scholarly journals GPs’ understanding of the benefits and harms of treatments for long-term conditions: an online survey

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101016 ◽  
Author(s):  
Julian Stephen Treadwell ◽  
Geoff Wong ◽  
Coral Milburn-Curtis ◽  
Benjamin Feakins ◽  
Trisha Greenhalgh
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Treatment Effects ◽  
Clinical Decision Making ◽  
Absolute Risk ◽  
Clinical Decision ◽  
Long Term Conditions ◽  
The Absolute ◽  
The Uk

BackgroundGPs prescribe multiple long-term treatments to their patients. For shared clinical decision-making, understanding of the absolute benefits and harms of individual treatments is needed. International evidence shows that doctors’ knowledge of treatment effects is poor but, to the authors knowledge, this has not been researched among GPs in the UK.AimTo measure the level and range of the quantitative understanding of the benefits and harms of treatments for common long-term conditions (LTCs) among GPs.Design & settingAn online cross-sectional survey was distributed to GPs in the UK.MethodParticipants were asked to estimate the percentage absolute risk reduction or increase conferred by 13 interventions across 10 LTCs on 17 important outcomes. Responses were collated and presented in a novel graphic format to allow detailed visualisation of the findings. Descriptive statistical analysis was performed.ResultsA total of 443 responders were included in the analysis. Most demonstrated poor (and in some cases very poor) knowledge of the absolute benefits and harms of treatments. Overall, an average of 10.9% of responses were correct allowing for ±1% margin in absolute risk estimates and 23.3% allowing a ±3% margin. Eighty-seven point seven per cent of responses overestimated and 8.9% of responses underestimated treatment effects. There was no tendency to differentially overestimate benefits and underestimate harms. Sixty-four point eight per cent of GPs self-reported ‘low’ to ‘very low’ confidence in their knowledge.ConclusionGPs’ knowledge of the absolute benefits and harms of treatments is poor, with inaccuracies of a magnitude likely to meaningfully affect clinical decision-making and impede conversations with patients regarding treatment choices.

scholarly journals Blood transfusion prescribing in the ACT: an insight into clinical decision making

2005 ◽  
Vol 29 (2) ◽  
pp. 240 ◽  
Author(s):  
Philip J Crispin ◽  
Bethany J Crowe ◽  
Anne M McDonald
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Early Discharge ◽  
Organisation Of Care ◽  
Metropolitan Hospital ◽  
Loss Of Appetite ◽  
Insight Into ◽  
Structured Questionnaire

This study aimed to determine the perspectives of a group of patients categorised as ?long-stay outliers? at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

scholarly journals CLINICAL DECISION MAKING FOR THE HEMODYNAMIC GRAY ZONE (FFR 0.75-0.80) AND IMPACT ON LONG TERM OUTCOMES

2016 ◽  
Vol 67 (13) ◽  
pp. 379 ◽  
Author(s):  
Shiv Kumar Agarwal ◽  
Mohan Edupuganti ◽  
Ahmed Almomani ◽  
Naga Venkata Pothineni ◽  
Jason Payne ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Gray Zone ◽  
Long Term Outcomes

Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making.

1997 ◽  
Vol 16 (4) ◽  
pp. 380-389 ◽  
Author(s):  
Abby C. King ◽  
Michaela Kiernan ◽  
Roy F. Oman ◽  
Helena C. Kraemer ◽  
Mary Hull ◽  
...  
Keyword(s):  
Physical Activity ◽  
Decision Making ◽  
Signal Detection ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences

Hand Therapy ◽  
2020 ◽  
pp. 175899832097213
Author(s):  
Emily McMullen ◽  
Megan Robson ◽  
Mark Paul Brewin ◽  
Poonam Valand ◽  
Leela Sayed ◽  
...  
Keyword(s):  
Decision Making ◽  
Upper Limb ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Service Planning ◽  
Cross Sectional Survey ◽  
Visual Technology ◽  
Limb Trauma ◽  
The Uk ◽  
Decision Making Tool

