Comparing adherence levels of CLL treatment from both the patient and physician perspective in the U.S.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19009-e19009
Author(s):  
Brad Schenkel ◽  
Pam Hallworth ◽  
Alex Rider ◽  
Brian Macomson ◽  
Jacquelyn McRae
Keyword(s):  
Treatment Decision ◽  
Categorical Variables ◽  
Drug Adherence ◽  
Continuous Variables ◽  
Capsule Formulation ◽  
Treatment Decision Making ◽  
Physician Perspective ◽  
Choice Of Therapy ◽  
The U.S ◽  
Disease Specific

e19009 Background: Prior research has shown that there is a lack of congruency between physicians and patients regarding choice of therapy in CLL care. The aim of this study was to look at whether there are any similar differences in regard to perceptions of drug adherence between a group of CLL patients and their corresponding physicians. Methods: From February to May 2016, the Adelphi CLL Disease Specific Programme (DSP) recruited US physicians who are responsible for treatment decision-making in CLL. Patient Record Forms (PRF) and Patient Self-Completion questionnaires (PSC) were completed by physicians and patients, respectively. Means and standard deviations (SD) were calculated for continuous variables, and proportions were calculated for categorical variables. Results: A total of 81 physicians and 326 patients participated in the CLL DSP. The majority of physicians were heme-oncologists (68%), male (79%), and practiced in both a hospital and office-based setting (86%). Physicians reported that 87% of their CLL patients were “always” or “almost always” adherent to their CLL treatment. However, only 42% of patients reported that they were “never” or “hardly ever” non-adherent to CLL treatment. Patients reported that their physicians addressed adherence in the following methods: physicians asked patients about adherence (56%), nurses/other staff assisted patients (23%), physician did not check (15%), pill checking (3%), materials/resources were given (1%), and other (2%). Three-quarters (75%) of physicians reported that they discussed adherence with their CLL patients consistently. Conclusions: In this study, patients’ and physicians’ perceptions of adherence with regard to CLL treatment were not aligned. Although most physicians reported consistent discussions about adherence with their patients, the majority of patients reported subpar adherence to CLL treatment. As more oncology medications, including those approved in CLL, are available in a pill or capsule formulation and thus self-administered, it will be increasingly important to make patients aware of the importance of adhering to their medication and including physicians and caregivers in this dialogue.

Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes

2020 ◽  
Vol 132 (3) ◽  
pp. 692-699 ◽  
Author(s):  
Sarah K. Bick ◽  
Marjan S. Dolatshahi ◽  
Benjamin L. Grannan ◽  
Andrew J. Cole ◽  
Daniel B. Hoch ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Treatment Decision ◽  
Temporal Lobectomy ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foramen Ovale ◽  
Mri Findings ◽  
Noninvasive Methods ◽  
Diagnostic Modality ◽  
Diagnostic Investigations

OBJECTIVEForamen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure.METHODSAll cases of diagnostic investigations performed with FOEs at the authors’ institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.RESULTSNinety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018).CONCLUSIONSFOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.

Treatment decision making in metastatic prostate cancer (mPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 224-224
Author(s):  
Alicia K. Morgans ◽  
Angela Fought ◽  
Benjamin Lee ◽  
David James VanderWeele ◽  
Maha H. A. Hussain ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Good Health ◽  
Clinical Encounter ◽  
Treatment Choice ◽  
Categorical Variables ◽  
Exact Test ◽  
Treatment Decision Making ◽  
High Level ◽  
The Relationship

