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

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025173 ◽  
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.

Meeting Patients Where They Are

2017 ◽  
pp. 351-368
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.

scholarly journals Right For Me: a pragmatic multi-arm cluster randomised controlled trial of two interventions for increasing shared decision-making about contraceptive methods

2021 ◽  
Author(s):  
Rachel Thompson ◽  
Gabrielle Stevens ◽  
Ruth Manski ◽  
Kyla Z Donnelly ◽  
Daniela Agusti ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Literacy ◽  
Usual Care ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Contraceptive Methods ◽  
Care Visit ◽  
Health Care Visit

Objectives: There is a paucity of evidence on how to facilitate shared decision-making under real-world conditions and, in particular, whether interventions should target patients, health care providers, or both groups. Our objectives were to assess the comparative effectiveness, feasibility, and acceptability of patient- and provider-targeted interventions for improving shared decision-making about contraceptive methods in a pragmatic trial that prioritised applicability to real-world care. Design: The study design was a 2X2 factorial cluster randomized controlled trial with four arms: (1) video + prompt card ("video"), (2) decision aids + training ("decision aids"), (3) dual interventions ("dual"), and (4) usual care. Clusters were 16 primary and/or reproductive health care clinics that deliver contraceptive care in the Northeast United States. Participants: Participants were people who had completed a health care visit at a participating clinic, were assigned female sex at birth, were aged 15-49 years, were able to read and write English or Spanish, and had not previously participated in the study. Participants were enrolled for 13 weeks before interventions were implemented in clinics (pre-implementation cohort) and for 26 weeks after interventions were implemented in clinics (post-implementation cohort). 5,018 participants provided data on at least one study outcome. Interventions: Interventions were a video and prompt card that encourage patients to ask three specific questions in the health care visit and a suite of decision aids on contraceptive methods and training for providers in how to use them to facilitate shared decision-making with patients in the health care visit. Main outcome measures: The primary outcome was shared decision-making about contraceptive methods. Secondary outcomes spanned psychological, behavioural, and health outcomes. All outcomes were patient-reported via surveys administered immediately, four weeks, and six months after the health care visit. Results: We did not observe any between-arm difference in the differences in shared decision-making between the pre- and post-implementation cohorts for the sample as a whole (video vs. usual care: adjusted odds ratio (AOR)=1.23 (95% confidence interval (CI): 0.82 to 1.85), p=0.80; decision aids vs. usual care: AOR=1.47 (95% CI: 0.98 to 2.18), p=0.32; dual vs. video: AOR=0.95 (95% CI: 0.64 to 1.41), p=1.00; dual vs. decision aids: AOR=0.80 (95% CI: 0.54 to 1.17), p=0.72) or for participants with adequate health literacy. Among participants with limited health literacy, the difference in shared decision-making between the pre- and post-implementation cohorts was different in the video arm from the usual care arm (AOR=2.40 (95% CI: 1.01 to 5.71), p=.047) and was also different in the decision aids arm from the usual care arm (AOR=2.65 (95% CI: 1.16 to 6.07), p=.021), however these differences were not robust to adjustment for multiple comparisons. There were no intervention effects on the secondary outcomes among all participants nor among prespecified subgroups. With respect to intervention feasibility, rates of participant-reported exposure to the relevant intervention components were 9.4% for the video arm, 31.5% for the decision aids arm, and 5.0% for the dual arm. All interventions were acceptable to most patients. Conclusions: The interventions studied are unlikely to have a meaningful population-wide impact on shared decision-making or other outcomes in real-world contraceptive care without additional strategies to promote and support implementation. Selective use of the interventions among patients with limited health literacy may be more promising and, if effective, could reduce disparities in shared decision-making. Trial registration: ClinicalTrials.gov NCT02759939.

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

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.

Shared decision-making attitudes and practices in multidisciplinary cancer care teams.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 180-180
Author(s):  
Christina Mangir ◽  
Leigh Boehmer ◽  
Sandra E. Kurtin ◽  
Lalan S. Wilfong ◽  
Rena Kass ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Multidisciplinary Team ◽  
Decision Aids ◽  
Shared Decision ◽  
Patient Decision Aids ◽  
Attitudes And Practices ◽  
Patient Decision ◽  
Wide Range

180 Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health literacy. Methods: ACCC convened a steering committee of multidisciplinary specialists and advocacy representatives to guide this research. The survey included 26 mostly closed-ended questions and was open to multidisciplinary cancer programs from 10/29/19 to 2/20/20. Exploratory analysis was performed on this data set of 305 complete responses. Results: While most respondents reported engaging patients in decision-making to some degree, only 50% reported that SDM is a top organizational priority. 33% reported organizational efforts to formally integrate SDM into the clinical workflow, with only 15% indicating staff opportunities for basic SDM training. The three most frequently cited perceived barriers to engaging in SDM were patients feeling overwhelmed (53%), wanting to defer decisions to clinicians (46%), and having limited health literacy (46%). Only 13% indicated that lack of time was a barrier. Less than half (41%) of respondents reported using patient decision aids to support SDM. Respondents represented a wide range of multidisciplinary team members, though surgical oncologists and general surgeons (20% and 16% respectively) are overrepresented in the results. Conclusions: SDM is commonly accepted as essential to patient engagement but clarity in terminology and prioritizing formal integration of SDM into practice is limited. Strategies to improve integration of SDM into oncology practice should include: 1) Educational initiatives and tools to overcome barriers to SDM, including patient decision aids and SDM training, 2) Initiatives to address health literacy as it relates to patient and caregiver engagement in decision making, 3) Psychosocial support for patients whose emotional upset is a barrier to SDM, 4) Healthcare policies that encourage and incentive providers to engage in SDM. Future analyses will require concurrent assessment of patient, caregiver, healthcare professional, and administrator perspectives.

scholarly journals Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026342 ◽  
Author(s):  
Jesse Jansen ◽  
Shannon McKinn ◽  
Carissa Bonner ◽  
Danielle Marie Muscat ◽  
Jenny Doust ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Decision Making ◽  
General Practice ◽  
Older People ◽  
Shared Decision Making ◽  
Patient Experiences ◽  
Shared Decision ◽  
Framework Analysis ◽  
Cvd Risk ◽  
Cvd Prevention

ObjectivesTo explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.Design, setting and participantsSemi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol)orhad received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.ResultsTwenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.ConclusionsResults demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.

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.

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.

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