People into Practice: Design of a Medical Decision Aid with Repetitive Stakeholders' Input

2013 ◽  
Vol 7 (1) ◽  
pp. 51-63 ◽  
Author(s):  
Carolina Leyva ◽  
Mike Zender ◽  
Katherine Staun ◽  
Anna Heeman ◽  
William Brinkman ◽  
...  
Keyword(s):  
Decision Aid ◽  
Medical Decision

scholarly journals Modeling recovery curves with application to prostatectomy

Biostatistics ◽  
2018 ◽  
Vol 20 (4) ◽  
pp. 549-564 ◽  
Author(s):  
Fulton Wang ◽  
Cynthia Rudin ◽  
Tyler H Mccormick ◽  
John L Gore
Keyword(s):  
Decision Aid ◽  
Medical Literature ◽  
Medical Decision ◽  
Clinical Settings ◽  
Curve Shape ◽  
Sharp Drop ◽  
Recovery Curve ◽  
Recovery Curves ◽  
Pre Treatment ◽  
Scalar Time Series

Summary In many clinical settings, a patient outcome takes the form of a scalar time series with a recovery curve shape, which is characterized by a sharp drop due to a disruptive event (e.g., surgery) and subsequent monotonic smooth rise towards an asymptotic level not exceeding the pre-event value. We propose a Bayesian model that predicts recovery curves based on information available before the disruptive event. A recovery curve of interest is the quantified sexual function of prostate cancer patients after prostatectomy surgery. We illustrate the utility of our model as a pre-treatment medical decision aid, producing personalized predictions that are both interpretable and accurate. We uncover covariate relationships that agree with and supplement that in existing medical literature.

scholarly journals Diagnosis Behaviors of Physicians and Non-Physicians When Supported by an Electronic Differential Diagnosis Aid

2019 ◽  
Vol 63 (1) ◽  
pp. 68-72
Author(s):  
Makenzie Pryor ◽  
Doug Ebert ◽  
Vicky Byrne ◽  
Khalaeb Richardson ◽  
Qua Jones ◽  
...  
Keyword(s):  
Decision Aid ◽  
Correct Diagnosis ◽  
Patient Simulation ◽  
Diagnosis And Treatment ◽  
Medical Decision ◽  
Medical Procedures ◽  
Limited Information ◽  
Support Tool ◽  
Patient Diagnosis ◽  
Diagnostic Support

The present study examined a diagnostic medical decision aid developed to help inexperienced operators to diagnose and treat a simulated patient. Diagnosis and treatment accuracy using the tool were assessed and compared across both physicians and non-physicians. Initial analysis revealed more accurate diagnostic and treatment choices for non-physicians, but upon further investigation, physicians were found to have recognized signs for another diagnosis and correctly diagnosed and treated based on the limited information in the patient simulation. This fit with other noted behaviors, such as non-physicians opening the diagnostic support tool within the aid more often than physicians, and frequently returning to the tool during the task. In general, non-physicians were supported in choosing the correct diagnosis and treatment by the aid, while physicians disregarded the aid’s recommendations to make decisions based on their own expertise. These results have implications for the development of future decision support aids for non-physicians performing medical procedures.

scholarly journals Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation

2021 ◽  
pp. 0272989X2199898
Author(s):  
Peter H. Schwartz ◽  
Kieran C. O’Doherty ◽  
Colene Bentley ◽  
Karen K. Schmidt ◽  
Michael M. Burgess
Keyword(s):  
Colon Cancer ◽  
Cancer Screening ◽  
Decision Aid ◽  
Decision Aids ◽  
Risk Information ◽  
Colon Cancer Screening ◽  
Public Deliberation ◽  
Screening Tests ◽  
Medical Decision ◽  
Baseline Risk

