Decision Aids Utilized by Patients and Clinicians During Treatment Decision Making for Multiple Myeloma: An Integrative Review

2017 ◽  
Vol 17 (1) ◽  
pp. e159
Author(s):  
Joseph Tariman ◽  
Bojan Kojovic
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Decision Aids ◽  
Treatment Decision ◽  
Integrative Review ◽  
Treatment Decision Making

scholarly journals Patient Decision Aids in Doctor-Patient Consultations: Treatment Decision Making on Starting Insulin

2017 ◽  
Vol 9 (4-2) ◽  
Author(s):  
Zuraidah Mohd Don ◽  
Ayeshah Syed
Keyword(s):  
Decision Making ◽  
Decision Aids ◽  
Treatment Decision ◽  
Information Provision ◽  
Patient Decision Aids ◽  
Demographic Profiles ◽  
Treatment Decision Making ◽  
Healthcare Settings ◽  
Patient Decision

Patient decision aids (PDAs) are increasingly used to support treatment decision making in type 2 diabetes. However, research on PDAs generally involves quantitative analysis or focuses on physicians’ communicative practices, with limited data on how PDAs are used collaboratively in doctor-patient consultations. We apply discourse analytic methods to 11 recorded consultations during which a PDA on starting insulin was used. Purposive sampling was used to select participants from different healthcare settings and demographic profiles. Our analysis first addresses general questions on PDA use in the consultations, such as when it was used or mentioned in the consultation and by whom, before categorising the turns in which the PDA is mentioned or used by doctors and patients, according to the actions being performed. Next, we focus on consultations in which the patients have already read the PDA, and analyse the sequences of talk that occur after the doctor brings the PDA into the conversation. Our analysis shows that doctor talk on the PDA not only facilitated information provision, but also allowed doctors to elicit and explore the patient’s knowledge and perspectives. However, the kinds of questions that doctors asked tend to limit patient participation, and their focus on the PDA at times overshadowed patient contributions. More attention to doctors’ discursive choices can facilitate more patient-centred practices in using PDAs.

Shared decision-making, decision aids, and the role of values in treatment decision-making

2017 ◽  
Author(s):  
Amiram Gafni ◽  
Cathy Charles
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Conceptual Development ◽  
Decision Aids ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Key Characteristics

Shared decision-making (SDM) between physicians and patients is often advocated as the ‘best’ approach to treatment decision-making in the clinical encounter. In this chapter we describe: (i) the key characteristics of a SDM approach; (ii) the clinical contexts for SDM; (iii) the definition and use of decision aids (DA), as well as their relationship to SDM; and (iv) the vexing problem of defining the meaning and role of values/preferences in treatment decision-making. Areas for further research and conceptual development are also suggested to help resolve outstanding issues in the above areas. Despite the widespread interest in promoting SDM, there does not seem to be as yet a universally accepted consensus on the meaning of this concept.

Integrating a touchscreen-based brief geriatric assessment in older adults with multiple myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21703-e21703 ◽  
Author(s):  
Nitya Nathwani ◽  
Supriya Gupta Mohile ◽  
Brea Lipe ◽  
Karen Carig ◽  
Laura DiGiovanni ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Dose Intensity ◽  
Treatment Decision ◽  
Activity Of Daily Living ◽  
Treatment Decision Making ◽  
Frailty Score

e21703 Background: Multiple myeloma (MM) is a disease of older adults (OAs) with > 60% of diagnoses and nearly 75% of deaths occurring in patients > 65 years old (YO). Geriatric Assessment (GA) is associated with toxicity and survival in OAs with MM, but not routinely used in practice. This project pilot tests a tablet-based modified Geriatric Assessment (mGA) that presents compiled GA results, including (the Palumbo) frailty score, to clinicians at a treatment decision-making visit in a single screen dashboard. Methods: In this multisite ongoing study, 210 patients with MM ≥65 YO facing a decision point for care will complete a mGA that includes the Charlson Comorbidity Index (CCI), Katz Activity of Daily Living (ADL) Score, and Lawton Instrumental Activity of Daily Living (IADL) Score prior to meeting with a physician. mGA results, including composite frailty score, are provided to physicians at the start of a visit. Results: Thirty-six patients have been enrolled to date; enrollment continues. Participants are 69% (n = 25) white, 64% (n = 23) male, and mean age of 72 YO (range 65-87). Most (74%, n = 20) currently receive ≥1 therapy and have few co-morbidities (CCI median 1, SD 1.95, range 0-8); 57% require assistance with IADLs and 37% require assistance with ADLs. Based on Palumbo score, 36% of participants were frail (n = 13), 33% intermediate (n = 12), and 31% fit (n = 11). Providers report mGA results influenced treatment decision (54%, n = 28) and frailty score was the most frequently cited result to impact treatment decision-making (61%, n = 39). The most common way the mCGA influenced decision-making was to reduce dose/dose intensity (25%, N = 8). Clinicians on average spent 5 minutesreviewing the mGA results. Patients reported an average of 7 minutes to complete the survey, most independently (83%, n = 30), and were satisfied with the electronic program overall (80%, n = 29), including how easy it was to use (88%, n = 32). Conclusions: Preliminary data support feasibility, usability, and acceptability of the tablet-based mGA and that frailty score influences provider decision-making ≥50% of the time. Future analyses will explore the relationship of the mGA with toxicity, dose modification and/or treatment discontinuation in OAs with MM.

