scholarly journals Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care (Preprint)

2018 ◽  
Author(s):  
Charles R Doarn ◽  
Mary Beth Vonder Meulen ◽  
Harini Pallerla ◽  
Shauna P Acquavita ◽  
Saundra Regan ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
Subject Matter ◽  
Iterative Process ◽  
The United States ◽  
Mobile App ◽  
Shared Decision ◽  
Subject Matter Experts

BACKGROUND Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. OBJECTIVE The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. METHODS A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. RESULTS Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. CONCLUSIONS Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building.

scholarly journals Clinical evaluation of e-Quit worRx: a mobile app to enhance smoking cessation shared decision making in primary care

mHealth ◽  
2019 ◽  
Vol 5 ◽  
pp. 22-22
Author(s):  
Matthew R. Tubb ◽  
Mary Beth Vonder Meulen ◽  
Harini Pallerla ◽  
Saundra Regan ◽  
Charles R. Doarn
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
Clinical Evaluation ◽  
Mobile App ◽  
Shared Decision

scholarly journals Shared Decision-Making: Implementing the AFib 2getherTM Mobile App: Study Design and Feasibility in the Era of COVID-19 (Preprint)

2020 ◽  
Author(s):  
Andreza Andrade ◽  
Anna Hayes ◽  
David McManus ◽  
Kathleen Mazor ◽  
Carl Possidente ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Mobile App ◽  
Perceived Usefulness ◽  
Management Approach ◽  
Shared Decision ◽  
Medical Centers ◽  
Control And Prevention ◽  
Provider Knowledge

BACKGROUND The Center for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7-6.1 million people in the United States. Furthermore, those who have AF tend to have a much higher stroke risk than others. Although many individuals could largely benefit from an anticoagulant (AC), a significant majority are hesitant to start AC therapy. To further this issue, some providers tend to find themselves struggling to determine the risks and benefits of prescribing their patients AC. To assist in the communication between patient and provider preferences and knowledge regarding AC, different strategies are being used to try and solve this gap. In this research study, we have both patients and providers utilize the AFib 2getherTM app with hopes that it will create a platform for shared decision-making regarding management and treatment of AF with AC. OBJECTIVE The aims of our study are to measure usability, perceived usefulness to patients and providers, and feasibility of conducting shared decision visits using the mobile app, AFib 2getherTM. To measure provider knowledge of and confidence in utilizing a modern AF management approach and its association with the usability and feasibility. METHODS Eligible patients and providers will evaluate the AFib 2getherTM mobile app for usability and helpfulness in facilitating shared decision making on understanding the patient’s risk of stroke and whether or not to start AC. Both patients and providers will review the app and complete multiple questionnaires about the usability & feasibility of the mobile app in a clinical setting. RESULTS Enrollment in the AFib 2getherTM shared decision-making study is still ongoing for both patients and providers. CONCLUSIONS The AFib 2getherTM app emerged from the desire to increase patient and provider ability for shared decision-making around understanding risk of stroke and about AC. We hope the AFib 2getherTM mobile app will facilitate patient discussion with their cardiology and other providers. Additionally, we hope the study will help us identify a focus point in barriers that providers face when placing patients on AC. We aim to demonstrate the usability and feasibility of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. CLINICALTRIAL NCT04118270

Development of a New Encounter Decision Aid for Smoking Cessation (Preprint)

2021 ◽  
Author(s):  
Herul Holland Da Sa Neto ◽  
Ines Habfast-Robertson ◽  
Christina Hempel-Bruder ◽  
Marie-Anne Durand ◽  
Isabelle Jacot-Sadowski ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
General Practitioners ◽  
Decision Aid ◽  
Tobacco Cessation ◽  
Decision Aids ◽  
Therapeutic Education ◽  
Shared Decision

BACKGROUND Smoking cessation is an essential part of preventing and reducing risk of smoking associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Encounter decision aids, short, patient-facing decision aids used during clinic visits, optimize therapeutic education and increase interaction and the therapeutic alliance. Such a decision aid for smoking cessation could potentially improve counselling and increase the use of pharmacological treatments. OBJECTIVE We aimed to develop and test an electronic encounter decision aid (DA) that facilitates physician-patient interaction and shared decision making for smoking cessation in primary care. METHODS We developed a DA (howtoquit.ch) adapted from a paper version developed by our team in 2017 following user-centered design principles. The DA is a one page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, a questionnaire was submitted to general practitioner residents of an academic general medicine department, five general practitioners, and five experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free text questions assessing the usability/acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision making and patients' choices, perceived strengths and weaknesses and if they would recommend the tool to other clinicians. RESULTS Six residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (n=11), and 4 additional experts provided open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5) and supported shared decision making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to the end users comments. CONCLUSIONS The overall assessment of the DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.

scholarly journals Usability, Perceived Usefulness, and Shared Decision-Making Features of the AFib 2gether Mobile App: Protocol for a Single-Arm Intervention Study

10.2196/21986 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e21986
Author(s):  
Alok Kapoor ◽  
Andreza Andrade ◽  
Anna Hayes ◽  
Kathleen Mazor ◽  
Carl Possidente ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Risk ◽  
The United States ◽  
Mobile App ◽  
Perceived Usefulness ◽  
Shared Decision ◽  
Medical Centers ◽  
Control And Prevention ◽  
Larger Sample

