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Clarence H Braddock - One of the best experts on this subject based on the ideXlab platform.
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measuring Informed Decision making about prostate cancer screening in primary care
Medical Decision Making, 2012Co-Authors: Amy Leader, Clarence H Braddock, Sylvia Bereknyei, Constantine Daskalakis, Elisabeth J S Kunkel, James Cocroft, Jeffrey M Riggio, Mark Capkin, Ronald E MyersAbstract:Purpose. To measure the extent of Informed Decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure. Methods. Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated Decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification. An IDM-9 score (range = 0–9) was determined for each encounter by summing the number of elements that were coded as present. Estimates of coding reliability and internal consistency were calculated. Results. Male patients tended to be white (59%), married (70%), and between the ages of 50 and 59 (70%). Physicians tended to be white (90%), male (74%), and have more than 10 years of pra...
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new elements for Informed Decision making a qualitative study of older adults views
Patient Education and Counseling, 2012Co-Authors: Erika Leemann Price, Sylvia Bereknyei, Wendy Levinson, Alma Kuby, Clarence H BraddockAbstract:Abstract Objective To explore older adults’ views of existing Informed Decision making (IDM) elements and investigate the need for additional elements. Methods We recruited persons 65 and older to participate in six focus groups. Participants completed questionnaires about IDM preferences, and discussed videotapes of idealized patient–physician interactions in light of seven IDM elements: (1) discussion of the patient's role in Decision making; (2) discussion of the clinical issue; (3) discussion of alternatives; (4) discussion of benefits/risks; (5) discussion of uncertainties; (6) assessment of patient understanding; and (7) exploration of patient preference. We used a modified grounded theory approach to assess agreement with existing IDM elements and identify new elements. Results In questionnaires, 97–100% of 59 participants rated each IDM element as “somewhat” or “very” important. Qualitative analysis supported existing elements and suggested two more: opportunity for input from trusted others, and discussion of Decisions’ impacts on patients’ daily lives. Elements overlapped with global communication themes. Conclusion Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients. Practice implications Incorporation of additional IDM elements into clinical practice can enhance Informed participation of older adults in Decision making.
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Informed Decision-making and colorectal cancer screening: is it occurring in primary care?
Medical care, 2008Co-Authors: Bruce S Ling, Clarence H Braddock, Jeanette M Trauth, Michael J Fine, Maria K Mor, Abby Resnick, Sylvia Bereknyei, Joel L Weissfeld, Robert E Schoen, Edmund M RicciAbstract:Current recommendations advise patients to participate in the Decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known. To assess the level of Informed Decision-making occurring during actual patient-provider communications on CRC screening and test for the association between Informed Decision-making and screening behavior. Observational study of audiotaped clinic visits between patients and their providers in the primary care clinic at a Veterans Administration Medical Center. Male patients, age 50-74 years, presenting to a primary care visit at the study site. The Informed Decision-Making (IDM) Model was used to code the audiotapes for 9 elements of communication that should occur to prepare patients for participation in Decision-making. The primary outcome is completion of CRC screening during the study period. The analytic cohort consisted of 91 patients due for CRC screening who had a test ordered at the visit. Six of the 9 IDM elements occurred in < or =20% of the visits with none addressed in > or =50%. CRC screening occurred less frequently for those discussing "pros and cons" (12% vs. 46%, P = 0.01) and "patient preferences" (6% vs. 47%, P = 0.001) compared with those who did not. We found that a lack of Informed Decision-making occurred during CRC screening discussions and that particular elements of the process were negatively associated with screening. Further research is needed to better understand the effects of Informed Decision-making on screening behavior.
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"Surgery is certainly one good option": quality and time-efficiency of Informed Decision-making in surgery.
The Journal of bone and joint surgery. American volume, 2008Co-Authors: Clarence H Braddock, Sylvia Bereknyei, Pamela L. Hudak, Jacob J. Feldman, Richard M Frankel, Wendy LevinsonAbstract:Background: Informed Decision-making has been widely promoted in several medical settings, but little is known about the actual practice in orthopaedic surgery and there are no clear guidelines on how to improve the process in this setting. This study was designed to explore the quality of Informed Decision-making in orthopaedic practice and to identify excellent time-efficient examples with older patients. Methods: We recruited orthopaedic surgeons, and patients sixty years of age or older, in a Midwestern metropolitan area for a descriptive study performed through the analysis of audiotaped physician-patient interviews. We used a valid and reliable measure to assess the elements of Informed Decision-making. These included discussions of the nature of the Decision, the patient's role, alternatives, pros and cons, and uncertainties; assessment of the patient's understanding and his or her desire to receive input from others; and exploration of the patient's preferences and the impact on the patient's daily life. The audiotapes were scored with regard to whether there was a complete discussion of each Informed-Decision-making element (an IDM-18 score of 2) or a partial discussion of each element (an IDM-18 score of 1) as well as with a more pragmatic metric (the IDM-Min score), reflecting whether there was any discussion of the patient's role or preference and of the nature of the Decision. The visit duration was studied in relation to the extent of the Informed Decision-making, and excellent time-efficient examples were sought. Results: There were 141 Informed-Decision-making discussions about surgery, including knee and hip replacement as well as wrist/hand, shoulder, and arthroscopic surgery. Surgeons frequently discussed the nature of the Decision (92% of the time), alternatives (62%), and risks and benefits (59%); they rarely discussed the patient's role (14%) or assessed the patient's understanding (12%). The IDM-18 scores of the 141 discussions averaged 5.9 (range, 0 to 15; 95% confidence interval, 5.4 to 6.5). Fifty-seven percent of the discussions met the IDM-Min criteria. The median duration of the visits was sixteen minutes; the extent of Informed Decision-making had only a modest relationship with the visit duration. Time-efficient strategies that were identified included use of scenarios to illustrate distinct choices, encouraging patient input, and addressing primary concerns rather than lengthy recitations of pros and cons. Conclusions: In this study, which we believe is the first to focus on Informed Decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent Informed Decision-making is feasible and can be accomplished in a time-efficient manner.
