The impact of a web-based prognostic intervention on physicians’ prognostic confidence.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12106-12106
Author(s):  
David Hui ◽  
Allison De La Rosa ◽  
Zeena Shelal ◽  
John P Maxwell ◽  
Monawar Hosain ◽  
...  
Keyword(s):  
Decision Making ◽  
Supportive Care ◽  
Advanced Cancer ◽  
Primary Outcome ◽  
Web Based ◽  
Care Clinic ◽  
Prognostic Accuracy ◽  
Before And After ◽  
Secondary Outcomes ◽  
The Impact

12106 Background: Clinicians often hesitate to discuss prognosis with patients because of prognostic uncertainty. The use of validated prognostic models may enhance prognostic confidence and/or prognostic accuracy. Prognostic confidence is a novel concept that has not been well studied and may support prognosis-based decision making. We examined the impact of a web-based prognostic intervention on physicians’ prognostic confidence. Methods: In this prospective study, palliative care specialists estimated the prognosis of patients with advanced cancer seen at an outpatient supportive care clinic using the temporal, surprise and probabilistic questions for 6 m, 3 m, 2 m, 1 m, 2 w, 1 w and 3 d survival. They then reviewed information from a web-based prognostic calculator ( www.predictsurvival.com ) that provided survival predictions from 7 validated prognostic scores, including the Palliative Prognostic Score, Palliative Prognostic Index, and Palliative Performance Status. The clinicians then provided their prognostic estimates post-intervention. The primary outcome was prognostic confidence (0-10 numeric rating scale, where 0 = not at all, 10 = most confident) before vs. after the study intervention. Secondary outcomes included (1) confidence to share the prognosis with patients, (2) confidence to make prognosis-based care recommendations (agreement = strongly agree or agree) and (3) prognostic accuracy. With 220 patients, we had 80% power to detect an effect size of 0.66 with 2-sided α 0.05. We compared the pre-post data using the Wilcoxon signed-rank test for the primary outcome and McNemar test for secondary outcomes. Results: 216 patients with advanced cancer (mean age 61, 50% female) were included and 154 (71%) died. The median (IQR) actual survival was 90 (39, 178) days; the median (IQR) predicted survival before and after intervention were 90 (60, 90) and 80 (60, 90) days, respectively. Prognostic confidence significantly increased after the intervention (pre vs. post: median 6 vs. 7, P < 0.001). A significantly greater proportion of clinicians reported that they felt confident enough about their prognostic estimate to share it with patients (44% vs. 74%, P < 0.001) and to formulate care recommendations (80% vs. 94%, P < 0.001) after the intervention. Prognostic accuracy did not differ significantly before and after the intervention, ranging from 72-100% for the temporal question, 45-97% for the surprise questions and 38%-100% for the probabilistic questions (P > 0.05). Conclusions: Among patients with advanced cancer seen at a supportive care clinic, the web-based prognostic intervention was associated with greater prognostic confidence and willingness to discuss prognosis, despite not significantly altering clinicians’ prognostic estimate or prognostic accuracy. Further research is needed to examine how prognostic tools may be able to augment prognostic discussions and clinical decision making.

scholarly journals Development of an electronic conversation aid to support shared decision making for children with acute otitis media

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jana L Anderson ◽  
e Silva Lucas Oliveira J ◽  
Juan P Brito ◽  
Ian G Hargraves ◽  
Erik P Hess
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Medical Knowledge ◽  
Complication Rates ◽  
Shared Decision ◽  
Web Based ◽  
Quality Issue ◽  
The Impact

Abstract Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.

scholarly journals effects of anemia education using web-based she smart to improve knowledge, attitudes, and practice in adolescent girls

2022 ◽  
Vol 5 (1) ◽  
pp. 44-49
Author(s):  
Ernawati Ernawati ◽  
Yusring Sanusi Baso ◽  
Healthy Hidayanty ◽  
Syafruddin Syarif ◽  
Aminuddin Aminuddin ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Statistical Tests ◽  
Sampling Technique ◽  
P Value ◽  
Growth Disorders ◽  
Normal Numbers ◽  
Web Based ◽  
Before And After ◽  
Smart Education ◽  
The Impact

Anemia is a state of hemoglobin levels in the bloodless than normal numbers according to the sex and age group. The impact of anemia in adolescents is a decrease in achievement and learning spirit and can cause symptoms such as paleness, lethargy, decreased appetite, and growth disorders. Anemia has an impact not only on the health of adolescent girls but can have a long impact on the health of the mother and fetus. You can see the influence of anemia education on knowledge, attitudes, and practice. Uses the Pre-experimental method with the design of one group pretest and posttest. Sampling technique using purposive sampling with the number of 47 adolescent girls. The research was conducted at Senior High School 12 Makassar in September-October 2021. Data analysis using the McNemar test. From the results of statistical tests showed that there was an influence on the use of web-based she smart education model on the use of adolescent girls about anemia with p-value = 0.000 (p<0.05), attitude p-value = 0.016 (p<0.05) and action p-value = 0.001 (p<0.05). Anemia education using web-based she smart can improve knowledge, attitudes, and practice before and after an intervention.

