National Institutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decision-making

1988 ◽  
Vol 36 (4) ◽  
pp. 342-347 ◽  
Author(s):  
A. Sue Brown ◽  
Kenneth Brummel-Smith ◽  
Lavola Burgess ◽  
Ralph B. D'Agostino ◽  
John W. Goldschmidt ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Assessment Methods ◽  
National Institutes Of Health ◽  
Consensus Development ◽  
Consensus Development Conference

Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts with gastrointestinal malignancy (GIM).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19586-e19586
Author(s):  
Nadine Jackson McCleary ◽  
Devin Wigler ◽  
Donna Lynn Berry ◽  
Kaori Sato ◽  
Arti Hurria ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Assessment ◽  
Clinical Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Touch Screen ◽  
Gastrointestinal Malignancy ◽  
Time To Completion ◽  
Computer Based ◽  
Touch Screen Computer

e19586 Feasibility of computer-based self-administered cancer-specific geriatric assessment (SA-CSGA) in older pts w/ gastrointestinal malignancy (GIM) Background: The CSGA (Hurria, JCO 2011) is a brief geriatric assessment consisting of validated measures primarily self-administered using paper format. We developed & tested feasibility of a computer-based SA-CSGA in pts ≥70 yrs w/ GIM. Methods: From 12/2009 - 6/2011, pts ≥70 yrs receiving treatment (rx) for GIM at Dana-Farber Cancer Institute were consented to complete SA-CSGA at baseline (T1= new or change rx) & follow-up (T2 = w/in 4 wks of completing rx). Feasibility endpts are (1) proportion of eligible pts consenting; (2) proportion completing SA-CSGA at T1 & T2; (3) time to completion of SA-CSGA; (4) proportion of MDs reporting change in clinical decision-making due to SA-CSGA. Results: Of the 49 eligible pts, 38 consented (55% female, 89% White, 76% enrolling prior to new rx). Mean age was 77yrs (range 70-89), 38% completed college, 49% married, 27% live alone, and 78% retired. 50% were diagnosed w/ colorectal cancer (ca). Mean MD-rated Karnofsky Performance Status was 87.5 at T1(range 60-100), 83.5 at T2 (range 70-100). At T1, 92% used a touch screen computer; 97% completed the SA-CSGA (51% independently). At T2, all pts used a touch screen computer; 71% completed the SA-CSGA (41% independently). Reasons for not completing SA-CSGA were withdrawal of consent (n=1 at T1 & T2), transfer of care (n=3; T2) or death (n=7; T2). The dominant reason for needing assistance was lack of computer familiarity (n=17 T1, n=14 T2). Mean time to completion was 23min at T1 (range 15-58); 20min at T2 (range 13-35). Among the 8 MDs who consented to participate, SA-CSGA added information to clinical assessment for 75% at T1 (n=27) and 65% at T2 (n=17) but did not alter immediate clinical decision-making. Conclusions: The computer-assisted SA-CSGA feasibility endpt was met for older pts w/ GIM although approximately half required assistance. While the SA-CSGA added information to clinical assessment, results did not impact clinical decision-making. Reasons for this may include relatively high-functioning patients enrolled in this study.

Validation Of a Comprehensive Health Status Assessment Scale In Older Patients (≥ 65 years) With Hematological Malignances. Gah Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2979-2979
Author(s):  
Santiago Bonanad ◽  
Ernesto Perez Persona ◽  
Itziar Oiartzabal ◽  
Bernardo Gonzalez ◽  
Carlos Fernandez-Lago ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Status ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Status Assessment ◽  
Comprehensive Health ◽  
Status Assessment ◽  
Test Retest Reliability

