scholarly journals Shared Decision-Making in Cardiac Electrophysiology Procedures and Arrhythmia Management

2021 ◽  
Author(s):  
Mina K. Chung ◽  
Angela Fagerlin ◽  
Paul J. Wang ◽  
Tinuola B. Ajayi ◽  
Larry A. Allen ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cardiac Arrhythmia ◽  
Cardiac Electrophysiology ◽  
Improve Patient Care ◽  
Heart Rhythm ◽  
Shared Decision ◽  
Heart Rhythm Disorders ◽  
Patient Reported ◽  
Arrhythmia Management

Shared decision-making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision-making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.

scholarly journals Patient and physician perspectives guiding intra-articular treatment choice in knee osteoarthritis: stakeholders are aligned on treatment priorities but have different assessments of treatment effect

2021 ◽  
pp. jisakos-2020-000578
Author(s):  
Vandana Menon ◽  
Caroline Huber ◽  
Alexandria Portelli ◽  
Marissa Baker-Wagner ◽  
Scott Kelley ◽  
...  
Keyword(s):  
Decision Making ◽  
Knee Osteoarthritis ◽  
Shared Decision Making ◽  
Symptom Relief ◽  
Activity Level ◽  
Shared Decision ◽  
Treatment Needs ◽  
Knee Oa ◽  
Patient Reported ◽  
Selection Factors

ObjectivesKnee osteoarthritis (OA) is a leading cause of health-related disability. In the absence of curative non-operative therapies, treatment goals are limited to symptom relief. Data are limited on how patients and physicians prioritise available treatment options. We assessed patients’ preferences for and physicians’ attitudes towards intra-articular treatments including corticosteroids (IACS), an extended-release corticosteroid (TA-ER) and hyaluronic acids (IAHA).MethodsWe conducted a prospective, IRB-exempt, double-blind survey of patients with and providers who treat knee OA. Respondents were required to have received or prescribed TA-ER in a non-trial setting. We evaluated patients’ OA history, impact of knee OA and treatment preferences, and physicians’ decision-making and prescribing experiences.ResultsOf the 97 patient participants, mean age was 56 years, 70.0% were women, 75.0% had bilateral knee OA and 46.4% were diagnosed over 5 years ago. Of the 50 physician participants, 34.0% were rheumatologists, 42.0% were orthopaedic surgeons and 60.0%, on average, treat 50+ patients with knee OA per month. Treatment selection factors considered ‘very important’ to patients and physicians included disease severity (88.7%, 82.0%), impact on quality of life (88.7%, 72.0%), disease extent (84.5%, 54.0%) and activity level (80.4%, 64.0%). A majority (93.8%) of patients indicated moderate to severe difficulty with their knees. Fewer patients (76.3%) reported shared decision making compared with physicians (92.0%). Half (50.5%) of the patients reported that they experienced months of pain relief with TA-ER, 27.7% with IACS and 18.8% with IAHA. Physician assessments were consistent but estimated a greater duration of treatment effects than that reported by patients across all therapies.ConclusionWhile knee OA has a tremendous impact on patients, there are significant unmet treatment needs. The increasing use of patient-reported outcomes will allow patients and physicians to track pain and functional status over time and across therapies, improving shared decision-making.

Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease (Preprint)

2021 ◽  
Author(s):  
Alysha Taxter ◽  
Lisa Johnson ◽  
Doreen Tabussi ◽  
Yukiko Kimura ◽  
Brittany Donaldson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Data ◽  
The United States ◽  
Shared Decision ◽  
Time Data ◽  
Vertical Orientation ◽  
Patient Reported ◽  
Data Elements ◽  
The Right

BACKGROUND Coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision making. Increasing communication between patients and care teams is particularly important for children with chronic conditions, such as juvenile idiopathic arthritis (JIA), which is the most common, chronic rheumatic condition of childhood, and is associated with increased pain, decreased function, and decreased quality of life. OBJECTIVE We aimed to design a dashboard prototype for use in coproducing care for JIA patients. We evaluated the context use and needs of end users, obtained consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. METHODS A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support coproduction of care in four diverse ambulatory pediatric rheumatology clinics across the United States. We engaged a multidisciplinary team (n=18) of patients/parents, clinicians, nurses, and staff during an in-person kick-off meeting, followed by bi-weekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. Final necessary dashboard components were determined using Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated using PDSA methodology. Patients and providers were surveyed about their experiences. RESULTS Teams achieved consensus on what data matters most at point-of-care to support JIA patients, families, and clinicians partnering together to make the best possible decisions for better health. Notable themes included: the right data, in the right place, at the right time; data in once for multiple purposes; patient and family self-management components; and opportunity for education and increased transparency. A final set of 11 dashboard data elements were identified which include patient-reported outcomes, clinical data, and medications. Important design considerations include incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper testing with 36 patients/families yielded positive feedback about the dashboard’s usefulness during clinic discussions, helped to talk about what mattered most, and informed healthcare decision making. CONCLUSIONS Our study developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications, that can be used during a clinic visit to support meaningful conversations and shared decision making between JIA patients/families and their clinicians and care teams. CLINICALTRIAL N/A

Abstract 189: Income Level Disparities in Consumer Reported Domains of Healthcare Experience Among Those With Established Atherosclerotic Cardiovascular Disease in United States: Insights From Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Paul D Capua ◽  
Haider Warraich ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Shared Decision ◽  
Panel Survey ◽  
Provider Satisfaction ◽  
Healthcare Experience ◽  
Patient Reported