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Informed Decision making in outpatient practice time to get back to basics
JAMA, 1999Co-Authors: Clarence H Braddock, Kelly Edwards, Nicole M Hasenberg, Tracy L Laidley, Wendy LevinsonAbstract:ContextMany clinicians have called for an increased emphasis on the patient's role in clinical Decision making. However, little is known about the extent to which physicians foster patient involvement in Decision making, particularly in routine office practice.ObjectiveTo characterize the nature and completeness of Informed Decision making in routine office visits of both primary care physicians and surgeons.DesignCross-sectional descriptive evaluation of audiotaped office visits during 1993.Setting and ParticipantsA total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons; 2 to 12 patients were recruited from each physician's community-based private office.Main Outcome MeasuresAnalysis of audiotaped patient-physician discussions for elements of Informed Decision making, using criteria that varied with the level of Decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic Decisions included discussion of the nature of the Decision and asking the patient to voice a preference; other categories had criteria that were progressively more stringent.ResultsThe 1057 audiotaped encounters contained 3552 clinical Decisions. Overall, 9.0% of Decisions met our definition of completeness for Informed Decision making. Basic Decisions were most often completely Informed (17.2%), while no intermediate Decisions were completely Informed, and only 1 (0.5%) complex Decision was completely Informed. Among the elements of Informed Decision making, discussion of the nature of the intervention occurred most frequently (71%) and assessment of patient understanding least frequently (1.5%).ConclusionsInformed Decision making among this group of primary care physicians and surgeons was often incomplete. This deficit was present even when criteria for Informed Decision making were tailored to expect less extensive discussion for Decisions of lower complexity. These findings signal the need for efforts to encourage Informed Decision making in clinical practice.
Wendy Levinson - One of the best experts on this subject based on the ideXlab platform.
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new elements for Informed Decision making a qualitative study of older adults views
Patient Education and Counseling, 2012Co-Authors: Erika Leemann Price, Sylvia Bereknyei, Wendy Levinson, Alma Kuby, Clarence H BraddockAbstract:Abstract Objective To explore older adults’ views of existing Informed Decision making (IDM) elements and investigate the need for additional elements. Methods We recruited persons 65 and older to participate in six focus groups. Participants completed questionnaires about IDM preferences, and discussed videotapes of idealized patient–physician interactions in light of seven IDM elements: (1) discussion of the patient's role in Decision making; (2) discussion of the clinical issue; (3) discussion of alternatives; (4) discussion of benefits/risks; (5) discussion of uncertainties; (6) assessment of patient understanding; and (7) exploration of patient preference. We used a modified grounded theory approach to assess agreement with existing IDM elements and identify new elements. Results In questionnaires, 97–100% of 59 participants rated each IDM element as “somewhat” or “very” important. Qualitative analysis supported existing elements and suggested two more: opportunity for input from trusted others, and discussion of Decisions’ impacts on patients’ daily lives. Elements overlapped with global communication themes. Conclusion Focus groups affirmed existing IDM elements and suggested two more with particular relevance for older patients. Practice implications Incorporation of additional IDM elements into clinical practice can enhance Informed participation of older adults in Decision making.
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Informed Decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.
Canadian journal of surgery. Journal canadien de chirurgie, 2011Co-Authors: Edward Etchells, Michel Ferrari, Alex Kiss, Nikki Martyn, Deborah Zinman, Wendy LevinsonAbstract:Background Prior studies show significant gaps in the Informed Decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk Decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate Informed Decision-making for major elective vascular surgery based on audiotapes of actual physician–patient conversations and, second, to compare ratings of Informed Decision-making for first visits to ratings for multiple visits by the same patient over time.
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"Surgery is certainly one good option": quality and time-efficiency of Informed Decision-making in surgery.
