scholarly journals Preference Phenotypes in Support of Shared Decision–Making at Point‐of‐Care for Patients With Rheumatoid Arthritis: A Proof‐of‐Concept Study

2019 ◽  
Vol 71 (5) ◽  
pp. 629-637 ◽  
Author(s):  
Betty Hsiao ◽  
Pauline Binder‐Finnema ◽  
W. Benjamin Nowell ◽  
George Michel ◽  
Carole Wiedmeyer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Point Of Care ◽  
Shared Decision ◽  
Proof Of Concept ◽  
Concept Study

It may help you to know. . .": The early phase qualitative development of a rheumatoid arthritis goal elicitation tool

2021 ◽  
pp. jrheum.201615
Author(s):  
Julie Kahler ◽  
Ginnifer Mastarone ◽  
Rachel Matsumoto ◽  
Danielle ZuZero ◽  
Jacob Dougherty ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Guidelines ◽  
Training Session ◽  
Clinic Visit ◽  
Shared Decision ◽  
Communication Tool ◽  
Group Setting ◽  
Patient Goals

Objective Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. Methods Tool development occurred in three phases: 1) clinician feedback on the initial prototype during a communication training session; 2) semi-structured interviews with RA patients; and 3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. Results Clinicians (n=15) and patients (n=10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool de-emphasizing goals outside of their perceived treatment domain or available resources, highlighted the benefits of the tool to facilitate conversation but raised concern regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and prepare for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. Conclusion A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers, such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher quality care in RA.

scholarly journals English Language Proficiency, Health Literacy, and Trust in Physician Are Associated with Shared Decision Making in Rheumatoid Arthritis

2014 ◽  
Vol 41 (7) ◽  
pp. 1290-1297 ◽  
Author(s):  
Jennifer L. Barton ◽  
Laura Trupin ◽  
Chris Tonner ◽  
John Imboden ◽  
Patricia Katz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Language Proficiency ◽  
English Language ◽  
English Language Proficiency ◽  
Shared Decision ◽  
Limited Health Literacy ◽  
Limited Health

Objective.Treat-to-target guidelines promote shared decision making (SDM) in rheumatoid arthritis (RA). Also, because of high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision making in 2 cohorts of adults with RA.Methods.Data were derived from patients enrolled in 1 of 2 longitudinal, observational cohorts [University of California, San Francisco (UCSF) RA Cohort and RA Panel Cohort]. Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately.Results.Of 509 patients across 2 cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel Cohort.Conclusion.This study of over 500 adults with RA from 2 demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the RA Panel Cohort. These findings underscore the need to examine the influence of SDM on health outcomes in RA.

scholarly journals Co-Developing an Antibiotic Stewardship Tool for Dentistry: Shared Decision-Making for Adults with Toothache or Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1345
Author(s):  
Wendy Thompson ◽  
Jonathan Sandoe ◽  
Sue Pavitt ◽  
Tanya Walsh ◽  
Lucie Byrne-Davis
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behaviour Change ◽  
Antibiotic Stewardship ◽  
Point Of Care ◽  
Ethnographic Study ◽  
Behaviour Change Techniques ◽  
Antibiotic Prescribing ◽  
Think Aloud ◽  
Shared Decision

Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally.

scholarly journals Qualitative Exploration of Triangulated, Shared Decision‐Making in Rheumatoid Arthritis

2019 ◽  
Vol 71 (12) ◽  
pp. 1576-1582
Author(s):  
Pauline Binder‐Finnema ◽  
Kathryn Dzurilla ◽  
Betty Hsiao ◽  
Liana Fraenkel
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Qualitative Exploration

scholarly journals Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis

2017 ◽  
Vol 77 (5) ◽  
pp. 678-683 ◽  
Author(s):  
Liana Fraenkel ◽  
W Benjamin Nowell ◽  
George Michel ◽  
Carole Wiedmeyer
Keyword(s):  
Rheumatoid Arthritis ◽  
Decision Making ◽  
Side Effects ◽  
Shared Decision Making ◽  
Latent Class ◽  
Information Criteria ◽  
Janus Kinase ◽  
Treat To Target ◽  
Treatment Preferences ◽  
Shared Decision

ObjectiveImplementing treat-to-target (TTT) strategies requires that patients with rheumatoid arthritis (RA) and their rheumatologists decide on how best to escalate care when indicated. The objective of this study was to develop preference phenotypes to facilitate shared decision-making at the point of care for patients failing methotrexate monotherapy.MethodsWe developed a conjoint analysis survey to measure the preferences of patient with RA for triple therapy, biologics and Janus kinase (JAK) inhibitors. The survey included seven attributes: administration, onset, bothersome side effects, serious infection, very rare side effects, amount of information and cost. Each choice set (n=12) included three hypothetical profiles. Preference phenotypes were identified by applying latent class analysis to the conjoint data.Results1273 participants completed the survey. A five-group solution was chosen based on progressively lower values of the Akaike and Bayesian information criteria. Members of the largest group (group 3: 38.4%) were most strongly impacted by the cost of the medication. The next largest group (group 1: 25.8%) was most strongly influenced by the risk of bothersome side effects. Members of group 2 (11.2%) were also risk averse, but were most concerned with the risk of very rare side effects. Group 4 (6.6%) strongly preferred oral over parenteral medications. Members of group 5 (18.0%) were most strongly and equally influenced by onset of action and the risk of serious infections.ConclusionsTreatment preferences of patients with RA can be measured and represented by distinct phenotypes. Our results underscore the variability in patients’ values and the importance of using a shared decision-making approach to implement TTT.

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