Meeting Patients Where They Are

2017 ◽

pp. 139-162

Author(s):

Geri Lynn Baumblatt

Keyword(s):

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Decision Aid ◽

Risk Information ◽

Shared Decision ◽

Low Health Literacy ◽

Improved Outcomes ◽

Aid Programs ◽

Patient Disclosure

In this chapter the author describes the challenges of engaging and communicating with patients and how technology can improve communication, elicit honest patient disclosure, and create more productive conversation and help patients engage and partner in their care. The author will also discuss how research with multimedia programs reveals it can help reduce anxiety, improve knowledge, help low health literacy audiences, and contribute to improved outcomes. This chapter will also examine how multimedia decision aid programs can help patients understand their options and complex risk information, while helping them consider their values and preferences so they can truly engage in shared decision making.

Download Full-text

Online decision aids for primary cardiovascular disease prevention: systematic search, evaluation of quality and suitability for low health literacy patients

BMJ Open ◽

10.1136/bmjopen-2018-025173 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025173 ◽

Cited By ~ 6

Author(s):

Carissa Bonner ◽

Pinika Patel ◽

Michael Anthony Fajardo ◽

Ruixuan Zhuang ◽

Lyndal Trevena

Keyword(s):

Cardiovascular Disease ◽

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Decision Aids ◽

Shared Decision ◽

Low Health Literacy ◽

Lower Health ◽

Cvd Prevention ◽

Lower Health Literacy

ObjectivesRecent guideline changes for cardiovascular disease (CVD) prevention medication have resulted in calls to implement shared decision-making rather than arbitrary treatment thresholds. Less attention has been paid to existing tools that could facilitate this. Decision aids are well-established tools that enable shared decision-making and have been shown to improve CVD prevention adherence. However, it is unknown how many CVD decision aids are publicly available for patients online, what their quality is like and whether they are suitable for patients with lower health literacy, for whom the burden of CVD is greatest. This study aimed to identify and evaluate all English language, publicly available online CVD prevention decision aids.DesignSystematic review of public websites in August to November 2016 using an environmental scan methodology, with updated evaluation in April 2018. The decision aids were evaluated based on: (1) suitability for low health literacy populations (understandability, actionability and readability); and (2) International Patient Decision Aids Standards (IPDAS).Primary outcome measuresUnderstandability and actionability using the validated Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P scale), readability using Gunning–Fog and Flesch–Kincaid indices and quality using IPDAS V.3 and V.4.ResultsA total of 25 unique decision aids were identified. On the PEMAT-P scale, the decision aids scored well on understandability (mean 87%) but not on actionability (mean 61%). Readability was also higher than recommended levels (mean Gunning–Fog index=10.1; suitable for grade 10 students). Four decision aids met criteria to be considered a decision aid (ie, met IPDAS qualifying criteria) and one sufficiently minimised major bias (ie, met IPDAS certification criteria).ConclusionsPublicly available CVD prevention decision aids are not suitable for low literacy populations and only one met international standards for certification. Given that patients with lower health literacy are at increased risk of CVD, this urgently needs to be addressed.

Download Full-text

Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy

Innovation in Aging ◽

10.1093/geroni/igab046.1154 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 299-299

Author(s):

Rebekah Halmo ◽

Siobhan McDonold ◽

Mara Schonberg ◽

Tamara Cadet

Keyword(s):

Colorectal Cancer ◽

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Shared Decision ◽

Structured Interviews ◽

National Guidelines ◽

Crc Screening ◽

High School Degree ◽

Low Health Literacy

Abstract National guidelines recommend adults >75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults >75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults >75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had < high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.

Download Full-text

Use of an Atrial Fibrillation Medication Decision Aid Improves Knowledge and Process for Decision Making (Preprint)

10.2196/preprints.12404 ◽

2018 ◽

Author(s):

Molly Beinfeld ◽

Suzanne Brodney ◽

Michael Barry ◽

Erika Poole ◽

Adam Kunin

Keyword(s):

Atrial Fibrillation ◽

Decision Making ◽

Shared Decision Making ◽

Anticoagulant Therapy ◽

Decision Aid ◽

Response Rate ◽

Intervention Group ◽

Shared Decision ◽

Community Based ◽

Baseline Group

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None

Download Full-text

InformedTogether: A decision aid to support shared decision making about mechanical ventilation in severe COPD patients

10.2196/preprints.9877.a ◽

2018 ◽

Author(s):

Meliss Basile ◽

Johanna Andrews ◽

Sonia Jacome ◽

Meng Zhang ◽

Andrzej Kozikowski ◽

...

Keyword(s):

Decision Making ◽

Mechanical Ventilation ◽

Shared Decision Making ◽

Decision Aid ◽

Shared Decision ◽

Copd Patients ◽

Severe Copd

Download Full-text

CP-021 The impact of a decision aid on depressed patient’s involvement in shared decision making: A pilot randomised controlled double blind study

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2016-000875.21 ◽

2016 ◽

Vol 23 (Suppl 1) ◽

pp. A9.3-A10 ◽

Cited By ~ 1

Author(s):

K Aljumah ◽

A Nwaf ◽

A Amed ◽

A Alhoutan ◽

M Aldhiab

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aid ◽

Blind Study ◽

Double Blind Study ◽

Shared Decision ◽

Double Blind ◽

Randomised Controlled ◽

The Impact

Download Full-text

Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01479-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

I. E. H. Kremer ◽

P. J. Jongen ◽

S. M. A. A. Evers ◽

E. L. J. Hoogervorst ◽

W. I. M. Verhagen ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aid ◽

Healthcare Professionals ◽

Treatment Options ◽

Shared Decision ◽

Patient Decision Aid ◽

Disease Modifying Drugs ◽

Patient Decision ◽

Further Development

Abstract Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

Download Full-text