scholarly journals Doctor-Patient Communication about Treatment Decisions in Multiple Myeloma: Findings from the Cancer Experience Registry

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2624-2624
Author(s):  
Joanne S. Buzaglo ◽  
Victoria Kennedy ◽  
Clare Karten ◽  
Melissa F. Miller ◽  
Anne Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Second Opinion ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
Cancer Experience

Abstract Background: The US prevalence of multiple myeloma (MM) is estimated at 83,118 as of January 1, 2011(SEER, 2014), and about 24,050 new MM cases will be diagnosed in 2014 (ACS, 2014). With advances in treatment, MM patients are living longer and are confronted with increasingly complex therapeutic decisions. Frequently patients are not fully prepared to discuss the possible treatment options effectively with their provider. Methods: From July 2013 to July 2014, the Cancer Support Community (CSC) registered 495 people living with MM to the Cancer Experience Registry: MM, an online initiative designed to investigate and raise awareness about the psychosocial impact of MM. Registrants were recruited through an outreach program that included the CSC and The Leukemia & Lymphoma Society (LLS) network of community-based affiliates/chapters, CSC and LLS online communities, CSC’s helpline and LLS’s information resource center, other advocacy organizations, social and other media channels. Those who registered completed a survey about their MM history, status and treatment. Results: General: 406 (82%) registrants responded to the questionnaire. The present analysis is limited to 280 US based registrants who answered on treatment decision making. The participant median age was 64 years; 54% female, 87% Caucasian, 9.5% African American. Total annual income: 35% <$40K; 35% $40-79K; 30% at least $80K. Median time since MM diagnosis was 4.5 years. 26% did not know stage of their MM. Among those who reported stage: 20% stage I; 18% stage II; 48% Stage III; 10% “other”. 40% reported they experienced a relapse of MM. Treatment Decision Making: Prior to making a treatment decision, 94% reported receiving information about their diagnosis, and 80% received information about their treatment options. 45% described their level of knowledge about treatment options as “quite a bit” or “very much”. However, 33% reported they were not knowledgeable regarding MM treatment (21% “not at all” and 12% “a little bit”). 40% received treatment decision support prior to therapy, and 36% would have liked more support. 16% had little or no involvement in their treatment decision-making process. 25% did not feel they had a treatment choice, and 20% reported they did not have enough time to make a treatment decision. Two-thirds (66%) received a second opinion about medical treatment. 64% of registrants reported that a member of their health care team spoke to them about cancer clinical trials, and 29% participated in a clinical trial. Patient Satisfaction and Empowerment. A majority of MM registrants were satisfied with various aspects of the treatment decision-making process: outcome of the treatment(s) received (82%); doctor’s explanation of the benefits (74%); how they arrived at a decision (71%); how much they participated in making the decision (68%); and their doctor’s explanation of the risks and side effects (67%). 66% received a second opinion about medical treatment. Those who got a second opinion were slightly more satisfied with how they arrived at their treatment decision (OR=1.61; 95% CI=0.90, 2.88; p=0.11), but getting a second opinion did not affect patient’s satisfaction with treatment outcomes. Those who wrote down a list of questions prior to their first visit to discuss treatment options with their health care provider felt significantly more prepared to discuss their treatment options (p<0.01). 65% and 70%, respectively, thought it would be important to get help with gathering information or developing a written list of questions before meeting with their cancer specialists. Conclusion: Although nearly three-quarters of the sample were satisfied with various aspects of treatment decision-making, including communication about treatment decisions with physicians, more than one-third of MM patients thought they had no choice or felt rushed in making a decision. Those who prepared a list of questions prior to a consultation with the doctor felt significantly more prepared to make appropriate decisions. While most patients reported receiving information about their treatment options, less than half report being knowledgeable about treatment options, and a significant proportion reported not having enough knowledge or support to fully engage in treatment decisions. Further efforts are needed to address gaps in the delivery of treatment decision support to MM patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Integrating a Touchscreen-Based Assessment and Screening Tool for Adults with Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2373-2373 ◽  
Author(s):  
Tanya M Wildes ◽  
Carrie T. Stricker ◽  
William Dudley ◽  
Diana Harris ◽  
Nitya Nathwani ◽  
...  
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Geriatric Assessment ◽  
Research Funding ◽  
Predictive Ability ◽  
Treatment Decision ◽  
Touch Screen ◽  
Consensus Building ◽  
Knowledge Gaps ◽  
Treatment Decision Making