Purpose We carried out the first public deliberation to elicit lay input regarding guidelines for the design and evaluation of decision aids, focusing on the example of colorectal (“colon”) cancer screening. Methods A random, demographically stratified sample of 28 laypeople convened for 4 days, during which they were informed about key issues regarding colon cancer, screening tests, risk communication, and decision aids. Participants then deliberated in small and large group sessions about the following: 1) What information should be included in all decision aids for colon screening? 2) What risk information should be in a decision aid and how should risk information be presented? 3) What makes a screening decision a good one (reasonable or legitimate)? 4) What makes a decision aid and the advice it provides trustworthy? With the help of a trained facilitator, the deliberants formulated recommendations, and a vote was held on each to identify support and alternative views. Results Twenty-one recommendations (“deliberative conclusions”) were strongly supported. Some conclusions matched current recommendations, such as that decision aids should be available for use with and without providers present (conclusions 1–4) and should support informed choice (conclusion 9). Some conclusions differed from current recommendations, at least in emphasis—for example, that decision aids should disclose cost of screening (conclusion 11) and should be kept simple and understandable (conclusion 14). Deliberants recommended that decision aids should disclose the baseline risk of getting colon cancer (conclusions 15, 17). Limitations Single location and medical decision. Conclusions Guidelines for design of decision aids should consider putting a greater focus on disclosing cost and keeping decision aids simple, and they possibly should recommend disclosing less extensive amounts of quantitative information than currently recommended.

Knowledge Representation and Utilisation in a Man-Machine Dialogue with a Medical Decision Aid System

1982 ◽  
Vol 21 (02) ◽  
pp. 59-64 ◽  
Author(s):  
M. Joubert ◽  
M. Fieschi ◽  
D. Fieschi ◽  
M. Roux
Keyword(s):  
Knowledge Representation ◽  
Decision Aid ◽  
Medical Discourse ◽  
Medical Decision ◽  
Truth Values ◽  
Man Machine Dialogue ◽  
Machine Communication

This study presents the man-machine communication procedure, called MEDIUM, with the medical decision aid system SPHINX. The knowledge processed by this procedure is concerned with the entities of the medical discourse, that is the signs, the symptoms and the results of clinical and paraclinical examinations. At first level, the knowledge is constituted by the definitions of the entities and their specific properties. At a second level, the knowledge is constituted by logical formulas which translate the relations that link entities. Part of the coherence of the discourse is judged with regard to the definitions of the entities. The coherence is completely established by evaluating the truth values of the formulas according to the data already stored during the session. Parts of sessions with the procedure MEDIUM are presented and results are discussed.

scholarly journals Conflicting Perspectives on the Value of Neprilysin Inhibition in Heart Failure Revealed During Development of a Decision Aid Focusing on Patient Costs for Sacubitril/Valsartan

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Grace E. Venechuk ◽  
Larry A. Allen ◽  
Katherine Doermann Byrd ◽  
Neal Dickert ◽  
Daniel D. Matlock
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Decision Aid ◽  
Enzyme Inhibitor ◽  
Receptor Blocker ◽  
Medical Decision ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Heart Failure Medication ◽  
Neprilysin Inhibitor

Background: Despite concerns about rising costs in health care, cost is rarely an issue discussed by patients and clinicians when making treatment decisions in a clinical setting. This study aimed to understand stakeholder perspectives on a patient decision aid (PtDA) meant to help patients with heart failure choose between a generic and relatively low-cost heart failure medication (ACE [angiotensin-converting enzyme] inhibitor or angiotensin II receptor blocker) and a newer, but more expensive, heart failure medication (angiotensin II receptor blocker neprilysin inhibitor). Methods and Results: Feedback on the PtDA was solicited from 26 stakeholders including patients, clinicians, and the manufacturer. Feedback was recorded and discussed among development team members until consensus regarding both the interpretation of the data and the appropriate changes to the PtDA was reached. Stakeholders found the PtDA sufficient in clarifying the different treatment options for heart failure. However, patients, physicians, and the manufacturer had different opinions on the importance of highlighting cost in a PtDA. Patients indicated issues of cost were crucial to the decision while physicians and manufacturers expressed that the cost issue was secondary and should be de-emphasized. Conclusions: The stratified perspectives on the role of cost in medical decision-making expressed by our participants underscore the importance and challenge of having clear, frank discussions during clinic visits about treatment cost and perceived value.

