scholarly journals Personalized treatment options for chronic diseases using precision cohort analytics

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenney Ng ◽  
Uri Kartoun ◽  
Harry Stavropoulos ◽  
John A. Zambrano ◽  
Paul C. Tang
Keyword(s):  
Decision Making ◽  
Chronic Diseases ◽  
Primary Care Physicians ◽  
Treatment Guidelines ◽  
Point Of Care ◽  
Data Extraction ◽  
Treatment Options ◽  
Personalized Treatment ◽  
Medical Decision ◽  
Similarity Model

AbstractTo support point-of-care decision making by presenting outcomes of past treatment choices for cohorts of similar patients based on observational data from electronic health records (EHRs), a machine-learning precision cohort treatment option (PCTO) workflow consisting of (1) data extraction, (2) similarity model training, (3) precision cohort identification, and (4) treatment options analysis was developed. The similarity model is used to dynamically create a cohort of similar patients, to inform clinical decisions about an individual patient. The workflow was implemented using EHR data from a large health care provider for three different highly prevalent chronic diseases: hypertension (HTN), type 2 diabetes mellitus (T2DM), and hyperlipidemia (HL). A retrospective analysis demonstrated that treatment options with better outcomes were available for a majority of cases (75%, 74%, 85% for HTN, T2DM, HL, respectively). The models for HTN and T2DM were deployed in a pilot study with primary care physicians using it during clinic visits. A novel data-analytic workflow was developed to create patient-similarity models that dynamically generate personalized treatment insights at the point-of-care. By leveraging both knowledge-driven treatment guidelines and data-driven EHR data, physicians can incorporate real-world evidence in their medical decision-making process when considering treatment options for individual patients.

scholarly journals Implicit persuasion in medical decision-making

2018 ◽  
Vol 7 (2) ◽  
pp. 209-227
Author(s):  
Ellen G. Engelhardt ◽  
Arwen H. Pieterse ◽  
Anne M. Stiggelbout
Keyword(s):  
Decision Making ◽  
Patient Participation ◽  
Medical Decision Making ◽  
Treatment Options ◽  
Medical Decision ◽  
Potential Pitfall ◽  
Participation In Decision Making

Abstract If the arguments to support a recommendation are partly implicit, the free exchange of ideas between discussants can be hampered. In this paper, we will focus on the potential pitfall for clinicians when informing patients about treatment options: implicit persuasion. We will describe a set of implicitly persuasive behaviors observed during decision-making consultations, and reflect on how these behaviors could undermine efforts to stimulate patient participation in decision-making. We will also reflect on possible explanations for why clinicians exhibit such behaviors.

scholarly journals Medical decision making among patients with heart failure – does migration background matter?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olaf von dem Knesebeck ◽  
Martin Scherer ◽  
Gabriella Marx ◽  
Sarah Koens
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Migration Background ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnosis And Management ◽  
Migration History

Abstract Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p < 0.05), but a consistent tendency: Primary care doctors more often asked lifestyle and psychosocial questions, they more often diagnosed HF, they gave more advice to rest and how to behave in case of deterioration, they more often auscultated the lung, and more often referred to a specialist when the patient has a Turkish migration history compared to a non-migrant patient. Differences in the medical decisions between the two groups ranged between 1.6 and 15.8%. In 10 out of 12 comparisons, differences were below 10%. Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.

scholarly journals NCOG-09. TREATMENT DECISION MAKING IN THE SETTING OF ADVANCED CANCER

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi160-vi160
Author(s):  
Kristen Triebel ◽  
Kyler Maulhauser ◽  
John Fiveash ◽  
Dario Marrotta ◽  
Meredith Gammon ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Metastatic Cancer ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Treatment Decision ◽  
Medical Decision ◽  
Control Group ◽  
Treatment Decision Making

Abstract OBJECTIVE To investigate medical decision-making capacity (MDC) in patients with advanced stage cancer. METHODS Participants were 113 newly diagnosed adults with brain metastases and 41 adults with metastatic cancer without brain metastases who were recruited from an academic medical center and 40 demographically-matched healthy controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) Vignette B and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant using cutoff scores derived statistically from the performance of the control group. RESULTS Both of the metastatic cancer groups (with and without brain metastasis) performed significantly below controls on consent standards of understanding and reasoning. The brain metastasis group performed below the non-metastatic cancer group on understanding. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 65% of the participants with brain metastases and 51% of participants with metastatic cancer without brain metastases were impaired on at least one MDC standard. CONCLUSION Over half of participants with metastatic cancer regardless of whether they have brain disease have reduced capacity to make treatment decisions. The finding of impaired MDC in patients without brain metastases is surprising and suggests this group likely exhibits cognitive deficits that impact their ability to understand and reason about different treatment options. This finding suggests that clinicians need to carefully consider the patient’s ability to engage in treatment decision making when they are discussing treatment options for metastatic cancer. These results also indicate a need for the development and investigation of interventions to support MDC in this patient population.

