The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
Victor M. Montori - One of the best experts on this subject based on the ideXlab platform.
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Exploring differences in the use of the statin choice Decision Aid and diabetes medication choice Decision Aid in primary care.
BMC medical informatics and decision making, 2017Co-Authors: Aimee C. Yu Ballard, Victor M. Montori, Maya E. Kessler, Marianne R. Scheitel, Rajeev ChaudhryAbstract:Shared Decision making is essential to patient centered care, but can be difficult for busy clinicians to implement into practice. Tools have been developed to Aid in shared Decision making and embedded in electronic medical records (EMRs) to facilitate use. This study was undertaken to explore the patterns of use and barriers and facilitators to use of two Decision Aids, the Statin Choice Decision Aid (SCDA) and the Diabetes Medication Choice Decision Aid (DMCDA), in primary care practices where the Decision Aids are embedded in the EMR. A survey exploring factors that influenced use of each Decision Aid was sent to eligible primary care clinicians affiliated with the Mayo Clinic in Rochester, MN. Survey data was collected and clinician use of each Decision Aid via links from the EMR was tracked. The survey response rate was 40% (105/262). Log file data indicated 51% of clinicians used the SCDA and 9% of clinicians used the DMCDA. Reasons for lack of use included lack of knowledge of the EMR link, not finding the Decision Aids helpful, and time constraints. Survey responses indicated that use of the tool as intended was low, with many clinicians only discussing Decision Aid topics that they found relevant. Although guidelines for both the treatment of blood cholesterol with a statin and for the treatment of hyperglycemia in type 2 diabetes recommend shared Decision making, tools that facilitate shared Decision making are not routinely used even when embedded in the EMR. Even when Decision Aids are used, their use may not reflect patient centered care.
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Decision Aid for cigarette smokers scheduled for elective surgery
Anesthesiology, 2015Co-Authors: David O. Warner, Annie Leblanc, Sandeep Kadimpati, Kristin S. Vickers, Yu Shi, Victor M. MontoriAbstract:BACKGROUND Decision Aids can increase patient involvement in Decision-making about health care. The study goal was to develop and test a Decision Aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery. METHODS In formative work, a Decision Aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the Decision Aid would improve measures of Decisional quality compared with usual care. RESULTS The final Decision Aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each Decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the Decision Aid significantly (P < 0.05) improved measures of Decisional quality and patient involvement in Decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In Decision-making scale, respectively). However, the Decision Aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices. CONCLUSIONS Although the use of a Decision Aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of Decisional quality, it alone did not change perioperative tobacco use behavior.
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Decision Aid for Cigarette Smokers Scheduled for Elective Surgery.
Anesthesiology, 2015Co-Authors: David O. Warner, Annie Leblanc, Sandeep Kadimpati, Kristin S. Vickers, Yu Shi, Victor M. MontoriAbstract:Decision Aids can increase patient involvement in Decision-making about health care. The study goal was to develop and test a Decision Aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery. In formative work, a Decision Aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the Decision Aid would improve measures of Decisional quality compared with usual care. The final Decision Aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each Decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the Decision Aid significantly (P < 0.05) improved measures of Decisional quality and patient involvement in Decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In Decision-making scale, respectively). However, the Decision Aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices. Although the use of a Decision Aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of Decisional quality, it alone did not change perioperative tobacco use behavior.
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use of a Decision Aid to improve treatment Decisions in osteoporosis the osteoporosis choice randomized trial
The American Journal of Medicine, 2011Co-Authors: Victor M. Montori, Nilay D Shah, Megan E Branda, Laurie J Pencille, Holly K Van Houten, Brian A Swiglo, Rebecca L Kesman, Sidna M Tulledgescheitel, Thomas M Jaeger, Ruth E JohnsonAbstract:Abstract Objective Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed. Methods Eligible postmenopausal women with bone mineral density T-scores less than −1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a Decision Aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in Decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles. Results A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the Decision Aid (n=52) or usual care (n=48). Patients receiving the Decision Aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the Decision Aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the Decision Aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the Decision Aid (n=23 [100%] vs n=14 [74%]; P = .009). Conclusion A Decision Aid improved the quality of clinical Decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.
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The Statin Choice Decision Aid in primary care: a randomized trial.