Getting It Wrong Most of The Time: Comparing Trialists’ Choice of Primary Outcome With What Patients And Health Professionals Want

2021 ◽  
Author(s):  
Shaun Treweek ◽  
Viviane Miyakoda ◽  
Dylan Burke ◽  
Frances Shiely
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Care Professionals ◽  
Primary Outcome ◽  
Healthcare Professionals ◽  
Breast Cancer Patients ◽  
Additional Information ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Secondary Outcomes

Abstract Background: Randomised trials support improved decision-making through the data they collect. One important piece of data is the primary outcome – so called because it is what the investigators decide is the most important. Secondary outcomes provide additional information to support decision-making. We were interested in knowing how important patients and healthcare professionals consider the outcomes (especially the primary outcome) measured in a selection of published trials. Methods: The work had three stages: 1. We identified a body of late-stage trials in two clinical areas, breast cancer management and nephrology. 2. We identified the primary and secondary outcomes for these trials. 3. We randomly ordered these outcomes and presented them to patients and healthcare professionals (with experience of the clinical area), and we asked them to rank the importance of the outcomes. They were not told which outcomes trial authors considered primary and secondary. Results: In our sample of 44 trials with 46 primary outcomes, 29 patients, one patient representative and 12 healthcare professionals together ranked the primary outcome as the most important outcome 13/46 times, or 30%. Breast cancer patients and health care professionals considered the primary outcome to be the most important outcome for 8/21 primary outcomes chosen by trialists. For nephrology, the equivalent figure was 5/25. The primary outcome appeared in a respondent’s top 5 ranked outcomes 151/178 (85%) times for breast cancer and 225/259 (87%) times for nephrology even if the primary wasn’t considered the most important outcome. Conclusions: The primary outcome in a trial is the most important piece of data collected. It is used to determine how many participants are required, and it is the main piece of information used to judge whether the intervention is effective or not. Our study found that in the view of patients and healthcare professionals, teams doing trials in breast cancer management and nephrology got their choice of primary outcome wrong 70% of the time.

scholarly journals 1033. Effectiveness of a Physician-Driven Automated Antibiotic Time Out in the Setting of Gram-negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S363-S364
Author(s):  
Sana Mohayya ◽  
Navaneeth Narayanan ◽  
Daniel Cimilluca ◽  
Parth Vaidya ◽  
Alexander Malanowski ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Antibiotic Prescribing ◽  
Gram Negative ◽  
Time Out ◽  
Days Of Therapy ◽  
Gram Negative Bacteremia ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background In an effort to minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO). Despite the increasing adoption of the ATO, limited data are available to support its effectiveness. This study was designed to assess the impact of an automated ATO integrated into the electronic medical record (EMR) on the rate of antibiotic modification in patients receiving broad-spectrum antibiotic(s) for Gram-negative bacteremia (GNB). Methods This was a single-center retrospective cohort study of inpatients from January 2017 to June 2018 conducted at a large academic medical center. ATO was implemented on October 31, 2017. Adult patients with GNB who received at least 72 hours of a systemic antibiotic were included. Patients with neutropenia or polymicrobial infections were excluded. The primary outcome was the proportion of patients who received a modification of therapy within 24 hours of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. Results There was a total of 88 patients who met inclusion criteria, 37 patients pre-ATO and 51 patients post-ATO. The primary outcome of modification of therapy within 24 hours of final culture results was not significantly different for patients in the pre-ATO and post-ATO groups (19% vs. 20%, P = 0.94, respectively). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (62% vs. 66%, P = 0.67). Of the 47 patients who received a modification of therapy, the mean time to modification was significantly shorter in the post-ATO group (52.8 hours vs. 45.26 hours, P < 0.05,). All other secondary outcomes were not significantly different between study groups. Conclusion The ATO alert was not associated with a higher rate of antibiotic modification within 24 hours of culture results in patients with GNB, although there was a significant reduction in the time to antibiotic modification. Further efforts are needed to improve the time to modification and optimize antibiotic prescribing practices. Disclosures All authors: No reported disclosures.

