The impact of caregiver’s role preference on decisional conflicts and psychiatric distresses in decision making to help caregiver’s disclosure of terminal disease status.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10106-10106
Author(s):  
Shin Hye Yoo ◽  
Young Ho Yun ◽  
Kyoung-Nam Kim ◽  
Jung Lim Lee ◽  
Jeanno PARK ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Aid ◽  
Passive Control ◽  
Disease Status ◽  
Control Group ◽  
Change Scores ◽  
Terminal Disease ◽  
Role Preference ◽  
Patient Reported ◽  
The Impact

10106 Background: A decision aid (DA) increases knowledge, decreases decisional conflicts and regrets and improves post-decision satisfaction, emotional distress. However, few DA trials have revealed whether decisional role preferences have an impact on patient-reported outcomes by decision making. The objective of this study was to investigate the impact of caregiver’s decisional role preference on decisional conflicts and psychiatric distresses in decision making. Methods: 406 of 444 caregivers of terminally ill cancer patients enrolled onto a previous trial determining the efficacy of the decision aid about disclosure of terminal disease status were included in this analysis. The analysis outcomes were change score of decisional conflicts using the Decision Conflict Scale (DCS) and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) at 1 and 3 months from baseline. Participants were divided into 4 groups: active caregiver who received DA (active-DA), active caregiver in control group (active-control), passive caregiver who received DA (passive-DA), and passive caregiver in control group (passive-control). Linear mixed model was conducted to find out the impact of caregiver’s decisional role preference on the DCS and the HADS. Results: Among 406 caregivers, 137 (33.7%) showed active role preference, and 269 (66.3%) showed passive role preference. In post-hoc analysis of adjusted differences of change scores between passive-DA and active-DA groups, non-significant differences were observed in DCS. However, at 3 months, change scores of HADS depression subscale increased as 4.43 (95% confidence interval (CI), 0.78-8.07; P< 0.007; effect size (ES) 0.71) and those of HADS anxiety subscales increased as 4.14 (95% CI, 0.37-7.91; P= 0.021; ES 0.61) in passive-DA group than in active-DA group, showing moderate to large difference. Conclusions: These findings suggest that information about decision making might be provided with tailored format for how much individual wish to involve in decision making.

Evaluating a Web-Based Training Program for Nurses on Shared Decision-Making and Screening for Down Syndrome: Protocol for a Randomized Control Trial (Preprint)

2020 ◽  
Author(s):  
Alex Poulin Herron ◽  
Titilayo Tatiana Agbadjé ◽  
Mélissa Côté ◽  
Codjo-Djignefa Djade ◽  
Geneviève Roch ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Training Program ◽  
Decision Aid ◽  
Prenatal Screening ◽  
Control Group ◽  
Intention To Use ◽  
Shared Decision ◽  
Web Based ◽  
The Impact

BACKGROUND Pregnant women have difficulty choosing from amongst the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid (DA) and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses have responsibilities regarding maternity care and thus the potential to do decision coaching on prenatal screening. However, there is a gap of knowledge concerning the effectiveness of SDM interventions in this area of nursing practice. OBJECTIVE This study aims to assess the impact of an SDM training program on nurses’ intention to use a decision aid for prenatal screening as well as their knowledge and overall appreciation of the training. METHODS This is a two-arm parallel randomized trial. Nurses working with pregnant women from the province of Quebec, and speaking in French, will be recruited online by a private survey firm. They will be randomly allocated (1:1 ratio) to either an experimental group, which will complete a web-based SDM training program for prenatal screening, or to a control group, which will complete a web-based training program focusing on prenatal screening alone. The experimental intervention consists of a three hour web-based and fully automated training activity hosted on the University Laval platform and has four modules: 1) SDM; 2) Down syndrome prenatal screening; 3) DA; and 4) Communication between healthcare professionals and the patient. For the control group, the topic of SDM in Module 1 has been replaced with “Context and history of prenatal screening” and the topic of DA in Module 3 has been replaced with “Consent in prenatal screening.” In addition to sociodemographic questions using a self-administered questionnaire with closed ended questions, we will assess 1) intention to use a DA in prenatal screening clinical practice; 2) knowledge; 3) satisfaction with the training; 4) acceptability; and 5) perceived usefulness. The randomization will be done by a predetermined sequence and include 36 nurses. Participants and researchers will be blinded. Intention to use DA will be assessed by a Student t test and bivariate and multivariate analysis will be performed to assess knowledge and overall appreciation of the training. RESULTS This study is ongoing and results will be available at the end of 2020 CONCLUSIONS This study results will inform on the impact of an SDM training program on nurses’ intention to use a decision aid for prenatal screening as well as their knowledge and overall appreciation of the training. It will also provide feedback on ways to upgrade the SDM training program, if needed. CLINICALTRIAL ClinicalTrials.gov ID NCT04162288

scholarly journals Impact of decision aids used during clinical encounters on clinician outcomes and consultation length: a systematic review

