scholarly journals The Influence of Personalised Sarcoma Care (PERSARC) Prediction Modelling on Clinical Decision Making in a Multidisciplinary Setting

Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
H. S. Femke Hagenmaier ◽  
Annelies G. K. van Beeck ◽  
Rick L. Haas ◽  
Veroniek M. van Praag ◽  
Leti van Bodegom-Vos ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Patient Centered ◽  
Treatment Protocols ◽  
Treatment Decision Making ◽  
Heterogenous Group ◽  
Centered Care ◽  
Made In

Background. With soft-tissue sarcoma of the extremity (ESTS) representing a heterogenous group of tumors, management decisions are often made in multidisciplinary team (MDT) meetings. To optimize outcome, nomograms are more commonly used to guide individualized treatment decision making. Purpose. To evaluate the influence of Personalised Sarcoma Care (PERSARC) on treatment decisions for patients with high-grade ESTS and the ability of the MDT to accurately predict overall survival (OS) and local recurrence (LR) rates. Methods. Two consecutive meetings were organised. During the first meeting, 36 cases were presented to the MDT. OS and LR rates without the use of PERSARC were estimated by consensus and preferred treatment was recorded for each case. During the second meeting, OS/LR rates calculated with PERSARC were presented to the MDT. Differences between estimated OS/LR rates and PERSARC OS/LR rates were calculated. Variations in preferred treatment protocols were noted. Results. The MDT underestimated OS when compared to PERSARC in 48.4% of cases. LR rates were overestimated in 41.9% of cases. With the use of PERSARC, the proposed treatment changed for 24 cases. Conclusion. PERSARC aids the MDT to optimize individualized predicted OS and LR rates, hereby guiding patient-centered care and shared decision making.

The Business Values of Patient Knowledge Management (PKM) in the Healthcare Industry

2013 ◽  
Vol 8 (2) ◽  
pp. 70-79 ◽  
Author(s):  
Mohammad Soltani Delgosha ◽  
Ali Amoei Ojaki ◽  
Hamidreza Farhadi
Keyword(s):  
Decision Making ◽  
Knowledge Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Specific Information ◽  
Patient Knowledge ◽  
Patient Centered ◽  
Patient Decision Making ◽  
Business Values ◽  
Centered Care

Today, healthcare has become a progressive industry with novel techniques, approaches and findings in this field quickly being evaluated and improved. One of these approaches is patient-centered care (PCC), which is defined essentially as an approach that respects and responds to individual patient’s preferences, needs and values. As such, PCC concept focuses not only on the disease, but also on leveraging specific information of a patient. PCC approach is therefore going to enlarge the role of patients and families in the process of clinical decision making. Still, the authors are observing the lack of innovation in this particular domain. In this paper, the authors develop the concept of patient knowledge management (PKM) based on customer knowledge management and PCC approaches. PKM creates many values such as decreasing opportunity costs and treatment costs, aiding patient decision making to be efficient and effective, as well as creating new knowledge and developing new treatment methods.

Causal inference for clinicians

2019 ◽  
Vol 24 (3) ◽  
pp. 109-112 ◽  
Author(s):  
Steven D Stovitz ◽  
Ian Shrier
Keyword(s):  
Decision Making ◽  
Causal Inference ◽  
Clinical Decision Making ◽  
Causal Effect ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Directed Acyclic Graphs ◽  
Causal Effects ◽  
Treatment Decision Making ◽  
Inference Methods

Evidence-based medicine (EBM) calls on clinicians to incorporate the ‘best available evidence’ into clinical decision-making. For decisions regarding treatment, the best evidence is that which determines the causal effect of treatments on the clinical outcomes of interest. Unfortunately, research often provides evidence where associations are not due to cause-and-effect, but rather due to non-causal reasons. These non-causal associations may provide valid evidence for diagnosis or prognosis, but biased evidence for treatment effects. Causal inference aims to determine when we can infer that associations are or are not due to causal effects. Since recommending treatments that do not have beneficial causal effects will not improve health, causal inference can advance the practice of EBM. The purpose of this article is to familiarise clinicians with some of the concepts and terminology that are being used in the field of causal inference, including graphical diagrams known as ‘causal directed acyclic graphs’. In order to demonstrate some of the links between causal inference methods and clinical treatment decision-making, we use a clinical vignette of assessing treatments to lower cardiovascular risk. As the field of causal inference advances, clinicians familiar with the methods and terminology will be able to improve their adherence to the principles of EBM by distinguishing causal effects of treatment from results due to non-causal associations that may be a source of bias.

