scholarly journals “Lock and Protect”: Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth

2021 ◽  
Vol 12 ◽  
Author(s):  
Joan R. Asarnow ◽  
Lucas Zullo ◽  
Stephanie M. Ernestus ◽  
Chase W. Venables ◽  
David B. Goldston ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Decision Aid ◽  
Discharge Planning ◽  
Decision Aids ◽  
Qualitative Interviews ◽  
Routine Care ◽  
Care Providers ◽  
Digital Tool ◽  
Web Based ◽  
Lethal Means

Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing.Method: A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders (N = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders.Results: The final “Lock and Protect” decision aid was viewed as “useful for changing access to lethal means” by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a “human touch,” as part of safety and discharge planning.Conclusions: “Lock and Protect” is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.

scholarly journals Implementation of a decision aid for localized prostate cancer in routine care: A successful implementation strategy

2019 ◽  
Vol 26 (2) ◽  
pp. 1194-1207
Author(s):  
Julia J van Tol-Geerdink ◽  
Inge M van Oort ◽  
Diederik M Somford ◽  
Carl J Wijburg ◽  
Arno Geboers ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Aid ◽  
Implementation Strategy ◽  
Decision Aids ◽  
Routine Care ◽  
Localized Prostate Cancer ◽  
Successful Implementation ◽  
Care Providers ◽  
Implementation Rate ◽  
Patient Decision

For the treatment choice of localized prostate cancer, effective patient decision aids have been developed. The implementation of decision aids in routine care, however, lags behind. Main known barriers are lack of confidence in the tool, lack of training on its use, lack of resources and lack of time. A new implementation strategy addresses these barriers. Using this implementation strategy, the implementation rate of a decision aid was measured in eight hospitals and questionnaires were filled out by 24 care providers and 255 patients. The average implementation rate was 60 per cent (range 31%–100%). Hardly any barriers remained for care providers. Patients who did not use the decision aid appeared to be more unwilling than unable to use the decision aid. By addressing known barriers, that is, informing care providers on the effectiveness of the decision aid, providing instructions on its use, embedding it in the existing workflow and making it available free of charge, a successful implementation of a prostate cancer decision aid was reached.

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making

2016 ◽  
Vol 37 (1) ◽  
pp. 113-126 ◽  
Author(s):  
Clarissa Hsu ◽  
David T. Liss ◽  
Dominick L. Frosch ◽  
Emily O. Westbrook ◽  
David Arterburn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aid ◽  
Qualitative Interviews ◽  
Accurate Information ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Attitudes ◽  
Provider Perspectives

Background. A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health’s Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. Design. In-depth, qualitative interviews with specialty care providers in two specialties—orthopedics and cardiology—at two time points during DA implementation. Data were analyzed using a thematic analysis approach. Results. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Conclusions. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

Engagement patterns of users and providers: a study of messaging on app usage in a smartphone app for the treatment of eating disorders (Preprint)

2020 ◽  
Author(s):  
Jane Kim ◽  
Jisung Park ◽  
Jenna Tregarthen
Keyword(s):  
Eating Disorders ◽  
Health Care Providers ◽  
Digital Health ◽  
Communication Styles ◽  
Care Providers ◽  
Digital Tool ◽  
Self Monitoring ◽  
Multiple Phenotypes ◽  
Monitoring Tools ◽  
Level Data