The frequency of references to decision-making capacity in reports to the NSW Mental Health Review Tribunal did not change after legislative reforms that promoted them

2020 ◽  
Vol 28 (2) ◽  
pp. 171-174
Author(s):  
Tim Foley ◽  
Christopher J Ryan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Education Campaign ◽  
Mental Health Act ◽  
Decision Making Capacity ◽  
Before And After ◽  
Legislative Reforms ◽  
The Impact ◽  
Health Review

Objective: To assess the impact of a 2015 reform to the Mental Health Act 2007 (NSW) ( MHA) that was interpreted as requiring a reference to decision-making capacity (DMC) in reports to the NSW Mental Health Review Tribunal (MHRT). Method: A sample of reports to the MHRT were audited for references to the MHA’s treatment criteria and DMC in periods before and after the reforms, and the frequency of references between the two periods was compared. Results: The frequency of references to DMC did not change significantly after the reforms. (However, references to the ‘least restriction’ criterion increased markedly between the two periods). Conclusion: Despite legislative reforms and a supporting education campaign promoting the importance of consideration of DMC, references to DMC did not increase after the reforms.

scholarly journals Don’t cry for me Britannia: The resilience of the European Union to Brexit

2019 ◽  
Vol 21 (1) ◽  
pp. 152-172 ◽  
Author(s):  
Narisong Huhe ◽  
Daniel Naurin ◽  
Robert Thomson
Keyword(s):  
Decision Making ◽  
European Union ◽  
Network Analysis ◽  
Spatial Model ◽  
The Political ◽  
The European Union ◽  
Member States ◽  
Decision To Leave ◽  
Before And After ◽  
The Impact

We assess the impact of the United Kingdom’s 2016 decision to leave the European Union on the Council of the European Union, where Brexit is likely to have the clearest observable implications. Using concepts and models from the spatial model of politics and network analysis, we formulate and test expectations regarding the effects of Brexit. We examine two of the most prominent datasets on recent decision-making in the European Union, which include data on cooperation networks among member states before and after the 2016 referendum. Our findings identify some of the political challenges that Brexit will bring, but also highlight the factors that are already helping the European Union’s remaining member states to adapt to Brexit.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico

2019 ◽  
Vol 35 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Mirza Jacqueline Alcalde-Castro ◽  
Enrique Soto-Perez-de-Celis ◽  
Alfredo Covarrubias-Gómez ◽  
Sofía Sánchez-Román ◽  
Paulina Quiróz-Friedman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Solid Tumors ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
First Year ◽  
Advanced Solid Tumors ◽  
Care Clinic ◽  
Care Services ◽  
Oncology Care

Background: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. Methods: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. Results: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). Conclusion: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

scholarly journals Parenting while living with advanced cancer: A qualitative study

2016 ◽  
Vol 31 (3) ◽  
pp. 231-238 ◽  
Author(s):  
Eliza M Park ◽  
Devon K Check ◽  
Mi-Kyung Song ◽  
Katherine E Reeder-Hayes ◽  
Laura C Hanson ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Functional Status ◽  
Advanced Cancer ◽  
Metastatic Cancer ◽  
Eastern Cooperative Oncology Group ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Parental Concerns ◽  
The Impact

Background: Patients with advanced cancer who have dependent children are an important population with a life-limiting illness and high levels of psychological distress. Few studies have addressed the experience of being a parent with advanced cancer and their potential palliative needs. Aim: To describe the experience of living with advanced cancer as a parent, including illness experience, parental concerns, and treatment decision making and to explore whether these experiences differ by their functional status. Design: We conducted a cross-sectional, qualitative study using in-depth, semi-structured interviews. Data were analyzed using thematic content analysis. Setting and participants: A total of 42 participants with metastatic cancer and with at least one child under the age of 18 years were recruited from a comprehensive cancer center. 25 participants were rated as having high functional status (the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale = 0–1) and 17 with low functional status (ECOG=2–4). Results: We identified four themes regarding the experience of being a parent with advanced cancer: (1) parental concerns about the impact of their illness and death on their children, (2) “missing out” and losses of parental role and responsibilities, (3) maintaining parental responsibilities despite life-limiting illness, and (4) parental identity influencing decision making about treatment. Parental functional status influenced not only physical responsibilities but also intensified parenting psychological concerns. Conclusion: Parents with metastatic cancer may have unique palliative care needs as they experience parenting concerns while managing the psychological and physical demands of advanced cancer.

High Risk AML Outpatient Management: A Retrospective Analysis of Bacteremia Incidence Following Chemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 884-884 ◽  
Author(s):  
Timotheus Y. Halim ◽  
Julye C. Lavoie ◽  
Michael J. Barnett ◽  
Stephen H. Nantel ◽  
Thomas J. Nevill ◽  
...  
Keyword(s):  
High Risk ◽  
Supportive Care ◽  
Bacterial Infections ◽  
Antimicrobial Prophylaxis ◽  
Early Discharge ◽  
Management Policy ◽  
Care Clinic ◽  
Comparative Review ◽  
A Minor ◽  
The Impact