2018 ◽  
Vol 28 (6) ◽  
pp. 499-510 ◽  
Author(s):  
Claudia Caroline Dobler ◽  
Manuel Sanchez ◽  
Michael R Gionfriddo ◽  
Neri A Alvarez-Villalobos ◽  
Naykky Singh Ospina ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Aid ◽  
Evidence Synthesis ◽  
Decision Aids ◽  
Medical Decision ◽  
Control Group ◽  
Clinical Encounters ◽  
Prevention And Treatment ◽  
The Future ◽  
The Impact

BackgroundClinicians’ satisfaction with encounter decision aids is an important component in facilitating implementation of these tools. We aimed to determine the impact of decision aids supporting shared decision making (SDM) during the clinical encounter on clinician outcomes.MethodsWe searched nine databases from inception to June 2017. Randomised clinical trials (RCTs) of decision aids used during clinical encounters with an unaided control group were eligible for inclusion. Due to heterogeneity among included studies, we used a narrative evidence synthesis approach.ResultsTwenty-five papers met inclusion criteria including 22 RCTs and 3 qualitative or mixed-methods studies nested in an RCT, together representing 23 unique trials. These trials evaluated healthcare decisions for cardiovascular prevention and treatment (n=8), treatment of diabetes mellitus (n=3), treatment of osteoporosis (n=2), treatment of depression (n=2), antibiotics to treat acute respiratory infections (n=3), cancer prevention and treatment (n=4) and prenatal diagnosis (n=1). Clinician outcomes were measured in only a minority of studies. Clinicians’ satisfaction with decision making was assessed in only 8 (and only 2 of them showed statistically significantly greater satisfaction with the decision aid); only three trials asked if clinicians would recommend the decision aid to colleagues and only five asked if clinicians would use decision aids in the future. Outpatient consultations were not prolonged when a decision aid was used in 9 out of 13 trials. The overall strength of the evidence was low, with the major risk of bias related to lack of blinding of participants and/or outcome assessors.ConclusionDecision aids can improve clinicians’ satisfaction with medical decision making and provide helpful information without affecting length of consultation time. Most SDM trials, however, omit outcomes related to clinicians’ perspective on the decision making process or the likelihood of using a decision aid in the future.

scholarly journals Educational Intervention for Effective Postoperative Pain Management in Low Resource Settings: Evidence from Ethiopia

2019 ◽  
Author(s):  
Million Tesfaye Eshete ◽  
Petra I. Baeumler ◽  
Markos Tesfaye ◽  
Yemane Ayele ◽  
Abraham Haileamlak ◽  
...  
Keyword(s):  
Decision Making ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Educational Intervention ◽  
Patient Reported Outcomes ◽  
Postoperative Pain Management ◽  
Control Group ◽  
Patient Reported ◽  
The Impact

Abstract Background The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. Healthcare professionals and patients in education might help in controlling postoperative pain effectively. However, data from low-income countries investigating the impact of educational intervention on postoperative pain are very scanty, and reports from the developed settings are inconclusive. The study has investigated the impact of preoperative patient education and health care professionals education on improving the quality of postoperative pain management; in patients scheduled for major elective orthopedic, gynecologic and general surgery; as measured by patient-reported outcomes. Methods This was a quasi-experimental, non-equivalent control group design with before and after measures. We have recruited 700 consecutive patients; who are eighteen years or more, scheduled for general, orthopedic and gynecologic surgery. Outcome measures were patient-reported outcomes (postoperative pain intensity, pain interference, and perception of care) and adequacy of pain management used. Results Generally, no significant difference was observed in most outcome measures except for the worst level of pain, least level of pain, patient participation in decision making and feeling of drowsiness between the treatment and control group. Conclusion Results of this study contained very important information in understanding the effectiveness of educational interventions in the postoperative setting. The treatment was successful in increasing patients participation in decision making, as anticipated. However, its impact on decreasing pain intensity was only noted at the last measurement point after surgery.