BACKGROUND By offering the ability to immediately communicate with health care providers, digital health apps may significantly bolster the therapeutic relationship. Increasing opportunities of engagement with a digital tool, self-monitoring tools show confer promise in allowing patients to go through periods in between in-clinic visits. Little is known however, regarding the usage of the apps and whether communication between providers and app users in fact encourages usage. OBJECTIVE The objective of this study was to investigate the users of an app for eating disorders and summarize the characteristics of usage, characteristics of communication (i.e. messages sent and received), and assess whether the degree of communication and the degree of app usage (of the main features of the app precluding provider contact) were related. METHODS Users of an app for eating disorders (Tregarthen et al) consented for their de-identified, aggregate level data to be utilized for research. Records of five hundred users were randomly sampled from May 2017 to July 2017. All users in the sampled cohort were linked to a clinician. Raw data included 97,732 observations of meal logs submitted via app across 500 individuals. RESULTS Our data demonstrated a high degree of variability across users in their engagement patterns of the app. Receiving more messages on average had a greater effect on usage than sending messages, implying that being checked in on by clinicians may encourage users to engage more with their app. Data also demonstrated that there were multiple phenotypes in terms of preferences regarding communication – while a portion of users seemed to benefit, a large minority did not demonstrate a change in usage based on the frequency of communication. CONCLUSIONS Understanding usage phenotypes can be instrumental in helping clinician and apps understand who their user is. This work demonstrates that variability among the user population in terms of usage and communication styles, as well as usage and behavior. This information can ultimately be leveraged for guiding effective treatment delivery.

scholarly journals Feasibility and Assessment of a Cascade Traceback Screening Program (FACTS): Protocol for a Multisite Study to Implement and Assess an Ovarian Cancer Traceback Cascade Testing Program

2021 ◽  
Vol 11 (6) ◽  
pp. 543
Author(s):  
Anna DiNucci ◽  
Nora B. Henrikson ◽  
M. Cabell Jonas ◽  
Sundeep Basra ◽  
Paula Blasi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Genetic Testing ◽  
Health Care Providers ◽  
Screening Program ◽  
Qualitative Interviews ◽  
Care Providers ◽  
Genetic Privacy ◽  
Program Outcomes ◽  
Cascade Testing ◽  
Program Costs

Ovarian cancer (OVCA) patients may carry genes conferring cancer risk to biological family; however, fewer than one-quarter of patients receive genetic testing. “Traceback” cascade testing —outreach to potential probands and relatives—is a possible solution. This paper outlines a funded study (U01 CA240747-01A1) seeking to determine a Traceback program’s feasibility, acceptability, effectiveness, and costs. This is a multisite prospective observational feasibility study across three integrated health systems. Informed by the Conceptual Model for Implementation Research, we will outline, implement, and evaluate the outcomes of an OVCA Traceback program. We will use standard legal research methodology to review genetic privacy statutes; engage key stakeholders in qualitative interviews to design communication strategies; employ descriptive statistics and regression analyses to evaluate the site differences in genetic testing and the OVCA Traceback testing; and assess program outcomes at the proband, family member, provider, system, and population levels. This study aims to determine a Traceback program’s feasibility and acceptability in a real-world context. It will account for the myriad factors affecting implementation, including legal issues, organizational- and individual-level barriers and facilitators, communication issues, and program costs. Project results will inform how health care providers and systems can develop effective, practical, and sustainable Traceback programs.

scholarly journals The Role of Rehabilitation in Reducing Resource Use and Lowering Hospital Readmission Through Discharge Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-804
Author(s):  
Kenneth Miller
Keyword(s):  
Health Care Providers ◽  
Resource Use ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Care Transitions ◽  
Healthcare Team ◽  
Transition Management ◽  
Care Providers ◽  
Initial Examination ◽  
The Individual

Abstract The transitions between medical settings, the community and back again is a complex and intimidating process for patients, families and caregivers. These transitions are vulnerable points where planning is key and must begin at the initial examination with rehabilitation providers (PTs/OTs,SLPs). These providers are key members of the healthcare team to facilitate effective transition management. In this session, attendees will learn the critical factors rehabilitation providers use to evaluate patients in order to facilitate successful care transitions. An overview of the indications for rehabilitation referral will be presented, as well as evidence for effective rehabilitation strategies. The speaker will present tools from the American Physical Therapy Association Home Health Toolbox and outline a decision-making process for care transitions based on the individual, caregivers, and health care providers to achieve successful transitions that reduce resource use and hospital readmission rates. Attendees will learn strategies to facilitate inter-professional collaboration, communication, and advocacy.

scholarly journals Use and Effects of Patient Access to Medical Records in General Practice Through a Personal Health Record in the Netherlands: Protocol for a Mixed-Methods Study