Abstract Treatment of acute myeloid leukemia (AML) involves aggressive remission inducing (IND) chemotherapy, and consolidation (CON) chemotherapy aimed at preventing or delaying relapse. Since September 2001, our institution has implemented a selective discharge protocol, which allows the majority of CON cycles, and some selected IND cycles, to be administered entirely on outpatient (OP), or early discharge (ED: prior to ANC >0.5 x 109/L or before d+15) basis. One of the primary concerns associated with this novel practice is the prompt management of infections in these high-risk neutropenic patients, requiring immediate administration of empirical broad spectrum parenteral antibiotics. Our group previously reported the safety and feasibility of OP management (Savoie Blood 2002, 100:11 p766a). We now present a comparative review of the incidence of septicemia over a 5 year period, encompassing the change in management policy. We investigated the impact of selective discharge on infectious morbidity, and the spectrum of bacterial pathogens and their resistance profile. OP received all standard chemotherapy and supportive care in outpatient settings. Supportive care was modified for OP, adding Ciprofloxacin 500mg po BID as antimicrobial prophylaxis d+1 from the start of chemotherapy. Universal supportive care for all pts consisted of Acyclovir 600mg po qid or Valacyclovir 500mg po od (if HSV IgG positive) and Fluconazole 200–400mg po od or Itraconazole 200mg po bid (if previously aspergillus infection). The prophylaxis was stopped upon ANC recovery. Pts were not routinely treated with G-CSF. Between Feb 1999 and Feb 2004, 328 IND and 295 CON cycles of chemotherapy (total=623) were given to 295 patients. Following guidelines adopted in Sep 1, 2001 the majority of CON cycles [84% (133/159)] were administered to pts in our OP day-care clinic, also a smaller number of CON and some IND cycles were candidates for ED. Analysis of trends indicated a minor decrease in overall bacteremia incidence following the implementation of OP protocol. [21% (65/303) before 1-Sept-01, 19% (61/320) after 1-Sept-01),NS]. However, a significant decrease in bacteremia was observed in the CON cycle subgroup (which included the largest OP population), from 31% (42/136) before, to 19% (29/159) after 1-Sept-01 (p=0.01). In addition, a notable shift in incidence of gram-ve bacteremia occurred in IP (-cipro prophylaxis) compared to OP (+cipro prophylaxis) from 49% to 27% of total bacterial infections. Nevertheless, a larger fraction of gram-ve isolates from OP exhibited resistance to ciprofloxacin. No treatment related deaths occurred as a result of infection in the OP population. This report constitutes the first comparative study of bacteremial complications in high risk neutropenic AML patients treated in OP settings. OP management in conjunction with prophylactic antibiotherapy is safe, and results in a significant decrease in bacteremia. However, the use of gram-ve coverage prophylaxis introduced a shift in pathogenic microorganisms and emergence of resistance. Supported by our findings we propose that selective OP management of AML pts should be encouraged, keeping in mind the change in the spectrum of infections.

Frequency, predictors, and outcomes of urine drug test among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 94-94
Author(s):  
Joseph Anthony Arthur ◽  
Tonya Edwards ◽  
David Hui ◽  
Jessica Marie Waletich-Flemming ◽  
Suresh K. Reddy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Opioid Therapy ◽  
Cancer Stage ◽  
Chronic Opioid Therapy ◽  
Advanced Cancer Patients ◽  
Care Clinic ◽  
Urine Drug ◽  
Outpatient Supportive Care

94 Background: Data on the utilization and outcomes of urine drug tests (UDT) among advanced cancer patients is limited. The main objective of this study was to determine the factors associated with UDT ordering and results in advanced cancer outpatients. Methods: A retrospective chart review of 1058 patients seen from March 2014 to November 2015 at an outpatient supportive care clinic was conducted. Sixty-one patients on chronic opioid therapy who underwent UDT were identified. A control group of 120 patients who did not undergo UDT was selected for comparison of information on demographic and clinical characteristics. Results: 61/1058 patients (6%) underwent UDT. 33/61 patients (54%) had abnormal results. Multivariate analysis found that the odds ratio for UDT ordering was 3.9 in CAGE positive patients (p = 0.002), 4.41 in patients less than 45years (p < 0.001), 5.58 in patients with moderate to severe pain (ESAS pain score ≥ 4) (p < 0.001), 0.27 in patients with advanced cancer stage, (p = 0.008), and 0.25 in patients with moderate to severe fatigue (p = 0.001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were: prescribed opioids absent in urine (14/52, 27%) and un-prescribed opioids in urine (13/52, 25%). Conclusions: UDT was used infrequently among advanced cancer patients receiving outpatient chronic opioid therapy. Younger age, CAGE positivity, early cancer stage or NED status, higher pain intensity, and lower fatigue were significant predictors of UDT ordering. More than 50% of UDTs were abnormal. More research is necessary to better characterize aberrant opioid use in advanced cancer patients.

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