Patient education and counseling, 2009Co-Authors: Devin M. Mann, Victor M. Montori, Diego Ponieman, Jacqueline Arciniega, Thomas McginnAbstract:Objective To assess the impact of a Decision Aid on perceived risk of heart attacks and medication adherence among urban primary care patients with diabetes. Methods We randomly allocated 150 patients with diabetes to participate in a usual primary care visit either with or without the Statin Choice tool. Participants completed a questionnaire at baseline and telephone follow-up at 3 and 6 months. Results Intervention patients were more likely to accurately perceive their underlying risk for a heart attack without taking a statin (OR: 1.9, CI: 1.0-3.8) and with taking a statin (OR: 1.4, CI: 0.7-2.8); a decline in risk overestimation among patients receiving the Decision Aid accounts for this finding. There was no difference in statin adherence at 3 or 6 months. Conclusion A Decision Aid about using statins to reduce coronary risk among patients with diabetes improved risk communication, beliefs, and Decisional conflict, but did not improve adherence to statins. Practice implications Decision Aid enhanced communication about the risks and benefits of statins improved patient risk perceptions but did not alter adherence among patients with diabetes.
Annette M. O'connor - One of the best experts on this subject based on the ideXlab platform.
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Randomized trial of a Decision Aid for patients with cystic fibrosis considering lung transplantation.
American journal of respiratory and critical care medicine, 2009Co-Authors: Katherine L. Vandemheen, Annette M. O'connor, Scott C. Bell, Andreas Freitag, Peter T. P. Bye, Alphonse Jeanneret, Yves Berthiaume, Neil Brown, Pearce G. Wilcox, Gerard RyanAbstract:We developed an evidence-based Decision Aid for patients with advanced cystic fibrosis considering referral for lung transplantation. To prospectively evaluate whether use of the Decision Aid increased knowledge about the options, improved realistic expectations, and decreased Decisional conflict in adult patients. We performed a single-blind randomized controlled trial involving 149 adult patients with cystic fibrosis with an FEV(1) <or= 40% predicted from 14 Canadian and Australian centers. All participants received an education and counseling session from their cystic fibrosis team and were then randomized to receive the Decision Aid or usual care. The Decision Aid is available online at http://DecisionAid.ohri.ca/decAids.html. The primary end points measured were participants' knowledge, realistic expectations, and Decisional conflict evaluated 3 weeks after randomization. Patients randomized to the Decision Aid had greater knowledge about their options (P < 0.0001) and had more realistic expectations about the benefits and risks of lung transplantation (P < 0.0001) compared with those randomized to usual care. The total Decisional conflict score was significantly lower in the Decision Aid group 3 weeks postrandomization compared with the usual care group (11.6 vs. 20.4; P = 0.0007). Decisions were durable; 88% of patients in the Decision Aid group and 75% in the usual care group maintained the same choice 12 months after randomization (P = 0.06). Use of a Decision Aid for patients with cystic fibrosis considering referral for lung transplantation, in addition to usual education and counseling, improves patient knowledge, realistic expectations, Decisional conflict, and patient satisfaction. Clinical trial registered with www.clinicaltrials.gov (NCT00345449).
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Development and evaluation of a breast cancer prevention Decision Aid for higher‐risk women
Health Expectations, 2003Co-Authors: Dawn Stacey, Annette M. O'connor, Cathy Degrasse, Shailendra VermaAbstract:Objective To develop and evaluate the effectiveness of a breast cancer prevention Decision Aid for women aged 50 and older at higher risk of breast cancer. Design Pre-test–post-test study using Decision Aid alone and in combination with counselling. Setting Breast Cancer Risk Assessment Clinic. Participants Twenty-seven women aged 50–69 with 1.66% or higher 5-year risk of breast cancer. Intervention Self-administered breast cancer prevention Decision Aid. Main outcome measures Acceptability; Decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life-style practices; psychological distress; and satisfaction with preparation for consultation. Results The Decision Aid alone, or in combination with counselling, decreased some dimensions of Decisional conflict, increased knowledge (P
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Development and pilot testing of a Decision Aid for postmenopausal women with osteoporosis.
Patient education and counseling, 2002Co-Authors: Ann Cranney, Annette M. O'connor, Mary Jane Jacobsen, Peter Tugwell, Jonathan D. Adachi, Daylily S. Ooi, Lisa Waldegger, Rose Goldstein, George A. WellsAbstract:This study's aim was to develop and pilot test an evidence-based Decision Aid for postmenopausal women with osteoporosis who are considering options to prevent fractures. The Aid was based on the Ottawa Decision Support Framework, and integrated evidence from our Cochrane systematic reviews. Following development by a panel of experts in osteoporosis and Decision making, a user review panel of practitioners and women who had already made their Decision about osteoporosis therapy reviewed the Decision Aid for acceptability. Then the Decision Aid was pilot tested using a before-after design in women at the point of Decision making. Compared to baseline, there were statistically significant improvements in knowledge, realistic expectations and decreased Decisional conflict. Our Decision Aid shows promise in preparing women for counseling about osteoporosis therapies. Long-term adherence to chosen therapy and quality of life will be evaluated in a randomized controlled trial.