Background: While it is well established that significant health outcome disparities exist across patients of varying socio-economic status (SES) with established atherosclerotic cardiovascular disease (ASCVD), disparities in patients’ healthcare experiences are not well investigated. We explore income level differences in four central tenets of patient-reported healthcare experience (access to care, provider communication, shared decision making and provider satisfaction) as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, in a nationally representative adult US population with established ASCVD. Methods: The study population consisted of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We assessed the responses for each item as: a) difficult access to care (always/almost difficult), b) ineffective communication and shared decision making (never/sometimes), and c) poor provider satisfaction (lowest quartile on a scale of 0-10). We examined the relationship between scores in the lowest quartile of each domain composite scores, derived using the weighted average response from each items scores, with patients’ SES, using the high-income group as reference. Results: Lower SES was consistently associated with greater perceived difficulties in access, poor provider-patient communication, less shared decision making, as well as lower provider satisfaction (Table). Participants classified as poor vs. high income were 47% (95% CI 1.17-1.83) more likely to report difficulty accessing care, 39% (95% CI 1.09-1.78) and 26% (95% CI 0.99-1.60) reported a higher likelihood of experiencing poor communication and shared decision making respectively, as well as a 66% (95% CI 1.31-2.11) higher likelihood of reporting lower provider satisfaction. Conclusion: Among patients with established ASCVD, significant SES disparities exist in all domains of patient reported healthcare experience quality of care metrics. Targeted policies focusing on improving communication, engagement and satisfaction are needed to enhance patient healthcare experience among high-risk vulnerable populations.

scholarly journals Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure

2020 ◽  
pp. 0272989X2097787
Author(s):  
K. D. Valentine ◽  
Ha Vo ◽  
Floyd J. Fowler ◽  
Suzanne Brodney ◽  
Michael J. Barry ◽  
...  
Keyword(s):  
Decision Making ◽  
Construct Validity ◽  
Shared Decision Making ◽  
Small Sample ◽  
Decision Quality ◽  
Medical Decision ◽  
Shared Decision ◽  
Partial Credit ◽  
Patient Reported ◽  
Process Scale

Background The Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical decision. SDM Process items have been used previously in studies of surgical decision making and exhibited discriminant and construct validity. Method Secondary data analysis was conducted across 8 studies of 11 surgical conditions with 3965 responses. Each study contained SDM Process items that assessed the discussion of options, pros and cons, and preferences. Item wording, content, and number of items varied, as did inclusion of measures assessing decision quality, decisional conflict (SURE scale), and regret. Several approaches for scoring, weighting, and the number of items were compared to identify an optimal approach. Optimal SDM Process scores were compared with measures of decision quality, conflict, and regret to examine construct validity; meta-analysis generated summary results. Results Although all versions of the scale were highly correlated, a short, partial credit, equally weighted version of the scale showed favorable properties. Overall, higher SDM Process scores were related to higher decision quality ( d = 0.18, P = 0.029), higher SURE scale scores ( d = 0.57, P < 0.001), and lower decision regret ( d = −0.34, P < 0.001). Significant heterogeneity was present in all validity analyses. Limitations Included studies all focused on surgical decisions, several had small sample sizes, and many were retrospective. Conclusion SDM Process scores showed resilience to coding changes, and a scheme using the short, partial credit, with equal weights was adopted. The SDM Process scores demonstrated a small, positive relationship with decision quality and were consistently related to lower decision conflict and less regret, providing evidence of validity across several surgical decisions.

scholarly journals Comparison of Three Measures of Shared Decision Making: SDM Process_4, CollaboRATE, and SURE Scales

2019 ◽  
Vol 39 (6) ◽  
pp. 673-680 ◽  
Author(s):  
Suzanne Brodney ◽  
Floyd J. Fowler ◽  
Michael J. Barry ◽  
Yuchiao Chang ◽  
Karen Sepucha
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Quality ◽  
Herniated Disc ◽  
Shared Decision ◽  
Patient Centered ◽  
Patient Decision ◽  
Patient Reported ◽  
Patient Reported Measures ◽  
Lumbar Spinal

Objective. If shared decision making (SDM) is to be part of quality assessment, it is necessary to have good measures of SDM. The purpose of this study is to compare the psychometric performance of 3 short patient-reported measures of SDM. Methods. Patients who met with a specialist to discuss possible surgery for hip or knee osteoarthritis (hips/knees), lumbar herniated disc, or lumbar spinal stenosis (backs) were surveyed shortly after the visit and again 6 months later. Some of the patients saw a patient decision aid (PDA) prior to the meeting. The 3 SDM measures were the SDM Process_4 (SDMP) survey, CollaboRATE, and SURE scale. The follow-up survey included measures of decision regret, satisfaction, and decision quality. Results. Patients in the sample ( N = 649) had a mean age of 63.3 years, 51% were female, 60% were college educated, and there were more hip/knee patients than back patients (69% v. 31%). Forty-nine percent had surgery. For hips/knees, the SDMP and SURE scores were significantly associated with viewing all of the PDA compared with those who did not ( P < 0.001), but not for CollaboRATE ( P = 0.35). For backs, none of the scores were significantly associated with viewing all the PDA. All 3 scores were significantly associated with less regret and higher satisfaction ( P < 0.001) for hips/knees. For backs, only SURE and CollaboRATE were significantly associated with less regret, and only SDMP was significantly associated with higher satisfaction. For hips/knees and backs, the SDMP and SURE scales were significantly associated with an informed patient-centered decision ( P < 0.001), but this relationship was not significant for CollaboRATE (hips/knees: P = 0.24; backs: P = 0.25). Discussion. Each measure has some evidence of validity. SURE and SDMP better discriminate the use of PDAs and have higher decision quality.

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