10.2196/10193 ◽  
2018 ◽  
Vol 7 (9) ◽  
pp. e10193 ◽  
Author(s):  
Maria MT Vreugdenhil ◽  
Rudolf B Kool ◽  
Kees van Boven ◽  
Willem JJ Assendelft ◽  
Jan AM Kremer
Keyword(s):  
Health Care ◽  
General Practice ◽  
Health Care Providers ◽  
Personal Health Record ◽  
Mixed Methods Study ◽  
Personal Health ◽  
Care Providers ◽  
Group Discussions ◽  
Web Based ◽  
Staff Level

Background In the Dutch health care system, general practitioners hold a central position. They store information from all health care providers who are involved with their patients in their electronic health records. Web-based access to the summary record in general practice through a personal health record (PHR) may increase patients’ insight into their medical conditions and help them to be involved in their care. Objective We describe the protocol that we will use to investigate the utilization of patients’ digital access to the summary of their medical records in general practice through a PHR and its effects on the involvement of patients in their care. Methods We will conduct a multilevel mixed-methods study in which the PHR and Web-based access to the summary record will be offered for 6 months to a random sample of 500 polypharmacy patients, 500 parents of children aged <4 years, and 500 adults who do not belong to the former two groups. At the patient level, a controlled before-after study will be conducted using surveys, and concurrently, qualitative data will be collected from focus group discussions, think-aloud observations, and semistructured interviews. At the general practice staff (GP staff) level, focus group discussions will be conducted at baseline and Q-methodology inquiries at the end of the study period. The primary outcomes at the patient level are barriers and facilitators for using the PHR and summary records and changes in taking an active role in decision making and care management and medication adherence. Outcomes at the GP staff level are attitudes before and opinions after the implementation of the intervention. Patient characteristics and changes in outcomes related to patient involvement during the study period will be compared between the users and nonusers of the intervention using chi-square tests and t tests. A thematic content analysis of the qualitative data will be performed, and the results will be used to interpret quantitative findings. Results Enrollment was completed in May 2017 and the possibility to view GP records through the PHR was implemented in December 2017. Data analysis is currently underway and the first results are expected to be submitted for publication in autumn 2019. Conclusions We expect that the findings of this study will be useful to health care providers and health care organizations that consider introducing the use of PHR and Web-based access to records and to those who have recently started using these. Trial Registration Netherlands Trial Registry NTR6395; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6395 (Archived by WebCite at http://www.webcitation.org/71nc8jzwM) Registered Report Identifier RR1-10.2196/10193

scholarly journals Development of a tool to assess health applications for healthcare providers: A Delphi Expert Panel Study (Preprint)

2020 ◽  
Author(s):  
Immaculada Grau-Corral ◽  
Percy Efran Pantoja ◽  
Francisco J. Grajales III ◽  
Belchin Kostov ◽  
Valentí Aragunde ◽  
...  
Keyword(s):  
Literature Review ◽  
Health Care Providers ◽  
Expert Panel ◽  
Panel Study ◽  
Healthcare Providers ◽  
Care Providers ◽  
Web Based ◽  
Health Apps ◽  
Agreement Assessment ◽  
Health Applications

BACKGROUND The presence of the mobile phone and devices is generating knowledge about the use of applications to support patient care, but there are few recommendations for apps dedicated to healthcare professionals OBJECTIVE To establish a validated scale to assess healthcare mobile applications is the most efficient step for health care providers and systems. The main goal is to create and validate a tool to evaluate health apps destined to be used by health professionals. METHODS A five steps simplified methodology to assess of the scale was followed. The first step consists of building a scale for professionals based on a literature review. Next step would be an expert panel validation by a Delphi method, rating web-based questionnaires to evaluate inclusion and weight of the indicators. It was agreed to carry out, as many iterations as necessary, to reach a consensus of 75%. Finally, a pilot of the score was developed to evaluate the reliability of the scale. For the inter-rater agreement assessment during the pilot, the Cohen Kappa was used. RESULTS After the literature review, a first scale draft was developed. Two rounds of interactions of the local investigation group and the external panel of experts were needed to select final indicators. Seventeen indicators were included in the score. For the pilot test, 280 apps were evaluated and 66 meet the criteria. The interrater agreement was strong (higher than 82% with significant kappa >0.72 per app and item). CONCLUSIONS We have developed, with a reproducible methodology, a tool that allows us to evaluate health applications for clinical, surgical and general medical providers. The ISYScore-PRO scale to be reliable and reproducible. The assessment permitted to consolidate every step of the methodology. We were able to reach consensus on the dimensions and items on the scale with only two rounds. The process of validation included two robust methodologies. The ISYScore-PRO scale is reliable and reproducible.