scholarly journals ADOLESCENT PATIENTS AND THE CLINICAL DECISION ABOUT THEIR HEALTH

2019 ◽  
Vol 37 (4) ◽  
pp. 503-509
Author(s):  
Marlene Pereira Garanito ◽  
Vera Lucia Zaher-Rutherford
Keyword(s):  
Decision Making ◽  
Latin American ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Electronic Library ◽  
Data Synthesis ◽  
Treatment Decision Making ◽  
The Individual

ABSTRACT Objective: To carry out a review of the literature on adolescents’ participation in decision making for their own health. Data sources: Review in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases. We consider scientific articles and books between 1966 and 2017. Keywords: adolescence, autonomy, bioethics and adolescence, autonomy, ethics, in variants in the English, Portuguese and Spanish languages. Inclusion criteria: scientific articles, books and theses on clinical decision making by the adolescent patient. Exclusion criteria: case reports and articles that did not address the issue. Among 1,590 abstracts, 78 were read in full and 32 were used in this manuscript. Data synthesis: The age at which the individual is able to make decisions is a matter of debate in the literature. The development of a cognitive and psychosocial system is a time-consuming process and the integration of psychological, neuropsychological and neurobiological research in adolescence is fundamental. The ability to mature reflection is not determined by chronological age; in theory, a mature child is able to consent or refuse treatment. Decision-making requires careful and reflective analysis of the main associated factors, and the approach of this problem must occur through the recognition of the maturity and autonomy that exists in the adolescents. To do so, it is necessary to “deliberate” with them. Conclusions: International guidelines recommend that adolescents participate in discussions about their illness, treatment and decision-making. However, there is no universally accepted consensus on how to assess the decision-making ability of these patients. Despite this, when possible, the adolescent should be included in a serious, honest, respectful and sincere process of deliberation.

scholarly journals A sociodental approach in prosthodontic treatment decision making

2004 ◽  
Vol 12 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Cláudio Rodrigues Leles ◽  
Maria do Carmo Matias Freire
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Evidence Based ◽  
Critical Problem ◽  
Practice Model ◽  
Treatment Decision Making

A critical problem in the decision making process for dental prosthodontic treatment is the lack of reliable clinical parameters. This review discusses the limits of traditional normative treatment and presents guidelines for clinical decision making. There is a need to incorporate a sociodental approach to help determine patient's needs. Adoption of the evidence-based clinical practice model is also needed to assure safe and effective clinical practice in prosthetic dentistry.

Interactive Video Assists in Clinical Decision Making

1998 ◽  
Vol 37 (02) ◽  
pp. 201-205 ◽  
Author(s):  
B. E. Waitzfelder ◽  
E. P. Gramlich
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Interactive Video ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Medical Decision ◽  
Treatment Decision Making ◽  
Interactive Videodisk

AbstractThe Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating.

scholarly journals Immunohistochemistry for Prostate Biopsy—Impact on Histological Prostate Cancer Diagnoses and Clinical Decision Making

2021 ◽  
Vol 28 (3) ◽  
pp. 2123-2133
Author(s):  
Philipp Mandel ◽  
Mike Wenzel ◽  
Benedikt Hoeh ◽  
Maria N. Welte ◽  
Felix Preisser ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Diagnostic Purpose ◽  
Treatment Decision Making ◽  
Prostate Biopsies ◽  
Impact On Treatment ◽  
Baseline Characteristics

Background: To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. Methods: Between January 2017–June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic purpose. Final pathologic results after radical prostatectomy (RP) were analyzed regarding the effect of IHC at biopsy. Results: Of 606 biopsies, 350 (58.7%) received additional IHC staining. Of those, prostate cancer (PCa) was found in 208 patients (59.4%); while in 142 patients (40.6%), PCa could be ruled out through IHC. IHC patients harbored significantly more often Gleason 6 in biopsy (p < 0.01) and less suspicious baseline characteristics than patients without IHC. Of 185 patients with positive IHC and PCa detection, IHC led to a change in biopsy results in 81 (43.8%) patients. Of these patients with changes in biopsy results due to IHC, 42 (51.9%) underwent RP with 59.5% harboring ≥pT3 and/or Gleason 7–10. Conclusions: Patients with IHC stains had less suspicious characteristics than patients without IHC. Moreover, in patients with positive IHC and PCa detection, a change in biopsy results was observed in >40%. Patients with changes in biopsy results partly underwent RP, in which 60% harbored significant PCa.