Introduction For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

scholarly journals GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Martha M. C. Elwenspoek ◽  
Ed Mann ◽  
Katharine Alsop ◽  
Hannah Clark ◽  
Rita Patel ◽  
...  
Keyword(s):  
Online Survey ◽  
Liver Function Tests ◽  
Free Text ◽  
Negative Consequences ◽  
Patient Harm ◽  
Long Term Conditions ◽  
Current Testing ◽  
The Uk ◽  
Robust Evidence

Abstract Background We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. Methods Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. Results The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. Conclusion These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm.

scholarly journals Survey of the Impact of COVID-19 on Oncologists’ Decision Making in Cancer

2020 ◽  
pp. 1248-1257 ◽  
Author(s):  
Yüksel Ürün ◽  
Syed A. Hussain ◽  
Ziad Bakouny ◽  
Daniel Castellano ◽  
Saadettin Kılıçkap ◽  
...  
Keyword(s):  
Decision Making ◽  
Metastatic Disease ◽  
Online Survey ◽  
Kinase Inhibitors ◽  
Clinical Decision Making ◽  
Checkpoint Inhibitors ◽  
Clinical Decision ◽  
Immune Therapies ◽  
Novel Coronavirus ◽  
The Impact

PURPOSE To understand readiness measures taken by oncologists to protect patients and health care workers from the novel coronavirus (COVID-19) and how their clinical decision making was influenced by the pandemic. METHODS An online survey was conducted between March 24 and April 29, 2020. RESULTS A total of 343 oncologists from 28 countries participated. The median age was 43 years (range, 29-68 years), and the majority were male (62%). At the time of the survey, nearly all participants self-reported an outbreak in their country (99.7%). Personal protective equipment was available to all participants, of which surgical mask was the most common (n = 308; 90%). Telemedicine, in the form of phone or video encounters, was common and implemented by 80% (n = 273). Testing patients with cancer for COVID-19 via reverse transcriptase polymerase chain reaction before systemic treatment was not routinely implemented: 58% reported no routine testing, 39% performed testing in selected patients, and 3% performed systematic testing in all patients. The most significant factors influencing an oncologist’s decision making regarding choice of systemic therapy included patient age and comorbidities (81% and 92%, respectively). Although hormonal treatments and tyrosine kinase inhibitors were considered to be relatively safe, cytotoxic chemotherapy and immune therapies were perceived as being less safe or unsafe by participants. The vast majority of participants stated that during the pandemic they would use less chemotherapy, immune checkpoint inhibitors, and steroids. Although treatment in neoadjuvant, adjuvant, and first-line metastatic disease was less affected, most of the participants stated that they would be more hesitant to recommend second- or third-line therapies in metastatic disease. CONCLUSION Decision making by oncologists has been significantly influenced by the ongoing COVID-19 pandemic.

A Survey on the Use of Sensibility Tests by Therapists Hand Therapists in the UK

2002 ◽  
Vol 7 (2) ◽  
pp. 55-63 ◽  
Author(s):  
Christina Jerosch-Herold
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Postal Questionnaire ◽  
Specific Method ◽  
Assessment Practices ◽  
Frequency Of Use ◽  
Long Term Follow Up ◽  
The Uk ◽  
Evidence Based Guidelines

The assessment of sensibility of the hand, a practice often undertaken by hand therapists, is an important aspect of the long-term follow-up of patients with peripheral nerve injuries. Such assessments provide feedback to the patient and referring surgeon, and a basis for clinical decision-making, clinical audit and research. The purpose of this survey was to investigate the choice of tests and methods of application and interpretation of specific sensibility tests among hand therapists and to compare these findings with recommendations from published research. A postal questionnaire was designed to collect descriptive data on the sensibility assessment practices of hand therapists in the UK. A total of 432 questionnaires were posted to members of the British Association of Hand Therapists. The response rate was 52.1%. Assessments of sensibility are undertaken by 70.7% of respondents. Reasons for the choice of tests, their frequency of use and specific method of application and interpretation of sensibility tests were collated. The findings indicate that pragmatic reasons such as the availability of equipment, time and sufficient patients governed the choice of tests among a large proportion of hand therapists, rather than any research evidence. The need for more accessible and evidence-based guidelines, training and practice in the use of tests and better resources were identified.

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