scholarly journals A pharmaceutical therapy recommender system enabling shared decision-making

2021 ◽  
Author(s):  
Felix Gräßer ◽  
Falko Tesch ◽  
Jochen Schmitt ◽  
Susanne Abraham ◽  
Hagen Malberg ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Similarity Measures ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Shared Decision ◽  
Attribute Weights ◽  
Pharmaceutical Therapy ◽  
Scale Levels ◽  
User Friendly

AbstractData-based clinical decision support systems (CDSSs) can provide personalized support in medical applications. Such systems are expected to play an increasingly important role in the future of healthcare. Within this work, we demonstrate an exemplary CDSS which provides individualized pharmaceutical drug recommendations to physicians and patients. The core of the proposed system is a neighborhood-based collaborative filter (CF) that yields data-based recommendations. CFs are capable of integrating data at different scale levels and a multivariate outcome measure. This publication provides a detailed literature review, a holistic comparison of various implementations of CF algorithms, and a prototypical graphical user interface (GUI). We show that similarity measures, which automatically adapt to attribute weights and data distribution perform best. The illustrated user-friendly prototype is intended to graphically facilitate explainable recommendations and provide additional evidence-based information tailored to a target patient. The proposed solution or elements of it, respectively, may serve as a template for future CDSSs that support physicians to identify the most appropriate therapy and enable a shared decision-making process between physicians and patients.

scholarly journals Implementing an Electronic Clinical Decision Support Tool Into Routine Care: A Qualitative Study of Stakeholders’ Perceptions of a Post-Mastectomy Breast Reconstruction Tool

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110420
Author(s):  
Jessica Boateng ◽  
Clara N. Lee ◽  
Randi E. Foraker ◽  
Terence M. Myckatyn ◽  
Kimi Spilo ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Breast Reconstruction ◽  
Shared Decision Making ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Routine Care ◽  
Evidence Based ◽  
Shared Decision ◽  
Consultation Time

Objective. To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. Materials and Methods. A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer, and informatics professionals helped design and review the interview guide. Based on the Consolidated Framework for Implementation Research (CFIR), we conducted qualitative semistructured interviews with key stakeholders (patients, clinicians, informatics professionals) to explore intervention, setting characteristics, and process-level variables that can impact implementation. Interviews were transcribed, coded, and analyzed based on the CFIR framework using both inductive and deductive methods. Results. Fifty-seven potential participants were contacted; 49 (85.9%) were eligible, and 35 (71.4%) were enrolled, continuing until thematic saturation was reached. Participants consisted of 13 patients, 13 clinicians, and 9 informatics professionals. Stakeholders thought that BREASTChoice was useful and provided patients with an evidence-based source of information about post-mastectomy breast reconstruction, including their personalized risks. They felt that BREASTChoice could support shared decision making, improve workflow, and possibly save consultation time, but were uncertain about the best time to deliver BREASTChoice to patients. Some worried about cost, data availability, and security of integrating the tool into an electronic health record. Most acknowledged the importance of showing clinical utility to gain institutional buy-in and encourage routine adoption. Discussion and Conclusion. Stakeholders felt that BREASTChoice could support shared decision making, improve workflow, and reduce consultation time. Addressing key questions such as cost, data integration, and timing of delivering BREASTChoice could build institutional buy-in for CDS implementation. Results can guide future CDS implementation studies.

scholarly journals Shared Decision Making

2021 ◽  
Vol 02 (01) ◽  
pp. 111-117
Author(s):  
Wei Wang
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Emergency Management ◽  
Shared Decision Making ◽  
State Of The Art ◽  
Clinical Decision ◽  
Shared Decision ◽  
Patient Centered ◽  
Significant Potential

Shared decision making (SDM) is a process by which physicians and patients jointly participate in choosing to pursue one of several alternatives in a clinical decision. It is most relevant for decisions that involve significant potential harms and benefits with tradeoffs and uncertainty. This paper provides a state-of-the-art review about SDM covering its concept, value, implementation and application in emergency management and communication. SDM is valuable in the process of making decisions which patients may benefit most from, thus resulting in satisfying patient-centered outcomes. Although SDM can be challenging to incorporate into clinical practice, it is likely to become a useful tool of communication in future.

scholarly journals Individual Value Clarification Methods Based on Conjoint Analysis: A Systematic Review of Common Practice in Task Design, Statistical Analysis, and Presentation of Results