scholarly journals Treatment decisions for patients with peripheral artery disease and symptoms of claudication: Development process and alpha testing of the SHOW-ME PAD decision aid

2021 ◽  
pp. 1358863X2098878
Author(s):  
Kim G Smolderen ◽  
Christina Pacheco ◽  
Jeremy Provance ◽  
Nancy Stone ◽  
Christine Fuss ◽  
...  
Keyword(s):  
Decision Making ◽  
Peripheral Artery Disease ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Medical Decision ◽  
Peripheral Artery ◽  
Invasive Treatment ◽  
Supervised Exercise ◽  
Artery Disease

Patients with peripheral artery disease (PAD) face a range of treatment options to improve survival and quality of life. An evidence-based shared decision-making tool (brochure, website, and recorded patient vignettes) for patients with new or worsening claudication symptoms was created using mixed methods and following the International Patient Decision Aids Standards (IPDAS) criteria. We reviewed literature and collected qualitative input from patients ( n = 28) and clinicians ( n = 34) to identify decisional needs, barriers, outcomes, knowledge, and preferences related to claudication treatment, along with input on implementation logistics from 59 patients and 27 clinicians. A prototype decision aid was developed and tested through a survey administered to 20 patients with PAD and 23 clinicians. Patients identified invasive treatment options (endovascular or surgical revascularization), non-invasive treatments (supervised exercise therapy, claudication medications), and combinations of these as key decisions. A total of 65% of clinicians thought the brochure would be useful for medical decision-making, an additional 30% with suggested improvements. For patients, those percentages were 75% and 25%, respectively. For the website, 76.5% of clinicians and 85.7% of patients thought it would be useful; an additional 17.6% of clinicians and 14.3% of patients thought it would be useful, with improvements. Suggestions were incorporated in the final version. The first prototype was well-received among patients and clinicians. The next step is to implement the tool in a PAD specialty care setting to evaluate its impact on patient knowledge, engagement, and decisional quality. ClinicalTrials.gov Identifier: NCT03190382

A decision aid for women at increased risk for ovarian cancer

2003 ◽  
Vol 13 (1) ◽  
pp. 15-22 ◽  
Author(s):  
K. Tiller ◽  
B. Meiser ◽  
E. Reeson ◽  
M. Tucker ◽  
L. Andrews ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Cancer Risk ◽  
Decision Aid ◽  
Controlled Trial ◽  
Decision Aids ◽  
Medical Decision ◽  
Ovarian Cancer Risk ◽  
Management Options ◽  
Increased Risk

This paper reviews changes that have occurred within and without the medical profession that have fostered an increasing demand for decision aids as adjuncts to practitioners' counseling to prepare patients for decision making. In the absence of data on the efficacy of ovarian cancer screening and prophylactic strategies, decisions about optimal care are difficult for both women and their doctors. Because surveillance and preventive options are an area of great uncertainty, a decision aid has been developed specifically aimed at facilitating decisions involving ovarian cancer risk management options. This was achieved by reviewing and integrating the available literature on models of medical decision making, patient preferences for information and involvement in decision making, the utility of decision aids, and management options for ovarian cancer risk. Findings indicate that patients wish to be informed participants in the decision-making process and that decision aids are an acceptable and effective method of providing quality information in a format that facilitates an inclusive model of shared decision making. A decision aid designed for women at increased risk of ovarian cancer that facilitates informed decision making may be a valuable addition to patient support. A randomized controlled trial of this type of educational material will provide timely and much needed evidence on its acceptability and efficacy.

Connectionist expert systems as medical decision aid

1993 ◽  
Vol 5 (6) ◽  
pp. 515-523 ◽  
Author(s):  
Jorge M. Barreto ◽  
Fernando M. de Azevedo
Keyword(s):  
Expert Systems ◽  
Decision Aid ◽  
Medical Decision

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.

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