Abstract Background: More than 60% of multiple myeloma (MM) diagnoses and nearly 75% of deaths occur in patients over 65 years old. Because older adults (OAs) experience more treatment-related toxicities, treatment disruptions or dose reductions may be based on age and performance status alone, despite their poor predictive value for patient outcomes. Comprehensive Geriatric Assessment (CGA), including frailty indices, has shown predictive validity for toxicity and survival in OAs with MM, but is not routinely used in practice due to time and complexity, a lack of clarity about optimal tools and technologies to implement them, and clinician knowledge gaps on how to incorporate CGA into decision-making and care. Purpose: This project aims to address these gaps by pilot testing a tablet-based modified (m)CGA in 120 patients that presents compiled CGA results, including a frailty score, back to clinicians interacting with patients at the time of a treatment decision. Outcomes include feasibility, usability, utility, and impact on treatment decision-making, from both patient and provider perspectives. Pre-study implementation processes and milestones, including development of the mCGA, clinical workflow planning processes, training and other site-initiation activities are presented herein. Methods: The mCGA was developed using an iterative and dynamic consensus-driven process that included: 1) literature review and expert input to identify CGA domains for potential inclusion and 2) consensus building within a multi-disciplinary panel of gero-oncology experts, nurse scientists, and psychometricians. Domains and measures were selected based on predictive ability, length, and ability to administer via patient self-report so as to reduce clinician assessment burden. Study training and implementation procedures were developed using the same approach, as well as through workflow analysis and clinical team consensus building at the participating sites. Results: The Palumbo frailty index (FI) was chosen as the core of the mCGA tool given correlation with clinical outcomes specifically in OAs with MM. In addition to the 4 mGA measures comprising the Palumbo FI (age, comorbidity, ADL, and IADL), other GA variables were also chosen based on their strong predictive ability, clinical feasibility, and relevance to the MM population. This summary of results is displayed for ease of provider use within the Carevive dashboard (see Figure 1). Given prevalent knowledge gaps in use of CGA for MM treatment decision-making and care, a certified medical education self-study course was developed for training prior to the study intervention. Four geographically-dispersed academic and community hospitals who treat high volumes of diverse MM patients are participating to date. All 4 sites developed a process for ensuring treating providers would have easy access to the platform. Conclusions: Real-world, comprehensive and innovative solutions, combining education, geriatric assessment (GA) tools to determine a patient's fit/frailty status, realistic clinical work flow processes, and technology tools are needed to support and enhance treatment-decision making for patients with MM as well as their providers. Figure 1 Screenshot: Touch-screen based dashboard results display example Figure 1. Screenshot: Touch-screen based dashboard results display example Disclosures Wildes: Carevive Systems: Consultancy. Stricker:Carevive Systems, Inc.: Employment, Equity Ownership. Dudley:Carevive Systems, Inc.: Consultancy. Harris:Carevive Systems, Inc.: Consultancy. Nathwani:Carevive Systems, Inc.: Research Funding. Brant:Carevive Systems, Inc.: Research Funding. Kurtin:Carevive Systems, Inc.: Research Funding. Hurria:Boehringer Ingelheim Pharmaceuticals: Consultancy; GTx, Inc: Consultancy; Carevive: Consultancy; Celgene: Other: Research; Optum Health Care SOlutions: Consultancy, Other: Conference panel, research; Sanofi: Consultancy; Novartis: Other: Research.

Seeing it clearly: How to use graphics to guide collaborative consultation in pregnancy

2021 ◽  
pp. 103985622110570
Author(s):  
Philip Keightley ◽  
Ilona DiBella ◽  
Anne Sved Williams
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Decision Aids ◽  
Treatment Decision ◽  
Shared Decision ◽  
Collaborative Communication ◽  
Collaborative Consultation ◽  
Treatment Decision Making ◽  
In Pregnancy

Objective This study aims to examine the use of decision aids which may improve shared decision making through an exploration of risk apprehension and modes of collaborative communication. Conclusions Decision aids such as graphics have a key role in facilitating shared treatment decision making, perhaps particularly in perinatal mental health care. They are most useful within a trusting, two-way conversation.

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