scholarly journals Advancing Personalized Care for Patients with Myeloproliferative Neoplasms (MPNs): Findings from a Phase 2 Scale-up Quality Initiative across Two Large U.S. Oncology Systems

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1911-1911
Author(s):  
Srdan Verstovsek ◽  
Ruben A. Mesa ◽  
Shelby Sullivan ◽  
Jeffrey D Carter ◽  
Cherilyn Heggen
Keyword(s):  
Decision Making ◽  
Research Funding ◽  
Myeloproliferative Neoplasms ◽  
Treatment Options ◽  
Treatment Decision ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Treatment Decision Making ◽  
Black Patients ◽  
Centered Care

Abstract Background Myeloproliferative neoplasms (MPNs), a group of rare hematologic malignancies comprised of myelofibrosis, polycythemia vera and essential thrombocythemia, significantly impact the lives of patients with historically few effective treatment options. In this quality improvement (QI) initiative we assessed barriers to patient-centered MPN care in 2 large U.S. hospital systems. Methods Between 3/2021 and 5/2021, 24 hematology/oncology healthcare professionals (HCPs) from 2 large hospital systems completed surveys designed to characterize self-reported practice patterns, challenges, and barriers to collaborative MPN care. Additionally, 26 Black patients and 25 non-Black patients with MPNs completed surveys regarding their goals for treatment, barriers to care, and communication with providers. Findings from all surveys paired with patient chart data was presented to 18 HCPs from the systems in AF sessions to reflect on their own practice patterns and prioritize areas for improvement in MPN care. Participants developed team-based action plans to overcome identified challenges, including barriers in risk stratification, care coordination, and shared decision-making (SDM) for patients with MPNs. Surveys conducted before and after the small-group AF sessions evaluated changes in participants' knowledge and confidence in delivering collaborative, patient-centered MPN care. Results Team-Based Surveys: HCPs identified difficulty managing their symptoms (35%) and difficulty choosing therapy that best meets their treatment preferences and goals (25%) as the most pressing challenges their patient's face in their MPN care. The most challenging issue encountered by HCPs in selecting therapies for patients with MPNs is identifying when patients are undergoing disease progression/transformation (48%). HCPs reported effects on quality of life (75%) and treatment effectiveness (65%) as the most important factors for treatment decision-making among patients with MPNs. Teams were underutilizing SDM to provide patient-centered care, citing not enough time to engage in SDM (55%) and patients' low health literacy (50%) as the largest barriers. Patient Surveys: In contrast to HCP responses, the biggest challenge faced in their MPN care reported by Black patients was lack of reliable transportation or long distance to and from my care center (46%) difficulty managing my symptoms (36%) for non-Black patients. Furthermore, Black patients with MPN identified cost of treatment (56%) and advice from loved ones (40%) as the top factors for treatment decision-making, whereas, non-Black patients cited how the treatment is taken (52%) and how well the treatment will control my symptoms (50%). All patients identified they wish they had more time to discuss goals and preferences for treatment (62% Black, 64% non-Black ) with their provider. Black patients reported their MPN care team could improve most in education about MPNs and treatment options (73%), while non-Black patients felt improvements in empathy throughout the emotional journey of managing my MPN (68%) would be most beneficial. Small-Group AF Sessions: Across the 2 oncology centers, teams participating in the AF sessions (Table 1) shared a self-reported caseload of 219 patients with MPNs per month. HCPs reported meaningful shifts in confidence in their ability to provide optimal, patient-centered care (Figure 1) and knowledge of treatment options for MPNs (Figure 2). The aspects of patient-centered care HCPs will routinely discuss in more detail with patients are patients' goal and preferences (81%), results of genetic testing (63%), and risks and benefits of treatment options (56%). To achieve these goals, 63% of HCPs committed to improve team skills in appropriate risk stratification and differentiation of therapy based on patient-centered factors followed by sharing action plans with additional clinical team members (56%). Conclusions Participation in this QI initiative resulted in increased confidence in hematology/oncology HCPs ability to deliver patient-centered MPN care and improve commitment to team-based collaboration. Remaining practice gaps and challenges can inform future QI programs. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Incyte Corporation. The grantors had no role in the study design, execution, analysis, or reporting. Figure 1 Figure 1. Disclosures Verstovsek: CTI BioPharma: Research Funding; NS Pharma: Research Funding; Ital Pharma: Research Funding; Celgene: Consultancy, Research Funding; Roche: Research Funding; Protagonist Therapeutics: Research Funding; Promedior: Research Funding; PharmaEssentia: Research Funding; Gilead: Research Funding; Incyte Corporation: Consultancy, Research Funding; Genentech: Research Funding; Blueprint Medicines Corp: Research Funding; AstraZeneca: Research Funding; Novartis: Consultancy, Research Funding; Sierra Oncology: Consultancy, Research Funding; Constellation: Consultancy; Pragmatist: Consultancy. Mesa: Sierra Oncology: Consultancy, Research Funding; Gilead: Research Funding; Novartis: Consultancy; Celgene: Research Funding; Genentech: Research Funding; CTI: Research Funding; Abbvie: Research Funding; CTI: Research Funding; Incyte Corporation: Consultancy, Research Funding; Promedior: Research Funding; Samus: Research Funding; Constellation Pharmaceuticals: Consultancy, Research Funding; Pharma: Consultancy; AOP: Consultancy; La Jolla Pharma: Consultancy.