Abstract Background Older patients are increasingly prevalent in oncological practice. However, the evidence suggests that this group of patients is undertreated, mainly because of their advanced age, regardless of whether they are highly functional patients, do not present comorbidities, or could benefit from oncological therapies. The US National Comprehensive Cancer Network and the International Society of Geriatric Oncology have recommended that some form of geriatric assessment should be conducted to help Hematologists and Oncologists in order to identify current health problems and to guide interventions to reduce adverse outcomes and optimize the functional status Currently, the main tool for assessing older patients is a comprehensive geriatric assessment, although its complexity and duration may hinder its regular use in daily practice as a tool for clinical decision making. Several attempts have been made to assess comorbidities in the specific field of mielodysplasia, but mainly focused on organic damage rather than global assessment. Aim We are in the process of developing and validating a comprehensive health status assessment scale (Geriatric Assessment in Hematology, GAH Scale) with eight dimensions in patients ≥ 65 years with: Myelodysplastic syndromes (MDS), acute myeloblastic leukemia (AML) and multiple myeloma (MM). Methods After item-pool generation, stakeholder consultation and content validation, a brief scale of 8 dimensions with selected items has been created. Feasibility was confirmed in 83 patients. Afterwards, a multicenter, observational, prospective study has been carried out in 20 hospitals in Spain, enrolling 189 elderly naïve to treatment patients with newly diagnosed MDS, AML or MM. The scale validation process integrates the analysis of criterion and concept validity, internal consistency (Cronbach's alpha), test-retest reliability, as well as the evaluation of intraclass correlation coefficient (ICC) and factor analysis. After psychometric validation phase, further studies will be carried out in order to evaluate its clinical use for prognosis and clinical decision making. Results 189 patients fulfilling inclusion criteria have been enrolled in the study, 54% women. Median age at diagnosis was 73.3 ± 6.64 years. According to diagnosis, 103 patients (54.5%) had MDS or AML and 86 (45.5%) had MM. Regarding feasibility, mean time for filling in the questionnaire was 12.1 ± 4.5 min. 83.6% of patients answered 100% of questions of the scale. Mean percentage of unanswered questions per patient was 1%. Test-retest was completed by 112 patients. GAH Scale showed satisfactory test-retest reliability. ICC was statistically significant for each dimension, being greater than 0.65 for 6 of the 8 dimensions (p<0.05), indicating that GAH Scale is independent of the observer and is stable in clinically stable patients along the time. Floor and ceiling effects were no detected. Internal consistency, content validity and factor analysis are being carried out and results will be presented in the forthcoming congress. Conclusion This new GAH Scale is a valid, reliable and consistent tool, simple enough to assess health status in older patients with haematological malignancies. Further studies will have to stablish if it may be a tool to improve decision making in such patients. Disclosures: Bonanad: Celgene: Consultancy. Gonzalez:Celgene: Consultancy. Durán:Celgene: Employment. Marcos:Celgene: Employment. López:Celgene: Employment. Cruz-Jentoft:Celgene: Research Funding.

How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study

2019 ◽  
Vol 10 (6) ◽  
pp. 951-959 ◽  
Author(s):  
Suzanne Festen ◽  
Maaike Kok ◽  
Jana S. Hopstaken ◽  
Hanneke van der Wal-Huisman ◽  
Annya van der Leest ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Implementation Study ◽  
Patients With Cancer

scholarly journals Factors That Influence the Clinical Decision Making of Physical Therapists in Choosing a Balance Assessment Approach

2009 ◽  
Vol 89 (3) ◽  
pp. 233-247 ◽  
Author(s):  
Patricia Q McGinnis ◽  
Laurita M Hack ◽  
Kim Nixon-Cave ◽  
Susan L Michlovitz
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Inpatient Rehabilitation ◽  
Clinical Decision ◽  
Assessment Methods ◽  
Testing Time ◽  
Theory Approach ◽  
Balance Assessment ◽  
Balance Deficits

BackgroundMany methods for examining patients with balance deficits are supported by the literature. How or why therapists choose specific balance assessment methods during examination of patients remains unclear.ObjectivesThe aims of this study were: (1) to explore decision making during examination of patients with balance deficits, (2) to understand the selection and use of assessment methods from the clinician's perspective, and (3) to explore why specific methods were selected.DesignA qualitative design using a grounded theory approach permitted exploration of clinical decision making.MethodsEleven therapists were purposefully selected (6 from outpatient offices, 5 from inpatient rehabilitation settings) to participate in repeated interviews. Credibility of the findings was established through low-inference data, member check, and triangulation among participants and multiple data sources.ResultsA highly individualized approach to patient examination based on therapists’ practical knowledge emerged from the data, with limited influence of the literature. Movement observation was the primary assessment and diagnostic tool. When selecting assessment approaches for specific patients, the perceived value of information gathered mattered more than testing time. A 3-stage model of assessment decision making portrayed both the process and reasons influencing therapists’ choices.ConclusionsIn the context of the complex and busy nature of clinical practice, therapists gathered data that they considered meaningful during patient examination. The findings provide insight into factors influencing assessment decisions and suggest mechanisms to foster translation of research into clinical practice.

Clinical Decision Making and Preference Assessment for Individuals With Intellectual and Developmental Disabilities

2014 ◽  
Vol 119 (2) ◽  
pp. 151-170 ◽  
Author(s):  
Javier Virués-Ortega ◽  
Kristen Pritchard ◽  
Robin L. Grant ◽  
Sebastian North ◽  
Camilo Hurtado-Parrado ◽  
...  
Keyword(s):  
Decision Making ◽  
Developmental Disabilities ◽  
Clinical Decision Making ◽  
Preference Assessment ◽  
Clinical Decision ◽  
Task Engagement ◽  
Assessment Methods ◽  
Intellectual And Developmental Disabilities ◽  
Decision Making Model ◽  
Selection Of

Abstract Individuals with intellectual or developmental disabilities are able to reliably express their likes and dislikes through direct preference assessment. Preferred items tend to function as rewards and can therefore be used to facilitate the acquisition of new skills and promote task engagement. A number of preference assessment methods are available and selecting the appropriate method is crucial to provide reliable and meaningful results. The authors conducted a systematic review of the preference assessment literature, and developed an evidence-informed, decision-making model to guide practitioners in the selection of preference assessment methods for a given assessment scenario. The proposed decision-making model could be a useful tool to increase the usability and uptake of preference assessment methodology in applied settings.

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