Abstract 27: Patients' Perspectives on a Decision Aid to Facilitate Cost-sensitive Decisions for Sacubitril-Valsartan

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andrea R Mitchell ◽  
Grace Venechuk ◽  
Larry A Allen ◽  
Dan D Matlock ◽  
Miranda Moore ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Shared Decision ◽  
Cost Information ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: Decision aids frequently focus on decisions that are preference-sensitive due to an absence of superior medical option or qualitative differences in treatments. Out of pocket cost can also make decisions preference-sensitive. However, cost is infrequently discussed with patients, and cost has not typically been considered in developing approaches to shared decision-making or decision aids. Determining a therapy’s value to a patient requires an individualized assessment of both benefits and cost. A decision aid addressing cost for sacubitril-valsartan in heart failure with reduced ejection fraction (HFrEF) was developed because this medication has clear medical benefits but can entail appreciable out-of-pocket cost. Objective: To explore patients’ perspectives on a decision aid for sacubitril-valsartan in HFrEF. Methods: Twenty adults, ages 32-73, with HFrEF who met general eligibility for sacubitril-valsartan were recruited from outpatient HF clinics and inpatient services at 2 geographically-distinct academic health systems. In-depth interviews were conducted by trained interviewers using a semi-structured guide after patients reviewed the decision aid. Interviews were audio-recorded and transcribed; qualitative descriptive analysis was conducted using a template analytic method. Results: Participants confirmed that cost was relevant to this decision and that cost discussions with clinicians are infrequent but welcomed. Participants cited multiple ways that this decision aid could be helpful beyond informing a choice; these included serving as a conversation starter, helping inform questions, and serving as a reference later. The decision aid seemed balanced; several participants felt that it was promotional, while others wanted a more “positive” presentation. Participants valued the display of benefits of sacubitril-valsartan but had variable views about how to apply data to themselves and heterogenous interpretations of a 3% absolute reduction in mortality over 2 years. None felt this benefit was overwhelming; about half felt it was very small. The decision aid incorporated a novel “gist statement” to contextualize benefits and counter tendencies to dismiss this mortality reduction as trivial. Several participants liked this statement; few had strong impressions. Conclusion: Out of pocket cost should be part of shared decision-making. These data suggest patients are receptive to inclusion of cost in decision aids and that a “middle ground” between being promotional and negative may exist. The data, however, raise concerns regarding potential dismissal of clinically meaningful benefits and illustrate challenges identifying appropriate contextualizing language. The impact of various framings warrants further study, as does integration of decision aids with patient-specific out-of-pocket cost information during clinical encounters.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations

2018 ◽  
Vol 42 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Matthew Quigley ◽  
Michael P Dillon ◽  
Stefania Fatone
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Development Process ◽  
Decision Aids ◽  
Treatment Options ◽  
International Standards ◽  
Shared Decision ◽  
Patient Decision ◽  
Partial Foot Amputation

Background: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. Objectives: To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Conclusion: Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Measuring the impact of chemotherapy cost discussions between patients and providers at the time of prescribing.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 257-257 ◽  
Author(s):  
Ronan Joseph Kelly ◽  
Patrick M. Forde ◽  
Ashley Bagheri ◽  
Jenny Ahn ◽  
Arlene A. Forastiere ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Cost Of Care ◽  
Physician Satisfaction ◽  
Shared Decision ◽  
Cost Information ◽  
Nccn Guidelines ◽  
Negative Feelings ◽  
The Impact

257 Background: In 2007, the ASCO Cost of Care Task Force was established to deal with the soaring costs of cancer treatment in the United States. One of the key recommendations was that the cost of chemotherapy should be introduced into the patient-physician discussion from the outset. It is unknown if these discussions are occurring in academic Institutions and what if any is the impact on the doctor/patient relationship. Methods: The National Comprehensive Cancer Network (NCCN) Guidelines and the Eviti advisor platform were jointly used in an academic oncology center during the patient/doctor consultation to demonstrate treatment options to patients and display the costs at the time of prescribing to providers and patients alike. Questionnaires measured oncology providers attitudes to cost discussions and assessed physician satisfaction with the shared decision making process when costs are introduced into the patient/doctor relationship. Patients were interviewed before and after their doctor consultation to measure their satisfaction with the process using modifications of the shared decision making scale, satisfaction with decision scale and decisional conflict scale. Basic descriptive statistics were applied. Results: Only 5/18 oncologists (28%) reported feeling comfortable discussing costs with patients and just one (6%) admitted to regularly asking patients about financial difficulties. The majority (83%) of doctors reported that the NCCN guidelines should contain cost information. Seventy-one patients (42 females, 29 males) with metastatic breast (27%), lung (49%), and colorectal cancer (24%) have been interviewed. Interestingly, 70% of patients responded that no health care professional has ever discussed costs with them despite 57/71 (80%) rating this as very important information. The majority of patients (75%) had no negative feelings to hearing cost information. Only 4% admitted to developing significant negative feelings. Conclusions: In an era of rising co-pays, patients want cost of treatment discussions and these do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.

