scholarly journals The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

2020 ◽  
Author(s):  
Tatjana S. Potpara ◽  
Gregory Y. H. Lip ◽  
Carina Blomstrom-Lundqvist ◽  
Giuseppe Boriani ◽  
Isabelle C. Van Gelder ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Stroke Risk ◽  
Treatment Options ◽  
Symptom Control ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making

AbstractAtrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

scholarly journals Treatment Decision Making and Treatment Satisfaction Among Individuals Living with Chronic Myeloid Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4787-4787
Author(s):  
Julie Olson ◽  
Shauna McManus ◽  
Melissa F. Miller ◽  
Thomas W. LeBlanc ◽  
Eva Yuen ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Outcomes ◽  
Board Of Directors ◽  
Research Funding ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Advisory Committees ◽  
Treatment Decision Making ◽  
Satisfaction With Treatment

Abstract Background: Over the past decade, an increase in treatment options for chronic myeloid leukemia (CML) has dramatically changed the therapeutic landscape and has improved clinical outcomes. This abundance of treatment options may make it difficult for CML patients to feel knowledgeable about what options are available to them, may hinder patients' preparedness for having conversations about treatment, and, similarly, may contribute to patients feeling less involved in treatment decision making (TDM). In light of this changing landscape, we explored whether the TDM experience was linked to satisfaction with treatment outcomes in a national sample of CML patients. Methods: Using data from the Cancer Support Community's Cancer Experience Registry®, our analytic sample included 310 participants who reported CML as their primary diagnosis. The dependent variable in all analyses was a dichotomous, patient-reported indicator of satisfaction with treatment outcomes (satisfied or not satisfied). Our independent variables include three measures that capture the TDM experience: feeling involved in the TDM process; feeling knowledgeable about treatment options prior to making treatment decisions; and, feeling prepared to discuss treatment options with one's doctor. Respondents ranked TDM knowledge, preparedness, and involvement from 0 = "not at all" to 4 = "very much." Responses were dichotomized such that 1 = "quite a bit" or "very much" and 0 = "not at all," "a little bit" or "somewhat." Analytically, we compared patients who reported high satisfaction with treatment outcomes to those who reported low satisfaction, using Student's t-test. Then, we estimated multivariate logistic regression models predicting odds of being satisfied with treatment outcome by TDM knowledge, preparedness, and involvement. Regression models controlled for demographic characteristics including age, gender, and race; clinical factors such as time since diagnosis and symptom burden; treatment-related measures including financial impact of treatment; and the degree to which individuals felt their health care teams prepared them to manage treatment side effects. Results: Descriptively, our sample was 65% female and 87% non-Hispanic White, with an average age of 56.6 years (SD = 12) and mean time since diagnosis of 6 years (SD = 5). Most (74%) reported being "quite a bit" to "very much satisfied" with their treatment outcomes. Experiences with TDM, however, were variable. When making treatment decisions, 52% reported feeling involved, 41% reported feeling knowledgeable, and 21% felt prepared. Importantly, t-test results suggested that individuals with greater involvement, more knowledge, and higher preparedness were significantly more likely to report satisfaction with treatment outcomes. Results of the multivariate models demonstrated a greater likelihood of treatment satisfaction among individuals who felt prepared to discuss treatment options with their health care team, even after controlling for demographic, clinical, and treatment-related characteristics. In fact, prepared individuals were nearly 6 times as likely to be satisfied with their treatment outcomes, as compared to individuals who did not feel prepared to discuss treatment options (p < .05). Conclusion: Most of our patients with CML did not feel prepared to make treatment decisions. However, those who feel more prepared to discuss treatment options with their doctors are also more likely to report satisfaction with treatment outcomes. As new CML treatment options become available, our results highlight the need for an increased focus on shared decision making in clinical practice. This may necessitate providing patients with more resources to help prepare them for treatment-related conversations. Disclosures Birhiray: Takeda: Research Funding, Speakers Bureau; Genomic Health: Patents & Royalties; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alexion: Consultancy; Puma: Research Funding, Speakers Bureau; Pharmacyclics: Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Bristol Myers Squibb: Speakers Bureau; Norvatis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bayer: Membership on an entity's Board of Directors or advisory committees; Eli-Lilly: Speakers Bureau; Excelis: Speakers Bureau; Clovis Oncology: Speakers Bureau; Sanofi Oncology: Speakers Bureau; Incyte: Speakers Bureau; AstraZeneca: Speakers Bureau; Tessaro: Speakers Bureau; Pfizer: Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees; Helsinn: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees.