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A Decision Aid for Long‐Term Tube Feeding in Cognitively Impaired Older Persons
Journal of the American Geriatrics Society, 2001Co-Authors: Susan L. Mitchell, Jacqueline Tetroe, Annette M. O'connorAbstract:To describe the development and evaluation of a Decision Aid for long-term tube feeding in cognitively impaired older people. Before-and-after study. Acute care hospitals in Ottawa, Canada. Substitute Decision makers for 15 cognitively impaired inpatients 65 years and older being considered for placement of a percutaneous endoscopic gastrostomy tube. Questionnaires were used to compare the substitute Decision makers' knowledge, Decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the Decision Aid. The acceptability of the Decision Aid was also assessed. Substitute Decision makers significantly increased their knowledge (P = .004) and decreased their Decisional conflict (P = .004) regarding long-term tube feeding after using the Decision Aid. The impact of the Decision Aid on predisposition toward the intervention was greatest for those who were unsure of their preferences at baseline. All substitute Decision makers found the Decision Aid helpful and acceptable despite very difficult and emotional circumstances. A Decision Aid improves the Decision-making process for long-term tube feeding in cognitively impaired older patients by decreasing Decisional conflict and by promoting Decisions that are informed and consistent with personal values. There are particular challenges for developing and evaluating these tools in the context of end-of-life Decisions.
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Randomized trial of a patient Decision Aid for choice of surgical treatment for breast cancer.
Medical decision making : an international journal of the Society for Medical Decision Making, 2001Co-Authors: Vivek Goel, Carol Sawka, Elaine C. Thiel, Elaine H. Gort, Annette M. O'connorAbstract:A Decision Aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The Decision Aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the Decision Aid or a control pamphlet. Patients completed a questionnaire prior to using the Decision Aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or Decisional regret across the 2 groups. There was a nonsignificant trend toward lower Decisional conflict in the Decision Aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower Decisional conflict. Although the Decision Aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate Decision support interventions should be developed and evaluated.
Neal C Chen - One of the best experts on this subject based on the ideXlab platform.
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Decision Aid for trapeziometacarpal arthritis a randomized controlled trial
Journal of Hand Surgery (European Volume), 2019Co-Authors: Suzanne C Wilkens, David Ring, Teun Teunis, Sang Gil P Lee, Neal C ChenAbstract:Purpose Decision Aids increase patient participation in Decision making and reduce Decision conflict. The goal of this study was to evaluate the effect of a Decision Aid prior to the appointment, upon Decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the Decision Aid over time. Methods In this randomized controlled trial, we included 90 patients seeking the care of a hand surgeon for trapeziometacarpal (TMC) arthritis for the first time. Patients were randomly assigned to receive either usual care (an informational brochure) or an interactive Web-based Decision Aid. At enrollment, consult duration was recorded, and patients completed the following measures: (1) Decisional Conflict Scale; (2) Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); (3) pain intensity; (4) Physical Health Questionnaire (PHQ-2); (5) satisfaction with the visit; and (6) Consultation And Relational Empathy (CARE) scale. At 6 weeks and 6 months, patients completed: (1) pain intensity measure; (2) Decision Regret Scale; and (3) satisfaction with treatment. We also recorded changes in treatment and provider. Results Patients who reviewed the interactive Decision Aid prior to visiting their hand surgeon had less Decisional conflict at the end of the visit. Other outcomes were not affected. Conclusions Use of a Decision Aid prior to a first-time visit for TMC led to a measurable reduction in Decision conflict. Decision Aids make people seeking care for TMC arthritis more comfortable with their Decision making. Future research might address the ability of Decision Aids to reduce surgeon-to-surgeon variation, resource utilization, and dissatisfaction with care Clinical relevance Surgeons should consider the routine use of Decision Aids to reduce Decision conflict.
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Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial.
