that emotion dysregulation is involved in a mutually aggravating relationship between Borderline Personality Disorder (BPD) and insomnia. While BPD traits are highly associated with suicide ideation and attempts, these behaviors could be potentiated or enhanced in individuals presenting sleep disturbances. Because BPD and other mental disorders are often linked with the use of medication or other substances, it is also important to review the association between substance use disorders (SUD) and insomnia. SUD can disrupt sleep and foster insomnia, which in turn might increase motivation to use substances. Insomnia has also been shown to precede (i.e., predict) SUD, and can be present during withdrawal as well. These results highlight the need to assess and treat insomnia when working with patients who present a PD or SUD.
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Affiliation(s)
| | | | - Annie Vallières
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada
| | - Célyne H Bastien
- School of Psychology, Université Laval, Québec, QC, Canada; CERVO Brain Research Center, Québec, QC, Canada; Psycho- Socio- Cultural Sleep Laboratory, School of Psychology, Université Laval, Québec, QC, Canada; CHU Research Center - Université Laval, Québec, QC, Canada; Research Laboratory on Human Neurophysiology and Sleep, School of psychology, Université Laval, Québec, QC, Canada.
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7
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Hakim H, Provencher T, Chambers CT, Driedger SM, Dube E, Gavaruzzi T, Giguere AMC, Ivers NM, MacDonald S, Paquette JS, Wilson K, Reinharz D, Witteman HO. Interventions to help people understand community immunity: A systematic review. Vaccine 2018; 37:235-247. [PMID: 30528593 DOI: 10.1016/j.vaccine.2018.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herd immunity, or community immunity, occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. In this study, we aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. RESULTS We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating at least one effect of the interventions. Within these 10, 4/4 reported increased knowledge, 3/5 reported shifts of attitudes in favour of vaccination, 2/5 reported increased intentions to vaccinate. Of 3 studies evaluating interventions specifically about community immunity, 2 reported increased intentions to vaccinate. CONCLUSIONS A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to optimally communicate about this benefit may be important, because some evidence suggests that effective communication about community immunity can increase vaccination intentions.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | | | - Christine T Chambers
- Department of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eve Dube
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, ON, Canada.
| | | | - Jean-Sebastien Paquette
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
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8
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Dugas M, Trottier MÈ, Chipenda Dansokho S, Vaisson G, Provencher T, Colquhoun H, Dogba MJ, Dupéré S, Fagerlin A, Giguere AMC, Haslett L, Hoffman AS, Ivers NM, Légaré F, Légaré J, Levin CA, Menear M, Renaud JS, Stacey D, Volk RJ, Witteman HO. Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study. BMC Med Inform Decis Mak 2017; 17:12. [PMID: 28103862 PMCID: PMC5244537 DOI: 10.1186/s12911-016-0399-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 05/23/2016] [Accepted: 12/15/2016] [Indexed: 04/26/2024] Open
Abstract
Background Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. Methods To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Results Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18–7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23–9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users’ needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities. Conclusions There are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0399-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michèle Dugas
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Marie-Ève Trottier
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Gratianne Vaisson
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Thierry Provencher
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Sophie Dupéré
- Faculty of Nursing, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1C448, Salt Lake City, UT, 84132, USA
| | - Anik M C Giguere
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | - Lynne Haslett
- East End Community Health Centre, 1619 Queen Street East, Toronto, ON, M4L 1G4, Canada
| | - Aubri S Hoffman
- Department of Health Services Research, The MD Anderson Cancer Center, FCT9.5028, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Noah M Ivers
- Family Practice Health Centre, Institute for Health Systems Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada.,Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Ave, Toronto, ON, M5G1V7, Canada
| | - France Légaré
- Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Jean Légaré
- Patient Partner, 403 rue des Érables, Neuville, Québec, G0A 2R0, Canada
| | - Carrie A Levin
- Healthwise, Incorporated, 40 Court St, Suite 300, Boston, MA, 02108, USA
| | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, CHU de Québec, 10 de l'Espinay, Quebec, QC, G1V 0A6, Canada
| | - Jean-Sébastien Renaud
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Dawn Stacey
- School of Nursing and Ottawa Hospital Research Institute, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77230, USA
| | - Holly O Witteman
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
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9
