scholarly journals Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling

2017 ◽  
Vol 100 (7) ◽  
pp. 1374-1381 ◽  
Author(s):  
Christine Dehlendorf ◽  
Judith Fitzpatrick ◽  
Jody Steinauer ◽  
Lawrence Swiader ◽  
Kevin Grumbach ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Decision Support Tool ◽  
Field Testing ◽  
Shared Decision ◽  
Support Tool ◽  
Contraceptive Counseling

Creation of a Community-Driven Decision Support Tool for Caregivers of Children With Developmental Concerns

2021 ◽  
pp. 1-11
Author(s):  
Dawn M. Magnusson ◽  
Irena Shwayder ◽  
Natalie J. Murphy ◽  
Lindsay Ollerenshaw ◽  
Michele Ebendick ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Service Use ◽  
Decision Support Tool ◽  
Cultural Humility ◽  
Shared Decision ◽  
Plain Language ◽  
Support Tool ◽  
Key Aspects

Purpose Despite increasing standardization of developmental screening and referral processes, significant early intervention service disparities exist. The aims of this article are to: (a) describe methods used to develop a decision support tool for caregivers of children with developmental concerns, (b) summarize key aspects of the tool, and (c) share preliminary results regarding the tool's acceptability and usability among key stakeholders. Method Content and design of the decision support tool was guided by a systematic process outlined by the International Patient Decision Aid Standards (IPDAS) Collaborative. Three focus group interviews were conducted with caregivers ( n = 7), early childhood professionals ( n = 28), and a mix of caregivers and professionals ( N = 20) to assess caregiver decisional needs. In accordance with the IPDAS, a prototype of the decision support tool was iteratively cocreated by a subset of caregivers ( n = 7) and early child health professionals ( n = 5). Results The decision support tool leverages images and plain language text to guide caregivers and professionals along key steps of the early identification to service use pathway. Participants identified four themes central to shared decision making: trust, cultural humility and respect, strength-based conversations, and information-sharing. End-users found the tool to be acceptable and useful. Conclusions The decision support tool described offers an individualized approach for exploring beliefs about child development and developmental delay, considering service options within the context of the family's values, priorities, and preferences, and outlining next steps. Additional research regarding the tool's effectiveness in optimizing shared decision-making and reducing service use disparities is warranted.

scholarly journals Shared Decision-Making in Chronic Patients with Polypharmacy: An Interventional Study for Assessing Medication Appropriateness

2019 ◽  
Vol 8 (6) ◽  
pp. 904
Author(s):  
Valle Coronado-Vázquez ◽  
Juan Gómez-Salgado ◽  
Javier Cerezo-Espinosa de los Monteros ◽  
Diego Ayuso-Murillo ◽  
Carlos Ruiz-Frutos
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Intervention Group ◽  
Decision Support Tool ◽  
Control Group ◽  
Potentially Inappropriate Medications ◽  
Shared Decision ◽  
Support Tool ◽  
Inappropriate Medications ◽  
Medication Appropriateness

Potentially inappropriate medications are associated with polypharmacy and polypathology. Some interventions such as pharmacotherapy reviews have been designed to reduce the prescribing of inappropriate medications. The objective of this study is to evaluate how effective a decision-making support tool is for determining medication appropriateness in patients with one or more chronic diseases (hypertension, dyslipidaemia, and/or diabetes) and polypharmacy in the primary care setting. For this, a quasi-experimental study (randomised, controlled and multicentre) has been developed. The study compares an intervention group, which assesses medication appropriateness by applying a decision support tool, with a control group that follows the usual clinical practice. The intervention included a decision support tool in paper format, where participants were informed about polypharmacy, inappropriate medications, associated problems and available alternatives, as well as shared decision-making. This is an informative guide aimed at helping patients with decision-making by providing them with information about the secondary risks associated with inappropriate medications in their treatment, according to the Beers and START/STOPP criteria. The outcome measure was the proportion of medication appropriateness. The proportion of patients who confirmed medication appropriateness after six months of follow-up is greater in the intervention group (32.5%) than in the control group (27.9%) p = 0.008. The probability of medication appropriateness, which was calculated by the proportion of drugs withdrawn or replaced according to the STOPP/Beers criteria and those initiated according to the START criteria, was 2.8 times higher in the intervention group than in the control group (OR = 2.8; 95% CI 1.3–6.1) p = 0.008. In patients with good adherence to the treatment, the percentage of appropriateness was 62.1% in the shared decision-making group versus 37.9% in the control group (p = 0.005). The use of a decision-making support tool in patients with potentially inappropriate medications increases the percentage of medication appropriateness when compared to the usual clinical practice.

scholarly journals Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Lisa Carter-Harris ◽  
Robert Skipworth Comer ◽  
James E Slaven II ◽  
Patrick O Monahan ◽  
Emilee Vode ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Lung Cancer Screening ◽  
Decision Support Tool ◽  
Shared Decision ◽  
Community Based ◽  
Support Tool