scholarly journals Shared clinical decision-making experiences in nursing: a qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fen-Fang Chung ◽  
Pao-Yu Wang ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Medical Center ◽  
Clinical Decision ◽  
Sociocultural Factors ◽  
Patient Centered ◽  
Clinical Nursing

Abstract Background Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM. Methods This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data. Results The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education.

Abstract P214: Patient and Physician Factors Influence Decision-Making in Hypercholesterolemia

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Michel Krempf ◽  
Ross J Simpson ◽  
Dena R Ramey ◽  
Philippe Brudi ◽  
Hilde Giezek ◽  
...  
Keyword(s):  
Decision Making ◽  
Goal Attainment ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Treatment Recommendations ◽  
Treatment Choice ◽  
Treatment Recommendation ◽  
Double Blind

Objectives: Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We surveyed physicians’ treatment recommendations in high-risk patients with LDL-C not controlled on statin monotherapy. Methods: Physicians completed a questionnaire pre-randomization for each patient in a double-blind trial (NCT01154036) assessing LDL-C goal attainment rates with different treatment strategies. Patients had LDL-C ≥100 mg/dL after 5 weeks’ atorvastatin 10 mg/day and before randomization. Physicians were asked about treatment recommendations for three scenarios: (1) LDL-C near goal (100-105 mg/dL), (2) LDL-C far from goal (120 mg/dL), then (3) known baseline LDL-C of enrolled patients on atorvastatin 10 mg/day. Factors considered in their choice were specified. Physicians had been informed of projected LDL-C reductions for each treatment strategy in the trial. Regression analysis identified prognostic factors associated with each scenario, and projected LDL-C values for physicians’ treatment choices were compared to actual LDL-C values achieved in the trial. Results: Physicians at 296 sites completed questionnaires for 1535 patients. The most common treatment strategies for all three scenarios were: 1) not to change therapy, 2) double atorvastatin dose, 3) add ezetimibe, 4) double atorvastatin dose and add ezetimibe. Doubling atorvastatin dose was the most common treatment recommendation in all scenarios (43-52% of patients). ‘No change in therapy’ was recommended in 6.5% of patients when LDL-C was assumed far from goal. Treatment recommendations were more aggressive if actual LDL-C was known or considered far from goal. When compared with the ‘no change in therapy’ recommendation, CV risk factors and desire to achieve a more aggressive LDL-C goal were generally considered in decision-making for each treatment choice, regardless of LDL-C scenario. Patients randomized to a more aggressive regimen than recommended by physicians had larger reductions in LDL-C: the actual reduction in LDL-C in patients randomized to ‘add ezetimibe’ was -20.8% versus a projected reduction of -10.0% when physicians recommended ‘doubling atorvastatin dose’. Conclusions: This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. Targeting lower LDL-C and CV risk were key drivers in clinical decision-making but, generally, physicians were more conservative in their treatment choice than guidelines recommend, which may result in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose.

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