Changes over Time in Patient Stated Values and Treatment Preferences Regarding Aggressive Therapies: Insights from the DECIDE-LVAD Trial

2021 ◽  
pp. 0272989X2110282
Author(s):  
Christopher E. Knoepke ◽  
Erin L. Chaussee ◽  
Daniel D. Matlock ◽  
Jocelyn S. Thompson ◽  
Colleen K. McIlvennan ◽  
...  
Keyword(s):  
Patient Centered Care ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Treatment Preference ◽  
Treatment Preferences ◽  
Patient Centered ◽  
Centered Care ◽  
Aggressive Care ◽  
Changes Over Time ◽  
Over Time

Background Patient-centered care includes matching treatments to patient values and preferences. This assumes clarity and consistency of values and preferences relevant to major medical decisions. We sought to describe stability of patient-reported values regarding aggressiveness of care and preferences for left ventricular assist devices (LVADs) for advanced heart failure. Methods and Results We conducted a secondary analysis of patients undergoing LVAD evaluation at 6 US centers. Surveys at baseline, 1 month, and 6 months included a single 10-point scale on the value of aggressive care (score 1 = “do everything,” 10 = “live with whatever time I have left”) and treatment preference (LVAD, unsure, no LVAD). Data were captured for 232 patients, of whom 196 were ultimately deemed medically eligible for LVAD, and 161 were surgically implanted by 1 month. Values at baseline favored aggressive care (mean [SD], 2.49 [2.63]), trending toward less aggressive over time (1 month, 2.63 [2.05]; 6 months, 3.22 [2.70]). Between baseline and 1 month, values scores changed by ≥2 points in 28% (50/176), as did treatment preferences for 18% (29/161) of patients. Values score changes over time were associated with lower illness acceptance, depression, and eventual LVAD ineligibility. Treatment preference change was associated with values score change. Conclusion Most patients considering LVAD were stable in their values and treatment preferences. This stability, as well as the association between unstable treatment preferences and changes to stated values, highlighted the clinical utility of the values scale of aggressiveness. However, a substantial minority reported significant changes over time that may complicate the process of shared decision making. Improved methods to elicit and clarify values, including support to those with depression and low illness acceptance, is critical for patient-centered care. [Box: see text]

scholarly journals Patient-Centered Care: An Examination of Provider–Patient Communication Over Time

2019 ◽  
Vol 6 ◽  
pp. 233339281988287
Author(s):  
Leslie Riggle Miller ◽  
B. Mitchell Peck
Keyword(s):  
Positive Impact ◽  
Patient Centered Care ◽  
Patient Communication ◽  
Self Report ◽  
Primary Data ◽  
Provider Communication ◽  
Patient Centered ◽  
Centered Care ◽  
Over Time

Objective: To examine the quality of provider communication over time considering the increasing emphasis on patient-centered care (PCC). Patient-centered care has been shown to have a positive impact on health outcomes, care experiences, quality-of-life, as well as decreased costs. Given this emphasis, we expect that provider–patient communication has improved over time. Data Source: We collected primary data by self-report surveys between summer 2017 and fall 2018. Study Design: We use a quantitative retrospective cohort study of a national sample of 353 patients who had an ostomy surgery. Data Extraction Method: We measure provider communication from open-ended self-reports from patients of the number of stated inadequacies in their care. Principal Findings: Results show that the time since patients had their surgery is related to higher quality provider communication. That is, patients who had their surgery further back in time reported higher quality provider communication compared with patients who had their surgery performed more recently. Conclusion: Results suggest that the quality of provider communication has not improved even with an emphasis on PCC.

Psychometric Properties of the Treatment Perception and Preferences Measure

2016 ◽  
Vol 27 (6) ◽  
pp. 743-761 ◽  
Author(s):  
Souraya Sidani ◽  
Dana R. Epstein ◽  
Mary Fox ◽  
Joyal Miranda
Keyword(s):  
Side Effects ◽  
Psychometric Properties ◽  
Efficient Method ◽  
Patient Centered Care ◽  
Treatment Preferences ◽  
Alternative Treatments ◽  
Patient Centered ◽  
Centered Care ◽  
Behavioral Treatments ◽  
Informed Treatment

Patient-centered care involves the provision of treatments that are responsive to patients’ preferences. This study aimed to examine the psychometric properties of the Treatment Perception and Preferences measure. Participants ( n = 128) completed the measure relative to pharmacological, educational, and behavioral treatments for the management of insomnia. For each treatment, the measure presents a description of its goal, activities, mode and dose of delivery, and nine items to rate its perceived acceptability. All items measuring perception of treatment were internally consistent (α > .85) and loaded on one factor, except the item assessing severity of side effects. Differences in the measure’s scores between groups of participants provided evidence of validity: participants with a preference for a particular treatment rated it more favorably than alternative treatments. The measure provides a systematic and efficient method for eliciting well-informed treatment preferences. Its use in practice should be investigated.

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