scholarly journals Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Catherine H. Yu ◽  
◽  
Calvin Ke ◽  
Aleksandra Jovicic ◽  
Susan Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Priority Setting ◽  
Primary Care Physicians ◽  
Decision Aid ◽  
Treatment Options ◽  
Shared Decision ◽  
Usability Assessment

Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.

scholarly journals Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Qualitative Research ◽  
Primary Care Physicians ◽  
Medical Decision ◽  
Published Data ◽  
Qualitative Evidence Synthesis ◽  
Thematic Synthesis ◽  
Qualitative Evidence

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.

scholarly journals Understanding Medical Decision-making in Prostate Cancer Care

2018 ◽  
Vol 12 (5) ◽  
pp. 1635-1647 ◽  
Author(s):  
Rachel Thera ◽  
Dr. Tracey Carr ◽  
Dr. Gary Groot ◽  
Nicole Baba ◽  
Dr. Kunal Jana
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Decision Making ◽  
Health Care Professionals ◽  
Treatment Options ◽  
Health Care Team ◽  
Medical Decision ◽  
Shared Decision ◽  
System Quality ◽  
The Way

The availability of several treatment options for prostate cancer creates a situation where patients may need to come to a shared decision with their health-care team regarding their care. Shared decision-making (SDM) is the concept of a patient and a health-care professional collaborating to make decisions about the patient’s treatment course. Nurse navigators (NNs) are health-care professionals often involved in the SDM process. The current project sought to evaluate the way in which patients with prostate cancer make decisions regarding their care and to determine patients’ perspectives of the role of the NN in the SDM process. Eleven participants were recruited from the Prostate Assessment Centre by a NN. They were interviewed via telephone and their responses were analyzed using thematic analysis. Five interacting factors were determined to influence the way participants made decisions including level of anxiety, desire to maintain normalcy, support system quality, exposure to cancer narratives, and extent of practical concerns. NNs were found to increase knowledge, decrease indecision, and provide reassurance for participants. Based on the beneficial aspects of NN interaction reported in this study, the use of NNs in SDM programs should be encouraged. The results of the study demonstrate the complexity of the decision-making process when it comes to prostate cancer treatment. The factors elucidated in the study should be considered during the development and implementation of prostate cancer SDM programs.

scholarly journals Regulatory focus affects physician risk tolerance

2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Peter J. Veazie ◽  
Scott McIntosh ◽  
Benjamin P. Chapman ◽  
James G. Dolan
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Regulatory Focus ◽  
Primary Care Physicians ◽  
Randomization Test ◽  
Practice Variation ◽  
Risk Tolerance ◽  
Medical Decision ◽  
Test Results ◽  
Physician Decision Making

Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention – regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (P=0.01). The Cohen’s d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (P=0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

Primary care physicians’ medical decision making for late-life depression

1996 ◽  
Vol 11 (4) ◽  
pp. 218-225 ◽  
Author(s):  
Christopher M. Callahan ◽  
Robert S. Dittus ◽  
William M. Tierney
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Primary Care Physicians ◽  
Medical Decision Making ◽  
Late Life ◽  
Medical Decision ◽  
Late Life Depression

scholarly journals Family involvement in the context of chronic diseases: The role of social support in treatment decision-making for surgical procedures

2020 ◽  
Vol 32 (1) ◽  
pp. 45-71
Author(s):  
Elena Link ◽  
Doreen Reifegerste ◽  
Christoph Klimmt
Keyword(s):  
Social Support ◽  
Decision Making ◽  
Chronic Diseases ◽  
Family Involvement ◽  
Surgical Procedures ◽  
Qualitative Interviews ◽  
Family Members ◽  
Medical Decision ◽  
Personal Factors

If medical decision-making about complex treatment options (such as surgical procedures) is challenging for patients, family members can provide them with advice and health information. Previous research about family involvement in health communication has largely focused on cancer patients. Thus, it lacks an examination of family involvement in surgery decision-making in the context of non-life-threatening chronic diseases like arthrosis. In particular, we focus on the role of social support for family involvement in these situations. Against this background, we conducted semi-structured qualitative interviews with arthrosis patients and their family members (n = 32 patients; n = 8 relatives). To better understand family involvement in surgery decision-making, three research questions were analyzed: (1) What are the perceived characteristics of the arthroplasty decisional process? (2) Which patterns of family involvement exist with regard to social support? (3) What general circumstances are relevant for family involvement? Our results demonstrate that social support plays an important role in the patterns of family decision-making. Instrumental, emotional, and informational support can indirectly enhance family involvement in decision-making. In addition, relatives are also directly involved in decision-making processes and may instigate the decision. The type of family involvement is influenced by characteristics of the decision-making situation. In addition to personal factors and the relationship with the physician, which is perceived as less supportive, the need for familial decisional support intensifies.

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