Optimizing patient adherence to stroke rehabilitation: A mixed method telerehabilitation trial (Preprint)

2021 ◽  
Author(s):  
Isabelle Gaboury ◽  
Michel Tousignant ◽  
Hélène Corriveau ◽  
Matthew Menear ◽  
Guylaine Le Dorze ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Rehabilitation ◽  
Patient Adherence ◽  
Interprofessional Collaboration ◽  
Interdisciplinary Collaboration ◽  
Control Group ◽  
Shared Decision ◽  
The Impact

BACKGROUND Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration to normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration to normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured on clinicians. METHODS In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will entail 220 patients to receive stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation) versus face-to-face, standard of care (n = 110 patients). RESULTS Results: Our Research Ethics Board has approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS This study will contribute to minimize both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practices guidelines regarding telecare services and the provision of telerehabilitation, including recommendations regarding effective interdisciplinary collaboration regarding stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT04440215

scholarly journals Explicit and implicit markers of fairness preeminence in criminal judges

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hernando Santamaría-García ◽  
Jorge Martínez Cotrina ◽  
Nicolas Florez Torres ◽  
Carlos Buitrago ◽  
Diego Mauricio Aponte-Canencio ◽  
...  
Keyword(s):  
Decision Making ◽  
Ultimatum Game ◽  
Reaction Times ◽  
Control Group ◽  
Physiological Factors ◽  
Social Decision ◽  
Implicit Measurement ◽  
New Research ◽  
Social Decision Making ◽  
The Impact

AbstractAchieving justice could be considered a complex social decision-making scenario. Despite the relevance of social decisions for legal contexts, these processes have still not been explored for individuals who work as criminal judges dispensing justice. To bridge the gap, we used a complex social decision-making task (Ultimatum game) and tracked a heart rate variability measurement: the square root of the mean squared differences of successive NN intervals (RMSSD) at their baseline (as an implicit measurement that tracks emotion regulation behavior) for criminal judges (n = 24) and a control group (n = 27). Our results revealed that, compared to controls, judges were slower and rejected a bigger proportion of unfair offers. Moreover, the rate of rejections and the reaction times were predicted by higher RMSSD scores for the judges. This study provides evidence about the impact of legal background and expertise in complex social decision-making. Our results contribute to understanding how expertise can shape criminal judges’ social behaviors and pave the way for promising new research into the cognitive and physiological factors associated with social decision-making.

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.

scholarly journals Patient-Reported Satisfaction Following Radiation of Implant-Based Breast Reconstruction

2019 ◽  
Vol 27 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Eva Thiboutot ◽  
Peter Craighead ◽  
Carmen Webb ◽  
Claire Temple-Oberle
Keyword(s):  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Control Group ◽  
Arm Morbidity ◽  
Patient Reported ◽  
Cosmetic Outcomes ◽  
Baseline Characteristics ◽  
Pro Tools ◽  
Tumour Characteristics ◽  
The Impact

Background: Little is known with regard to patient-reported outcomes (PROs) in the setting of implant-based reconstruction (IBR) with post-mastectomy radiation therapy (PMRT). Methods: We identified patients who underwent immediate IBR from a prospectively compiled database. The Breast Reconstruction Satisfaction Questionnaire (BRECON-31) was scored and compared between patients with and without PMRT. Results: Sixty-four women met the study criteria. Forty-eight did not receive PMRT and 16 did. Nine women had an unanticipated indication for PMRT. The PMRT group was similar to the control group with regard to baseline characteristics (ie, age, marital status, body mass index, tobacco use, and comorbidities). However, treatment and oncologic characteristics (eg, diagnosis, tumour characteristics, systemic therapy use) differed. Of all complications, only capsular contracture rates differed (1.2% vs 13%; P = .01). Of the 9 subscales, 7 showed no difference in satisfaction between the groups. Radiated women scored lower in the arm concerns and breast appearance subscales. Scores were similar whether the indication for PMRT had been anticipated or not. Discussion: Women with immediate IBR scored similarly to their nonradiated counterparts across 7 of 9 domains of satisfaction. Arm concerns and breast appearance scores are lower with PMRT, likely secondarily to more extensive nodal procedures in higher stage patients and to the side effect profile of radiotherapy. Our findings are in line with the few available studies using other PRO tools to evaluate the impact of PMRT on patient satisfaction and studies objectively measuring the effect of PMRT on arm morbidity and cosmetic outcomes.

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