BACKGROUND Lung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed. OBJECTIVE The aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions. METHODS A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk—a web-based tailored computer program—while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician. RESULTS Knowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions. CONCLUSIONS LungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8694

scholarly journals Shared decision-making when choosing the feeding method of patients with severe dementia: a systematic review

2018 ◽  
Vol 21 (2) ◽  
pp. 232-242
Author(s):  
Rodrigo D’Agostini Derech ◽  
Fabricio de Souza Neves
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Severe Dementia ◽  
Double Blind ◽  
Support Tool ◽  
Feeding Method

Abstract Objectives: To evaluate whether the use of a support tool for shared decision-making in the choice of feeding method for patients with severe dementia can benefit the patient/caregiver dyad, and to evaluate the quality of the decision-making process. Method: A search was performed in the Medline, LILACS, IBECS, SciELO, WHOLIS databases for randomized controlled trials, whether double-blind or otherwise, and quasi-experimental, cohort, case-control, or cross-sectional observational studies in Portuguese, Spanish, English and French. Results: Eight articles were found that showed that the use of a decision support tool, as an aid for the shared decision-making method, is beneficial as it reduces decisional conflict and increases the knowledge of caregivers about the subject. The quality of the decision-making process is unsatisfactory due to the low frequency of discussions between caregivers and the health team and the poor evaluation of caregivers about the participation of the team in the decision-making process. Conclusion: Decision support tools provide benefits for caregivers/patients undergoing the difficult task of deciding about feeding methods. Findings suggest that the current quality of decision-making is inadequate.

scholarly journals Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial

10.2196/17050 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e17050
Author(s):  
Lisa Carter-Harris ◽  
Robert Skipworth Comer ◽  
James E Slaven II ◽  
Patrick O Monahan ◽  
Emilee Vode ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Lung Cancer Screening ◽  
Decision Support Tool ◽  
Shared Decision ◽  
Community Based ◽  
Support Tool

Background Lung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed. Objective The aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions. Methods A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk—a web-based tailored computer program—while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician. Results Knowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions. Conclusions LungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8694

scholarly journals Video decision support tool promoting values conversations in advanced care planning in cancer: protocol of a randomised controlled trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natasha Michael ◽  
Clare O’Callaghan ◽  
Ekavi Georgousopoulou ◽  
Adelaide Melia ◽  
Merlina Sulistio ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Cancer Patients ◽  
Personal Values ◽  
Decision Support Tool ◽  
Trial Registration ◽  
Randomised Control Trial ◽  
Care Planning ◽  
Advanced Directives ◽  
Support Tool

Abstract Background Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s. Methods This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. Conclusion We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered.

scholarly journals Current Status and Future Prospects for Shared Decision Making before and after Total Knee Replacement Surgery—A Scoping Review

2021 ◽  
Vol 18 (2) ◽  
pp. 668
Author(s):  
Geert van der Sluis ◽  
Jelmer Jager ◽  
Ilona Punt ◽  
Alexandra Goldbohm ◽  
Marjan J. Meinders ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Total Knee Replacement ◽  
Shared Decision Making ◽  
Knee Replacement ◽  
Study Design ◽  
Scoping Review ◽  
Decision Aids ◽  
Shared Decision ◽  
Total Knee

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.

Multivariable Automatisierungsentscheidungen*/Multivariate automation decisions – A tool for cost-benefit assessments as a basis for decision-making

2019 ◽  
Vol 109 (03) ◽  
pp. 134-139
Author(s):  
P. Burggräf ◽  
J. Wagner ◽  
M. Dannapfel ◽  
K. Müller ◽  
B. Koke
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Environmental Conditions ◽  
Cost Benefit ◽  
Decision Support Tool ◽  
Decision Making Process ◽  
Support Tool ◽  
Cost And Benefit ◽  
Benefit Evaluation ◽  
Level Of Automation

Der wachsende Bedarf an Wandlungsfähigkeit führt zu einer höheren Frequenz in der Umplanung von Montagesystemen und erfordert eine kontinuierliche Überprüfung und Anpassung des Automatisierungsgrades. Um auch die komplexen Umgebungsbedingungen abzubilden, sollen nicht-monetäre Faktoren in den Entscheidungsprozess eingebunden werden. Um die Entscheidung zu unterstützen, stellt dieser Beitrag ein Tool zur Identifizierung und Bewertung von Automatisierungsszenarien mittels einer Nutzwert-Aufwand-Analyse vor.   The increasing need for adaptability in assembly leads to a higher planning frequency of the system and requires continuous checks and adaptations of the appropriate level of automation. To account for the complex environmental conditions, non-monetary factors are included in the decision-making process. This paper presents a decision support tool to identify and evaluate automation scenarios by means of cost and benefit evaluation.

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