The Journal of hand surgery, 2018Co-Authors: Suzanne C Wilkens, David Ring, Teun Teunis, Sang Gil P Lee, Neal C ChenAbstract:Decision Aids increase patient participation in Decision making and reduce Decision conflict. The goal of this study was to evaluate the effect of a Decision Aid prior to the appointment, upon Decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the Decision Aid over time. In this randomized controlled trial, we included 90 patients seeking the care of a hand surgeon for trapeziometacarpal (TMC) arthritis for the first time. Patients were randomly assigned to receive either usual care (an informational brochure) or an interactive Web-based Decision Aid. At enrollment, consult duration was recorded, and patients completed the following measures: (1) Decisional Conflict Scale; (2) Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); (3) pain intensity; (4) Physical Health Questionnaire (PHQ-2); (5) satisfaction with the visit; and (6) Consultation And Relational Empathy (CARE) scale. At 6 weeks and 6 months, patients completed: (1) pain intensity measure; (2) Decision Regret Scale; and (3) satisfaction with treatment. We also recorded changes in treatment and provider. Patients who reviewed the interactive Decision Aid prior to visiting their hand surgeon had less Decisional conflict at the end of the visit. Other outcomes were not affected. Use of a Decision Aid prior to a first-time visit for TMC led to a measurable reduction in Decision conflict. Decision Aids make people seeking care for TMC arthritis more comfortable with their Decision making. Future research might address the ability of Decision Aids to reduce surgeon-to-surgeon variation, resource utilization, and dissatisfaction with care CLINICAL RELEVANCE: Surgeons should consider the routine use of Decision Aids to reduce Decision conflict. Copyright © 2019 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Rafael Meza - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a personalized web based Decision Aid for lung cancer screening
American Journal of Preventive Medicine, 2015Co-Authors: Yan Kwan Lau, Tanner J Caverly, Pianpian Cao, Sarah T Cherng, Mindy West, Charles Gaber, Douglas A Arenberg, Rafael MezaAbstract:Introduction Informed Decision making has been highlighted as an important aspect of lung cancer screening programs. This study seeks to assess the efficacy of a web-based patient Decision Aid for lung cancer screening, www.shouldiscreen.com. Methods A before-and-after study (August through December 2014) was conducted where participants navigated a web-based Decision Aid that provided information about low-dose computed tomography lung cancer screening. Using an established prediction model, the Decision Aid computed baseline lung cancer risk and an individual's chances of benefiting from, and risk of being harmed by, screening. Outcome measures included knowledge of lung cancer risk factors and lung cancer screening, Decisional conflict, concordance, and acceptability of the Decision Aid. Data were collected from 60 participants who were current or former smokers, had no history of lung cancer, and had not received a chest computed tomographic scan in the previous year. Analysis took place in 2015. Results Knowledge increased after seeing the Decision Aid compared with before ( p p p n =49), contrary to those who were eligible ( n =11). Ninety-seven percent of the participants reported that the Decision Aid was likely useful for lung cancer screening Decision making. Conclusions The web-based Decision Aid should be a helpful resource for individuals considering lung cancer screening, as well as for practitioners and health systems with lung cancer screening programs.
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Evaluation of a Personalized, Web-Based Decision Aid for Lung Cancer Screening.
American journal of preventive medicine, 2015Co-Authors: Yan Kwan Lau, Tanner J Caverly, Pianpian Cao, Sarah T Cherng, Mindy West, Charles Gaber, Douglas A Arenberg, Rafael MezaAbstract:Informed Decision making has been highlighted as an important aspect of lung cancer screening programs. This study seeks to assess the efficacy of a web-based patient Decision Aid for lung cancer screening, www.shouldiscreen.com. A before-and-after study (August through December 2014) was conducted where participants navigated a web-based Decision Aid that provided information about low-dose computed tomography lung cancer screening. Using an established prediction model, the Decision Aid computed baseline lung cancer risk and an individual's chances of benefiting from, and risk of being harmed by, screening. Outcome measures included knowledge of lung cancer risk factors and lung cancer screening, Decisional conflict, concordance, and acceptability of the Decision Aid. Data were collected from 60 participants who were current or former smokers, had no history of lung cancer, and had not received a chest computed tomographic scan in the previous year. Analysis took place in 2015. Knowledge increased after seeing the Decision Aid compared with before (p<0.001), whereas the score on the Decisional Conflict Scale decreased (p<0.001). Concordance between a participant's preference to screen and the U.S. Preventive Services Task Force recommendation improved after seeing the Decision Aid (p<0.001). Risk perceptions among the screen-ineligible group changed (n=49), contrary to those who were eligible (n=11). Ninety-seven percent of the participants reported that the Decision Aid was likely useful for lung cancer screening Decision making. The web-based Decision Aid should be a helpful resource for individuals considering lung cancer screening, as well as for practitioners and health systems with lung cancer screening programs. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Rinaa S. Punglia - One of the best experts on this subject based on the ideXlab platform.
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onlineDecision.org: a web-based Decision Aid for DCIS treatment.
Breast cancer research and treatment, 2015Co-Authors: Elissa M. Ozanne, Katharine H. Schneider, Djøra I. Soeteman, Natasha K. Stout, Deborah Schrag, Michael Fordis, Rinaa S. PungliaAbstract:Women diagnosed with DCIS face complex treatment Decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these Decisions for both providers and patients. We developed a web-based Decision Aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based Decision tools guided the development of the Decision Aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDecision.org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the Decision Aid in usability testing were interested in using it in their clinical practice. The Decision Aid is available in a web-based format and is planned to be publicly available. To improve treatment Decision making in patients with DCIS, we have developed a web-based Decision Aid onlineDecision.org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment Decisions.