Background The Centers for Disease Control and Prevention has estimated that atrial fibrillation (AF) affects between 2.7 million and 6.1 million people in the United States. Those who have AF tend to have a much higher stroke risk than others. Although most individuals with AF benefit from anticoagulation (AC) therapy, a significant majority are hesitant to start it. To add, providers often struggle in helping patients negotiate the decision to start AC therapy. To assist in the communication between patients and providers regarding preferences and knowledge about AC therapy, different strategies are being used to try and solve this problem. In this research study, we will have patients and providers utilize the AFib 2gether app with hopes that it will create a platform for shared decision making regarding the prevention of stroke in patients with AF receiving AC therapy. Objective The aim of our study is to measure several outcomes related to encounters between patients and their cardiology providers where AFib 2gether is used. These outcomes include usability and perceived usefulness of the app from the perspective of patients and providers. In addition, we will assess the extent and nature of shared decision making. Methods Eligible patients and providers will evaluate the AFib 2gether mobile app for usability and perceived usefulness in facilitating shared decision making regarding understanding the patient’s risk of stroke and whether or not to start AC therapy. Both patients and providers will review the app and complete multiple questionnaires about the usability and perceived usefulness of the mobile app in a clinical setting. We will also audio-record a subset of encounters to assess for evidence of shared decision making. Results Enrollment in the AFib 2gether shared decision-making study is still ongoing for both patients and providers. The first participant enrolled on November 22, 2019. Analysis and publishing of results are expected to be completed in spring 2021. Conclusions The AFib 2gether app emerged from a desire to increase the ability of patients and providers to engage in shared decision making around understanding the risk of stroke and AC therapy. We anticipate that the AFib 2gether mobile app will facilitate patient discussion with their cardiologist and other providers. Additionally, we hope the study will help us identify barriers that providers face when placing patients on AC therapy. We aim to demonstrate the usability and perceived usefulness of the app with a future goal of testing the value of our approach in a larger sample of patients and providers at multiple medical centers across the country. Trial Registration ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID) DERR1-10.2196/21986

scholarly journals Smoking cessation and shared decision‐making practices about lung cancer screening among primary care providers

2021 ◽  
Author(s):  
Maria A. Lopez‐Olivo ◽  
Jennifer A. Minnix ◽  
James G. Fox ◽  
Shawn P. E. Nishi ◽  
Lisa M. Lowenstein ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Lung Cancer Screening ◽  
Primary Care Providers ◽  
Shared Decision ◽  
Care Providers

scholarly journals Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care

10.2196/11300 ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. e11300
Author(s):  
Charles R Doarn ◽  
Mary Beth Vonder Meulen ◽  
Harini Pallerla ◽  
Shauna P Acquavita ◽  
Saundra Regan ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Smoking Cessation Counseling ◽  
Ipad App

Improving the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic

2021 ◽  
pp. JDNP-D-20-00078
Author(s):  
Sybilla Myers ◽  
Christopher Kennedy
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Cognitive Theory ◽  
Well Being ◽  
Mobile App ◽  
Shared Decision ◽  
Patient Centered ◽  
The Social

BackgroundPerceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.Local ProblemNo standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual’s likelihood of long-term success.MethodsDuring the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.InterventionsThe four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.ResultsAmong 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.ConclusionsThe SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.

Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease (Preprint)

2021 ◽  
Author(s):  
Alysha Taxter ◽  
Lisa Johnson ◽  
Doreen Tabussi ◽  
Yukiko Kimura ◽  
Brittany Donaldson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Data ◽  
The United States ◽  
Shared Decision ◽  
Time Data ◽  
Vertical Orientation ◽  
Patient Reported ◽  
Data Elements ◽  
The Right

BACKGROUND Coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision making. Increasing communication between patients and care teams is particularly important for children with chronic conditions, such as juvenile idiopathic arthritis (JIA), which is the most common, chronic rheumatic condition of childhood, and is associated with increased pain, decreased function, and decreased quality of life. OBJECTIVE We aimed to design a dashboard prototype for use in coproducing care for JIA patients. We evaluated the context use and needs of end users, obtained consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. METHODS A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support coproduction of care in four diverse ambulatory pediatric rheumatology clinics across the United States. We engaged a multidisciplinary team (n=18) of patients/parents, clinicians, nurses, and staff during an in-person kick-off meeting, followed by bi-weekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. Final necessary dashboard components were determined using Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated using PDSA methodology. Patients and providers were surveyed about their experiences. RESULTS Teams achieved consensus on what data matters most at point-of-care to support JIA patients, families, and clinicians partnering together to make the best possible decisions for better health. Notable themes included: the right data, in the right place, at the right time; data in once for multiple purposes; patient and family self-management components; and opportunity for education and increased transparency. A final set of 11 dashboard data elements were identified which include patient-reported outcomes, clinical data, and medications. Important design considerations include incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper testing with 36 patients/families yielded positive feedback about the dashboard’s usefulness during clinic discussions, helped to talk about what mattered most, and informed healthcare decision making. CONCLUSIONS Our study developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications, that can be used during a clinic visit to support meaningful conversations and shared decision making between JIA patients/families and their clinicians and care teams. CLINICALTRIAL N/A

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

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