scholarly journals A web-based clinical decision tool to support treatment decision-making in psychiatry: a pilot focus group study with clinicians, patients and carers

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Catherine Henshall ◽  
Lisa Marzano ◽  
Katharine Smith ◽  
Mary-Jane Attenburrow ◽  
Stephen Puntis ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Group ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Decision Tool ◽  
Focus Group Study ◽  
Web Based ◽  
Treatment Decision Making ◽  
Support Treatment

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.

Improving informed breast cancer systemic treatment decision-making.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 225-225
Author(s):  
Sarah T. Hawley ◽  
Larry An ◽  
Yun Li ◽  
Reshma Jagsi ◽  
Steven J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Systemic Treatment ◽  
Early Stage ◽  
Controlled Trial ◽  
Treatment Decision ◽  
Early Stage Breast Cancer ◽  
Decision Quality ◽  
Decision Tool ◽  
Treatment Decision Making

225 Background: Decision making for adjuvant chemotherapy is increasingly complicated for women with a new diagnosis of early stage breast cancer. Few decision tools are designed to help support informed systemic treatment decision-making, by improving knowledge and decision quality. Methods: We conducted a randomized controlled trial (RCT) of a tailored, comprehensive (locoregional and systemic treatment) and interactive decision tool (iCanDecide), compared with static online information. 537 newly diagnosed, early stage breast cancer patients were enrolled from 22 surgical practices. Participants were surveyed 5 weeks (N = 496; RR 92%) and those eligible for systemic treatment (N = 358) again at 9 months (N = 307; RR 88%). The main outcome for this analysis was knowledge about systemic treatment using 4 true/false items, categorized into high (3- 4 correct) vs. low (0-2 correct). We also assessed subjective decision quality (SDQ) for chemotherapy on a 5-point scale and dichotomized into high (4-5) vs. low (1-3) We evaluated the distribution of participants in each arm, and assessed the association between the study arm and the outcomes using bivariate and multivariable approaches. Results: Of the 358 respondents, 201 did not receive or intend to have chemotherapy. Significantly more intervention than control patients had high knowledge about systemic treatment (52.9% vs. 39.9%, p = 0.012). Overall SDQ for chemotherapy was slightly higher in intervention than control subjects (mean 4.8 vs. 4.6, p = 0.08). However, among women who did not receive chemotherapy, significantly more intervention subjects reported high SDQ than controls (87.1% vs. 75.2%, p = 0.06). Values significantly related to chemotherapy use included avoiding side effects, continuing to work, and being most extensive possible. Conclusions: We found that the interactive decision tool contributed significantly to higher knowledge about systemic treatment among eligible patients. We further found the tool shows promise for improving subjective decision quality, particularly in patients who choose not to have chemotherapy. Further work to integrate tools into the oncology clinical setting is needed. Clinical trial information: NCT01840163.

scholarly journals Physician–patient communication affects patient satisfaction in treatment decision-making: a structural equation modelling analysis of a web-based survey in patients with ulcerative colitis

2021 ◽  
Author(s):  
Katsuyoshi Matsuoka ◽  
Hirono Ishikawa ◽  
Takeo Nakayama ◽  
Yusuke Honzawa ◽  
Atsuo Maemoto ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Structural Equation ◽  
Treatment Decision ◽  
Patient Trust ◽  
Web Based ◽  
Treatment Decision Making ◽  
Modelling Analysis ◽  
Satisfaction With Treatment ◽  
Trust In Physicians

Abstract Background The relationship of bidirectional sharing of information between physicians and patients to patient satisfaction with treatment decision-making for ulcerative colitis (UC) has not been examined. Here, we conducted a web-based survey to evaluate this relationship. Methods Patients aged ≥ 20 years with UC were recruited from the IBD Patient Panel and Japanese IBD Patient Association. Patients completed our web-based survey between 11 May and 1 June 2020. The main outcomes were patient satisfaction (assessed by the Decision Regret Scale) and patient trust in physicians (assessed by the Trust in Physician Scale). Results In this study (n = 457), a structural equation modelling analysis showed that physician-to-patient and patient-to-physician information significantly affected patient satisfaction with treatment decision-making (standardised path coefficient: 0.426 and 0.135, respectively) and patient trust in physicians (0.587 and 0.158, respectively). Notably, physician-to-patient information had a greater impact. For patient satisfaction with treatment decision-making and patient trust in physicians, information on “disease” (indirect effect: 0.342 and 0.471, respectively), “treatment” (0.335 and 0.461, respectively), and “endoscopy” (0.295 and 0.407, respectively) was particularly important, and the level of this information was adequate or almost adequate. Patient-to-physician information on “anxiety and distress” (0.116 and 0.136, respectively), “intention and desire for treatment” (0.113 and 0.132, respectively), and “future expectations of life” (0.104 and 0.121, respectively) were also important for patient satisfaction with treatment decision-making and patient trust in physicians, but these concerns were not adequately communicated. Conclusions Adequate physician–patient communication, especially physician-to-patient information, enhanced patient satisfaction with treatment decision-making for UC.

Does Instrumented Movement Analysis Alter, Objectively Confirm, or Not Affect Clinical Decision-making in Musicians with Focal Dystonia?

2008 ◽  
Vol 23 (3) ◽  
pp. 99-106
Author(s):  
Maurizio Ferrarin ◽  
Marco Rabuffetti ◽  
Marina Ramella ◽  
Maurizio Osio ◽  
Enrico Mailland ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Clinical Assessment ◽  
Confidence Level ◽  
Treatment Decision ◽  
Movement Analysis ◽  
Clinical Decision ◽  
Focal Dystonia ◽  
Treatment Decision Making ◽  
Instrumental Assessment

Focal dystonia (FD) is a movement disorder that frequently affects instrumental musicians. Distinguishing between primary dystonic movement and secondary compensatory abnormal movement is crucial for the correct treatment planning in FD. Such distinction is complex in musicians because of the complexity, speed, and smallness of involved movement. The goal of the current study was to assess the influence of instrumented movement analysis (MA) in treatment decision-making in musician's FD. A group of 18 musicians with FD was instrumentally analyzed in an MA laboratory equipped with optoelectronic and electromyographic (EMG) acquisition systems. The muscle(s) primarily responsible for the dystonic movement or posture (trigger muscle) was identified on the basis of clinical assessment alone and, in a second phase, with the additional information provided by instrumented assessment. Comparison between clinical and instrumented assessment outcomes and the subjective rating of found differences were then analyzed. In 67% of patients, instrumental assessment changed the decision made by clinical assessment, indicating identification of a different trigger muscle or allowing for a more specific identification. In 28% of patients, instrumental assessment confirmed the outcome of the clinical assessment, with an increase in the confidence level of the clinical decision. The most frequent change was an improved specification of which finger flexor muscle (superficialis or profundus) was triggering the dystonic movement. Although caution is needed due to the non-blinded design of the present study, our results suggest that instrumented movement analysis is a useful complementary tool to clinical assessment in treatment planning for musician's focal dystonia—its use might change the identification of the muscles primarily responsible for dystonic movements as well as increase the confidence level of the clinician in treatment decision-making.

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.

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