2018 ◽  
Vol 38 (6) ◽  
pp. 746-755 ◽  
Author(s):  
Marieke G.M. Weernink ◽  
Janine A. van Til ◽  
Holly O. Witteman ◽  
Liana Fraenkel ◽  
Maarten J. IJzerman
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Conjoint Analysis ◽  
Decision Aids ◽  
Clinical Decision ◽  
Task Design ◽  
Shared Decision ◽  
Attribute Importance ◽  
Barriers To Implementation ◽  
Choice Tasks

Background. There is an increased practice of using value clarification exercises in decision aids that aim to improve shared decision making. Our objective was to systematically review to which extent conjoint analysis (CA) is used to elicit individual preferences for clinical decision support. We aimed to identify the common practices in the selection of attributes and levels, the design of choice tasks, and the instrument used to clarify values. Methods. We searched Scopus, PubMed, PsycINFO, and Web of Science to identify studies that developed a CA exercise to elicit individual patients’ preferences related to medical decisions. We extracted data on the above-mentioned items. Results. Eight studies were identified. Studies included a fixed set of 4–8 attributes, which were predetermined by interviews, focus groups, or literature review. All studies used adaptive conjoint analysis (ACA) for their choice task design. Furthermore, all studies provided patients with their preference results in real time, although the type of outcome that was presented to patients differed (attribute importance or treatment scores). Among studies, patients were positive about the ACA exercise, whereas time and effort needed from clinicians to facilitate the ACA exercise were identified as the main barriers to implementation. Discussion. There is only limited published use of CA exercises in shared decision making. Most studies resembled each other in design choices made, but patients received different feedback among studies. Further research should focus on the feedback patients want to receive and how the CA results fit within the patient–physician dialogue.

scholarly journals Understanding shared decision-making experience among vulnerable population: Focus group with food bank clients

2020 ◽  
pp. 1-8
Author(s):  
Young Ji Lee ◽  
Tiffany Brazile ◽  
Francesca Galbiati ◽  
Megan Hamm ◽  
Cindy Bryce ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Vulnerable Populations ◽  
Clinical Decision Making ◽  
Decision Aids ◽  
Clinical Decision ◽  
Therapeutic Options ◽  
Shared Decision ◽  
Food Bank

Abstract Introduction: Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective: To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods: Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results: Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion: Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.

Hereditary angioedema and shared decision making

2020 ◽  
Vol 41 (6) ◽  
pp. S55-S60 ◽  
Author(s):  
Russell A. Settipane ◽  
Don A. Bukstein ◽  
Marc A. Riedl
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Hereditary Angioedema ◽  
Clinical Decision Making ◽  
Unmet Need ◽  
Clinical Decision ◽  
Therapeutic Agents ◽  
Shared Decision ◽  
Widespread Implementation ◽  
High Degree

Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of complexity given the number of therapeutic agents that are available and the risk for significant morbidity and potential mortality attributable to the disease. Given this complexity, there is an opportunity to develop shared decision-making (SDM) aids and/or tools that would facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM in HAE, and the steps necessary to create a SDM tool specific for HAE, and outlines the challenges that must be navigated to guide the establishment and widespread implementation of SDM in the management of HAE.

scholarly journals Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making

2021 ◽  
Vol 29 (5) ◽  
pp. 243-252
Author(s):  
H. F. Groenveld ◽  
J. E. Coster ◽  
D. J. van Veldhuisen ◽  
M. Rienstra ◽  
Y. Blaauw ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Elderly Patients ◽  
Shared Decision Making ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Short Review ◽  
Implantable Cardioverter Defibrillators ◽  
Shared Decision

AbstractImplantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients’ options in this critical phase of their illness.

Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making

1997 ◽  
Vol 2 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Angela Coulter
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Shared Decision ◽  
Pros And Cons

The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.

SHARED DECISION MAKING FOR OTHER GENERAL CONDITIONS

2020 ◽  
Author(s):  
Jim Appleyard ◽  
Jón Snaedal
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Common Ground ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Confounding Variables ◽  
Empathic Communication ◽  
Informed Preferences

Shared decision making based on clinical evidence and the patient’s informed preferences improves patient knowledge and ability to participate in their care with improvement to those with long-term health problems. A common ground between the patient and the physician is achieved through empathic communication skills with the provision of evidence-based information about options, outcomes, and uncertainties, together with decision support counseling and a systematic approach to recording and implementing patient’s preferences. It is important to recognize that the complexities of the clinical decision-making process with the confounding variables create difficulties in obtaining and measuring reproducible outcomes.

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