Abstract P114: A Nurse-Led Multi-Component Behavioral Activation Program to Improve Treatment Decision-Making and Health Outcomes in Patients With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Wai Chi Polly LI ◽  
Doris Yu
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Standard Care ◽  
Decision Aid ◽  
Stroke Risk ◽  
Behavioral Activation ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Mba Program ◽  
Post Test

Introduction: Atrial fibrillation (AF) is a complex condition that requires a multifaceted management approach to reduce disease- and treatment-related complications. However, under-prescription of oral anticoagulant (OAC), non-adherence, suboptimal anticoagulation and risk factor control leave patients to increased risks of adverse outcomes. Methods: This mixed-methods study comprised a randomized controlled trial and an exploratory qualitative study. Community-dwelling patients with AF but no OAC treatment (N = 89) were randomized to receive either the Nurse-led Multi-component Behavioral Activation (N-MBA) program or standard care. The N-MBA program equipped patients as an active agent to manage their AF. Firstly, the nurse enabled patients to be aware of their stroke risk by using a decision-aid, then empowered them to discuss OAC use with physicians actively and be responsible for the medication and lifestyle-related self-care for stroke prevention. A purposive subsample (n=10) from the N-MBA program were interviewed for their engagement experience. Results: As compared with those received the standard care, the N-MBA group showed significantly greater intention to use OAC, and their OAC treatment option was more compatible with physician’s decision at immediate post-test ( p = .002). They also reported greater improvements on health-related quality of life (HRQoL) (immediate post-test: p = .023; 6-month post-test: p = .047) and AF knowledge (immediate post-test: p = .004) after attending the program. The N-MBA program was highly receptive with excellent attendance (92%) and mean satisfaction score (4.94/5.00 ± 0.88). The participants expressed that the decision-aid enabled them to make the OAC treatment decision through better understanding of their stroke risk, pros and cons of different treatments. Through attending the interactive health counseling, they found themselves as more assertive to discuss the treatment options with their physicians. Together with the prompt access of a nurse for advice, they perceived themselves as capable to perform AF-related self-care. Conclusions: The preliminary analysis showed that the N-MBA program is feasible and effective to optimize treatment decision making and HRQoL in AF patients.

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 Preferences and Perceptions Regarding Treatment Decision-Making for Relapsed or Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL)

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1928-1928
Author(s):  
Mallory Yung ◽  
Frederick Schnell ◽  
Mirko Vukcevic ◽  
Nuwan C. Kurukulasuriya
Keyword(s):  
Decision Making ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Treatment Decision ◽  
B Cell Lymphoma ◽  
Treatment Decisions ◽  
Line Treatment ◽  
Level Of Involvement ◽  
Treatment Decision Making ◽  
Large B Cell Lymphoma