The Perspectives of Women and Their Health-Care Providers Regarding Using an ECA to Support Mode of Birth Decisions

2021 ◽  
Vol 30 (3) ◽  
pp. 135-144
Author(s):  
Somphit Chinkam ◽  
Courtney Steer-Massaro ◽  
Ivan Herbey ◽  
Zhe Zhang ◽  
Timothy Bickmore ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Care Providers ◽  
Medical Center ◽  
Decision Aids ◽  
Tertiary Care ◽  
Easy Access ◽  
Care Providers ◽  
Embodied Conversational Agent ◽  
Tertiary Care Medical Center ◽  
Mode Of Birth

This study used focus groups to assess the feasibility and acceptability of adapting an Embodied Conversational Agent (ECA) to support decision-making about mode of birth after previous cesarean. Twelve women with previous cesareans, and eight prenatal providers at an academic, tertiary-care medical center, viewed a prototype ECA and were asked to share feedback on the potential role in helping women prepare for decision-making. Both groups felt that although it was somewhat “robot-like,” the ECA could provide easy access to information for patients and could augment the visit with providers. Future work is needed to improve ECA visual appeal and clarify the role and timing for utilization of decision aids using ECA technology to enhance the shared decision-making process.

Gynecologic Health Care Providers' Willingness to Provide Routine Care and Papanicolaou Tests for Transmasculine Individuals

2019 ◽  
Vol 28 (11) ◽  
pp. 1487-1492 ◽  
Author(s):  
Deirdre A. Shires ◽  
Lucas Prieto ◽  
Michael R. Woodford ◽  
Kim D. Jaffee ◽  
Daphna Stroumsa
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Routine Care ◽  
Care Providers

Why Do Patients Choose Chemotherapy Near the End of Life? A Review of the Perspective of Those Facing Death From Cancer

2006 ◽  
Vol 24 (21) ◽  
pp. 3490-3496 ◽  
Author(s):  
Robin Matsuyama ◽  
Sashidhar Reddy ◽  
Thomas J. Smith
Keyword(s):  
Health Care ◽  
Adverse Effects ◽  
End Of Life ◽  
Health Care Providers ◽  
Decision Aids ◽  
Good Choice ◽  
Care Providers ◽  
Number Of Patients ◽  
Small Benefit ◽  
Realistic Information

Purpose The number of patients receiving chemotherapy near the end of life is increasing, as are concerns about goals of treatment, toxicity, and costs. We sought to determine the available sources of knowledge, the choices, and concerns of actual patients, and how patients balanced competing issues. Methods We used a literature search from 1980 to present. Results Available patient sources provide little information about prognosis, choices, alternatives, consequences, or how to choose. Many patients would choose chemotherapy for a small benefit in health outcomes, and for a smaller benefit than perceived by their health care providers for their own treatment. Adverse effects are less a concern for patients than for their well health care providers. There are no decision aids to assist patients with metastatic disease in making their choices, such as there are for adjuvant breast therapy. Conclusion The perspective of the patient is different from that of a well person. Patients are willing to undergo treatments that have small benefits with major toxicity. Receiving realistic information about the different options of care and the likelihood of successful treatment or adverse effects is difficult. These factors may explain some of the increased use of chemotherapy near the end of life. Decision aids and honest, unbiased sources to inform patients of their prognosis, choices, consequences, typical outcomes, and ways to make decisions are needed. More prospective information about how patients make their choices, and what they would consider a good choice, would assist informed decision making.

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