224 Background: Multiple treatments exist for mPC, and optimal treatment choice is not defined. Shared decision making (SDM) in which physicians communicate treatment purpose, risks, and benefits, and patients (pts) communicate values/preferences can be used to determine treatment. SDM is associated with superior health outcomes in non-cancer populations, but whether it is used in mPC is unknown. We assessed mPC pt and caregiver perceptions of decision locus of control (DLOC) (SDM vs physician (PD) or pt (PtD) directed decisions), and characteristics associated with DLOC. Methods: Between 12/16 and 11/17, mPC patients and caregivers completed surveys of decision making practices after a clinical encounter in which a decision occurred. To evaluate the relationship between pt perception of DLOC type and categorical variables we used Fisher’s exact test, and Kruskal-Wallis was used to evaluate the relationship between DLOC and age. Results: 50 pt/caregivers participated, with median pt age of 72 yo. Most pts were Caucasian (96%), married (90%), and reported good health or better (18% excellent, 58% good, 24% fair). 66% of pts reported SDM, 10% reported PD only, 12% reported PD considering patient’s preferences, and 12% reported PtD considering physician’s recommendation. Caregivers reported numerically lower rates of SDM (56%), PD only (6%), and PD considering patient’s preferences (8%), but greater PtD considering physician’s recommendation (30%), (p=0.28). Neither reported PtD without considering physician recommendations. There was no association between pt DLCO and age (p=0.70) or clinician type, (p=0.13). All pts reporting PtD considering physician’s recommendation saw medical oncologists rather than urologists. Conclusions: Both pts and caregivers perceived a majority of decisions as SDM, indicating a high level of patient engagement in mPC decision making, and clinician type and patient age were not associated with pt reported DLOC. Pts seen by medical oncology in this cohort reported directing treatment choice when considering physician’s recommendation. Efforts to assess and support decision making in more diverse patient populations and explore the association between SDM, pt satisfaction and quality of life are underway.

scholarly journals Autoantibody Biomarkers in Rheumatic Diseases

2020 ◽  
Vol 21 (4) ◽  
pp. 1382 ◽  
Author(s):  
Eun Ha Kang ◽  
You-Jung Ha ◽  
Yun Jong Lee
Keyword(s):  
Rheumatic Diseases ◽  
Biological Effects ◽  
Treatment Decision ◽  
Clinical Value ◽  
Active Involvement ◽  
Treatment Decision Making ◽  
Tremendous Progress ◽  
Systemic Rheumatic Diseases ◽  
Pathogenic Process ◽  
Disease Specific

Autoantibodies encountered in patients with systemic rheumatic diseases bear clinical significance as a biomarker to help or predict diagnosis, clinical phenotypes, prognosis, and treatment decision-making. Furthermore, evidence has accumulated regarding the active involvement of disease-specific or disease-associated autoantibodies in the pathogenic process beyond simple association with the disease, and such knowledge has become essential for us to better understand the clinical value of autoantibodies as a biomarker. This review will focus on the current update on the autoantibodies of four rheumatic diseases (rheumatoid arthritis, myositis, systemic sclerosis, and anti-neutrophil cytoplasmic antibody associated vasculitis) where there has been a tremendous progress in our understanding on their biological effects and clinical use.

Patient Involvement in Treatment Decision Making Can Help or Hinder Placebo Analgesia

2014 ◽  
Vol 222 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Andrew L. Geers ◽  
Jason P. Rose ◽  
Stephanie L. Fowler ◽  
Jill A. Brown
Keyword(s):  
Patient Involvement ◽  
Cold Water ◽  
Prior Experience ◽  
Water Immersion ◽  
Treatment Decision ◽  
Cold Water Immersion ◽  
Not Given ◽  
Placebo Analgesia ◽  
Treatment Decision Making ◽  
Immersion Experience

Experiments have found that choosing between placebo analgesics can reduce pain more than being assigned a placebo analgesic. Because earlier research has shown prior experience moderates choice effects in other contexts, we tested whether prior experience with a pain stimulus moderates this placebo-choice association. Before a cold water pain task, participants were either told that an inert cream would reduce their pain or they were not told this information. Additionally, participants chose between one of two inert creams for the task or they were not given choice. Importantly, we also measured prior experience with cold water immersion. Individuals with prior cold water immersion experience tended to display greater placebo analgesia when given choice, whereas participants without this experience tended to display greater placebo analgesia without choice. Prior stimulus experience appears to moderate the effect of choice on placebo analgesia.

Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations

2017 ◽  
Vol 13 (2) ◽  
pp. 169-184 ◽  
Author(s):  
Shuya Kushida ◽  
Takeshi Hiramoto ◽  
Yuriko Yamakawa
Keyword(s):  
Decision Making ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Close Inspection ◽  
Important Resource ◽  
Treatment Decision Making ◽  
The Way

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.

Enhancing Involvement in Treatment Decision Making by Women with Breast Cancer

2007 ◽  
Author(s):  
Mary A. O'Brien ◽  
Timothy Whelan ◽  
Amiram Gafni ◽  
Cathy Charles ◽  
Peter Ellis
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Treatment Decision Making
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