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Witteman HO, Chipenda Dansokho S, Exe N, Dupuis A, Provencher T, Zikmund-Fisher BJ. Risk Communication, Values Clarification, and Vaccination Decisions. Risk Anal 2015; 35:1801-1819. [PMID: 25996456 DOI: 10.1111/risa.12418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many health-related decisions require choosing between two options, each with risks and benefits. When presented with such tradeoffs, people often make choices that fail to align with scientific evidence or with their own values. This study tested whether risk communication and values clarification methods could help parents and guardians make evidence-based, values-congruent decisions about children's influenza vaccinations. In 2013-2014 we conducted an online 2×2 factorial experiment in which a diverse sample of U.S. parents and guardians (n = 407) were randomly assigned to view either standard information about influenza vaccines or risk communication using absolute and incremental risk formats. Participants were then either presented or not presented with an interactive values clarification interface with constrained sliders and dynamic visual feedback. Participants randomized to the risk communication condition combined with the values clarification interface were more likely to indicate intentions to vaccinate (β = 2.10, t(399) = 2.63, p < 0.01). The effect was particularly notable among participants who had previously demonstrated less interest in having their children vaccinated against influenza (β = -2.14, t(399) = -2.06, p < 0.05). When assessing vaccination status reported by participants who agreed to participate in a follow-up study six months later (n = 116), vaccination intentions significantly predicted vaccination status (OR = 1.66, 95%CI (1.13, 2.44), p < 0.05) and rates of informed choice (OR = 1.51, 95%CI (1.07, 2.13), p < 0.012), although there were no direct effects of experimental factors on vaccination rates. Qualitative analysis suggested that logistical barriers impeded immunization rates. Risk communication and values clarification methods may contribute to increased vaccination intentions, which may, in turn, predict vaccination status if logistical barriers are also addressed.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
- Research Centre of the CHU de Québec, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Nicole Exe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Audrey Dupuis
- Department of Information and Communication, Laval University, Quebec City, Quebec, Canada
| | | | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Risk Science Center, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. "You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions. J Med Internet Res 2015; 17:e202. [PMID: 26290186 PMCID: PMC4642375 DOI: 10.2196/jmir.4209] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [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: 01/07/2015] [Revised: 06/03/2015] [Accepted: 07/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as "quantified self" advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. OBJECTIVE Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? METHODS We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. RESULTS Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients' self-tracked data. CONCLUSIONS Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered "illness work" connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their "illness work" more efficiently and effectively.
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Affiliation(s)
- Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy and Research, Division of Health Informatics, New York, NY, United States.
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11
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Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers. J Med Internet Res 2015; 17:e137. [PMID: 26043709 PMCID: PMC4526906 DOI: 10.2196/jmir.4381] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [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: 02/26/2015] [Revised: 04/11/2015] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. OBJECTIVE As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. METHODS Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. RESULTS A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work: managing transfers of medical information to solve problems was a tremendous amount of work that was largely unrecognized by the medical establishment. CONCLUSIONS We conclude that personal health information management should be recognized as an additional burden that MCC places upon patients. Effective structural solutions for information sharing, whether institutional ones such as care management or technological ones such as electronic health information exchange, are likely not only to improve the quality of information shared but reduce the burden on patients already weighed down by MCC.
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Affiliation(s)
- Jessica S Ancker
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
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12
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Witteman HO, Dansokho SC, Colquhoun H, Coulter A, Dugas M, Fagerlin A, Giguere AM, Glouberman S, Haslett L, Hoffman A, Ivers N, Légaré F, Légaré J, Levin C, Lopez K, Montori VM, Provencher T, Renaud JS, Sparling K, Stacey D, Vaisson G, Volk RJ, Witteman W. User-centered design and the development of patient decision aids: protocol for a systematic review. Syst Rev 2015; 4:11. [PMID: 25623074 PMCID: PMC4328638 DOI: 10.1186/2046-4053-4-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [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: 10/18/2014] [Accepted: 12/29/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. METHODS/DESIGN A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely to be optimal. DISCUSSION This systematic review will provide evidence of current practices to inform approaches for involving patients and other stakeholders in the development of patient decision aids. We anticipate that the results will help move towards the establishment of best practices for the development of patient-centered tools and, in turn, help improve the experiences of people who face difficult health decisions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013241.
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Affiliation(s)
- Holly O Witteman
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, Quebec City, QC G1V 0A6, Canada.
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Younkman J, Guay-Berry P, Rotello L, Provencher T, Hanke R. Improving the Quality and Timeliness of Nutrition Intervention Through Independent Dietitian Order Writing in a Community Hospital. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.jada.2008.06.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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