Abstract Patients with relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) who are not eligible for transplantation face complex treatment-related decisions, many of which are preference-sensitive. Shared decision making (SDM) has the potential to improve patient experience, engagement, and treatment satisfaction; however, limited data exist on preferences for R/R DLBCL patients and how they want to be involved in their treatment decision-making, particularly with respect to 2 nd- and 3 rd-line treatment decisions. We conducted a primary qualitative research study to understand preferences and values that impact treatment decision-making among R/R DLBCL patients, their caregivers, and physicians that treat R/R DLBCL patients in the US. Qualitative 60-minute semi-structured interviews were conducted with R/R DLBCL patients, their caregivers, and oncologists that treat R/R DLBCL patients. Patients and caregivers were recruited as pairs; physicians and patients were not linked. Patient interview questions were designed to elicit feedback on: 1) perceptions of their level of involvement in treatment decision-making, 2) 2 nd- and 3 rd-line patient preferences and goals, and 3) treatment satisfaction. Caregivers were asked about their level of involvement in treatment-related decisions and current practices around SDM. We used template analysis to code transcripts, using 6 codes decided a priori, allowing for additional codes to emerge. Two interviewers double coded 4 interviews, ensuring interrater reliability &gt;75% and reconciled differences, subsequently independently coding the remaining 26 interviews. We enrolled 14 R/R DLBCL patients, 8 caregivers, and 8 oncologists in this study. Overall, patients reported the shock from their diagnosis or from failing treatment constrained them from fully being involved in their treatment decisions. 71% of patients and 38% of caregivers perceived they had limited ability to be actively involved in treatment decision-making given that their treating physician had communicated that they were following a well-established standard of care. All physicians agreed that the limited 2 nd- and 3 rd-line treatment options available created limited opportunities for patients to make treatment decisions. Among 6 patients (43%), perceptions of autonomy in treatment decision-making improved as they experienced multiple lines of treatment, consistent with physician observations. 50% of patients shared that caregiver involvement was important for supplementing their understanding of 2 nd- and 3 rd-line treatment options; however, only 1 caregiver explicitly said that they had enough time to make an informed decision. Generally, physicians also said that they encourage caregivers to be included in treatment planning. 5 patients (36%) reported that their physicians did not effectively communicate the full spectrum of 1 st-line treatment outcome possibilities. As a result, they did not feel prepared for the possibility of treatment failure or needing another line of treatment. 10 patients (71%) noted that their oncologists shared educational materials with them regarding treatment options; however, 5 physicians (62%) identified lack of patient understanding or education on treatment options as a major barrier to involving patients in decision-making. While 71% of patients felt satisfied with their treatment experience, some shared that they would have appreciated a more individualized approach. 4 patients (29%) shared that their physicians were not equipped to address ancillary health concerns (e.g., mental health) and 2 patients noted that existing resources did not address concerns for young adults (e.g., fertility). Results suggest that while 2 nd- and 3 rd-line treatment options may be limited for R/R DLBCL patients, preferences related to patient-centered outcomes can be discussed and incorporated into the long-term treatment planning process. Opportunities for improvement include developing tailored materials outlining caregiver responsibilities throughout the care journey, as they were consistently identified as a critical component of the treatment decision-making process by both patients and physicians. Further, developing physician tools that can support integration of patients' lived experiences (e.g., social needs) into their typical workflows can minimize duplicative patient interactions. Figure 1 Figure 1. Disclosures Vukcevic: MorphoSys: Current Employment. Kurukulasuriya: MorphoSys: Current Employment, Current equity holder in publicly-traded company, Other: Support for attending meetings/travel.

scholarly journals Patients' priorities for treatment decision making during periods of incapacity: quantitative survey

2014 ◽  
Vol 13 (5) ◽  
pp. 1165-1183 ◽  
Author(s):  
Annette Rid ◽  
Robert Wesley ◽  
Mark Pavlick ◽  
Sharon Maynard ◽  
Katalin Roth ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Financial Burden ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Future Research ◽  
Quantitative Survey ◽  
Treatment Decision Making

AbstractObjective:Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making.Method:We employed a self-administered, quantitative survey of patients in a tertiary care center.Results:Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants.Significance of Results:Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients' treatment preferences. Clinicians should also discuss and document patients' priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making.

Achieving shared treatment decisions

2017 ◽  
Author(s):  
Martin H.N. Tattersall ◽  
David W. Kissane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Similar Treatment ◽  
Treatment Benefits ◽  
Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

Physicians' views on the influence of patient participation on treatment decisions - an explorative study

2007 ◽  
Vol 20 (3) ◽  
pp. 174-182 ◽  
Author(s):  
Elina Jaakkola
Keyword(s):  
Decision Making ◽  
Patient Participation ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Role Expectations ◽  
Customer Participation ◽  
Health Care Managers ◽  
Treatment Decision Making ◽  
Explorative Study ◽  
Significant Difference

While patient participation in treatment decisions is increasingly advocated in medical literature, patient demand has been considered to cause unnecessary prescribing. Using the concept of customer participation as discussed in services marketing and management literature as a theoretical base, the paper analyses the influence of patient participation on the medical service process and treatment decision-making. A qualitative, explorative study was conducted to investigate American and British physicians' views on patient participation in the treatment of osteoporosis and schizophrenia. It became evident that in the cases of both osteoporosis and schizophrenia, patients influence prescribing decisions despite the significant difference in their willingness and ability to participate. The manifestations of patient participation were divided into three groups: (1) resources, such as the patient's condition and information about it, and his/her preconceived notions and preferences, (2) actions, such as preparing for the service, negotiating decisions and implementing the treatment, and (3) the patient's role expectations and inclination to participate. The influence of such manifestations on prescribing decision-making is discussed in detail, and differences between the studied illnesses are explained. Implications to health-care managers and practitioners are discussed.

HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-089
Author(s):  
Sara Hayes ◽  
Brian M. Green ◽  
Shayna Yeates ◽  
Amrita Bhowmick ◽  
Kaitlyn McNamara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Cancer Care ◽  
Hospice Care ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Treatment Decision Making ◽  
Diagnosis Of Cancer

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.

Sign in / Sign up

Export Citation Format

Share Document