Development of a New Encounter Decision Aid for Smoking Cessation (Preprint)

2021 ◽  
Author(s):  
Herul Holland Da Sa Neto ◽  
Ines Habfast-Robertson ◽  
Christina Hempel-Bruder ◽  
Marie-Anne Durand ◽  
Isabelle Jacot-Sadowski ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
General Practitioners ◽  
Decision Aid ◽  
Tobacco Cessation ◽  
Decision Aids ◽  
Therapeutic Education ◽  
Shared Decision

BACKGROUND Smoking cessation is an essential part of preventing and reducing risk of smoking associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Encounter decision aids, short, patient-facing decision aids used during clinic visits, optimize therapeutic education and increase interaction and the therapeutic alliance. Such a decision aid for smoking cessation could potentially improve counselling and increase the use of pharmacological treatments. OBJECTIVE We aimed to develop and test an electronic encounter decision aid (DA) that facilitates physician-patient interaction and shared decision making for smoking cessation in primary care. METHODS We developed a DA (howtoquit.ch) adapted from a paper version developed by our team in 2017 following user-centered design principles. The DA is a one page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, a questionnaire was submitted to general practitioner residents of an academic general medicine department, five general practitioners, and five experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free text questions assessing the usability/acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision making and patients' choices, perceived strengths and weaknesses and if they would recommend the tool to other clinicians. RESULTS Six residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (n=11), and 4 additional experts provided open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5) and supported shared decision making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to the end users comments. CONCLUSIONS The overall assessment of the DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.

scholarly journals Effectiveness of decision aids on cancer-screening decision-making: an umbrella review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051156
Author(s):  
Masaya Hibino ◽  
Chisato Hamashima ◽  
Mitsunaga Iwata ◽  
Teruhiko Terasawa
Keyword(s):  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Systematic Reviews ◽  
Decision Aid ◽  
Decision Aids ◽  
Study Patient ◽  
Shared Decision ◽  
Umbrella Review ◽  
Delivery Methods

IntroductionAlthough systematic reviews have shown how decision aids about cancer-related clinical decisions improve selection of key options and shared decision-making, whether or not particular decision aids, defined by their specific presentation formats, delivery methods and other attributes, can perform better than others in the context of cancer-screening decisions is uncertain. Therefore, we planned an overview to address this issue by using standard umbrella review methods to repurpose existing systematic reviews and their component comparative studies.Methods and analysisWe will search PubMed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects from inception through 31 December 2021 with no language restriction and perform full-text evaluation of potentially relevant articles. We will include systematic reviews of randomised controlled trials or non-randomised studies of interventions that assessed a decision aid about cancer-screening decisions and compared it with an alternative tool or conventional management in healthy average-risk adults. Two reviewers will extract data and rate the study validity according to standard quality assessment measures. Our primary outcome will be intended and actual choice and adherence to selected options. The secondary outcomes will include attributes of the option-selection process, achieving shared decision-making and preference-linked psychosocial outcomes. We will qualitatively assess study, patient and intervention characteristics and outcomes. We will also take special care to investigate the presentation format, delivery methods and quality of the included decision aids and assess the degree to which the decision aid was delivered and used as intended. If appropriate, we will perform random-effects model meta-analyses to quantitatively synthesise the results.Ethics and disseminationEthics approval is not applicable as this is a secondary analysis of publicly available data. The review results will be submitted for publication in a peer-reviewed journal.Prospero registration numberCRD42021235957.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference-sensitivity and personal motives

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Simone Korger ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cruciate Ligament ◽  
Decision Aids ◽  
Future Research ◽  
Control Group ◽  
Decision Making Process ◽  
Shared Decision ◽  
Decision Strategies ◽  
The Impact

Objective: To participate in shared decision-making (SDM), patients need to understand their options and develop trust in their own decision-making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference-sensitivity (Study 1) and showing possible personal motives for decision-making (Study 2) in addition to providing information about the treatment options.Methods: Participants (Study 1: N=117; Study 2: N=217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video, and were randomized into one of three groups where they received additional information in the form of 1) narrative patient testimonials; 2) non-narrative decision strategies; 3) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P<.001, η²p=0.43; Study 2: P<.001, η²p=0.57) and evaluated the decision-making process more positively (Study 2: P<.001, η²p=0.13) than participants in the control condition. Decision certainty (Study 1: P<.001, η2p=0.05) and satisfaction (Study 1: P<.001, η2p=0.11; Study 2: P=.003, d=0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P<.001, η²p=0.05).Discussion: DAs that explain preference-sensitivity and personal motives can be beneficial for improving people’s feelings of being prepared and their perception of the decision-making process. To reach decision certainty and satisfaction, being well informed of one’s options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs.

scholarly journals Show Me the Money

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Neal W. Dickert ◽  
Andrea R. Mitchell ◽  
Grace E. Venechuk ◽  
Daniel D. Matlock ◽  
Miranda A. Moore ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Ejection Fraction ◽  
Decision Aid ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Specific Cost ◽  
Reduced Ejection Fraction ◽  
Medication Costs ◽  
Out Of Pocket Costs

Background: Out-of-pocket medication costs for patients who have heart failure with reduced ejection fraction may be an important part of shared decision-making, but cost has generally been excluded from clinical discussions. This study reports patients’ perspectives on a decision aid for sacubitril/valsartan that explicitly addresses out-of-pocket costs. Methods: Structured, in-depth interviews were conducted with 20 patients with heart failure with reduced ejection fraction from 2 medical centers to elicit their views on a publicly available decision aid for sacubitril/valsartan that explicitly incorporates considerations related to out-of-pocket costs. Qualitative descriptive analysis was conducted. Results: Key themes identified were general enthusiasm for decision aids for medication decisions, openness on the part of patients to incorporation of cost into decision-making and the decision aid, requests for greater specificity regarding patient-specific cost, and challenges communicating evidence of benefit in a way that allows patients to make cost-benefit analyses for themselves. Patients also raised questions regarding logistical challenges of incorporating a decision aid into the normal clinical and decision-making workflow. Conclusions: Patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions include developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients’ difficulties (and sometimes skepticism) applying trial evidence to their own situation. In addition, implementation strategies are important to develop to facilitate decision aid integration for routine medical decisions into clinic workflow.

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