The Journal of bone and joint surgery. American volume, 2008Co-Authors: Clarence H Braddock, Sylvia Bereknyei, Pamela L. Hudak, Jacob J. Feldman, Richard M Frankel, Wendy LevinsonAbstract:Background: Informed Decision-making has been widely promoted in several medical settings, but little is known about the actual practice in orthopaedic surgery and there are no clear guidelines on how to improve the process in this setting. This study was designed to explore the quality of Informed Decision-making in orthopaedic practice and to identify excellent time-efficient examples with older patients. Methods: We recruited orthopaedic surgeons, and patients sixty years of age or older, in a Midwestern metropolitan area for a descriptive study performed through the analysis of audiotaped physician-patient interviews. We used a valid and reliable measure to assess the elements of Informed Decision-making. These included discussions of the nature of the Decision, the patient's role, alternatives, pros and cons, and uncertainties; assessment of the patient's understanding and his or her desire to receive input from others; and exploration of the patient's preferences and the impact on the patient's daily life. The audiotapes were scored with regard to whether there was a complete discussion of each Informed-Decision-making element (an IDM-18 score of 2) or a partial discussion of each element (an IDM-18 score of 1) as well as with a more pragmatic metric (the IDM-Min score), reflecting whether there was any discussion of the patient's role or preference and of the nature of the Decision. The visit duration was studied in relation to the extent of the Informed Decision-making, and excellent time-efficient examples were sought. Results: There were 141 Informed-Decision-making discussions about surgery, including knee and hip replacement as well as wrist/hand, shoulder, and arthroscopic surgery. Surgeons frequently discussed the nature of the Decision (92% of the time), alternatives (62%), and risks and benefits (59%); they rarely discussed the patient's role (14%) or assessed the patient's understanding (12%). The IDM-18 scores of the 141 discussions averaged 5.9 (range, 0 to 15; 95% confidence interval, 5.4 to 6.5). Fifty-seven percent of the discussions met the IDM-Min criteria. The median duration of the visits was sixteen minutes; the extent of Informed Decision-making had only a modest relationship with the visit duration. Time-efficient strategies that were identified included use of scenarios to illustrate distinct choices, encouraging patient input, and addressing primary concerns rather than lengthy recitations of pros and cons. Conclusions: In this study, which we believe is the first to focus on Informed Decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent Informed Decision-making is feasible and can be accomplished in a time-efficient manner.
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Informed Decision making in outpatient practice time to get back to basics
JAMA, 1999Co-Authors: Clarence H Braddock, Kelly Edwards, Nicole M Hasenberg, Tracy L Laidley, Wendy LevinsonAbstract:ContextMany clinicians have called for an increased emphasis on the patient's role in clinical Decision making. However, little is known about the extent to which physicians foster patient involvement in Decision making, particularly in routine office practice.ObjectiveTo characterize the nature and completeness of Informed Decision making in routine office visits of both primary care physicians and surgeons.DesignCross-sectional descriptive evaluation of audiotaped office visits during 1993.Setting and ParticipantsA total of 1057 encounters among 59 primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons; 2 to 12 patients were recruited from each physician's community-based private office.Main Outcome MeasuresAnalysis of audiotaped patient-physician discussions for elements of Informed Decision making, using criteria that varied with the level of Decision complexity: basic (eg, laboratory test), intermediate (eg, new medication), or complex (eg, procedure). Criteria for basic Decisions included discussion of the nature of the Decision and asking the patient to voice a preference; other categories had criteria that were progressively more stringent.ResultsThe 1057 audiotaped encounters contained 3552 clinical Decisions. Overall, 9.0% of Decisions met our definition of completeness for Informed Decision making. Basic Decisions were most often completely Informed (17.2%), while no intermediate Decisions were completely Informed, and only 1 (0.5%) complex Decision was completely Informed. Among the elements of Informed Decision making, discussion of the nature of the intervention occurred most frequently (71%) and assessment of patient understanding least frequently (1.5%).ConclusionsInformed Decision making among this group of primary care physicians and surgeons was often incomplete. This deficit was present even when criteria for Informed Decision making were tailored to expect less extensive discussion for Decisions of lower complexity. These findings signal the need for efforts to encourage Informed Decision making in clinical practice.
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How Doctors and Patients Discuss Routine Clinical Decisions: Informed Decision Making in the Outpatient Setting
Journal of general internal medicine, 1997Co-Authors: Clarence H Braddock, Wendy Levinson, Stephan D. Fihn, Albert R. Jonsen, Robert A. PearlmanAbstract:OBJECTIVE: To characterize the Informed consent process in routine, primary care office practice. DESIGN: Cross-sectional, descriptive evaluation of audiotaped encounters. SETTING: Offices of primary care physicians in Portland, Oregon. PARTICIPANTS: Internists (54%) and family physicians (46%), and their patients. MEASUREMENTS AND MAIN RESULTS: Audiotapes of primary care office visits from a previous study of doctor-patient communication were coded for the number and type of clinical Decisions made. The discussion between doctor and patient was scored according to six criteria for Informed Decision making: description of the nature of the Decision, discussion of alternatives, discussion of risks and benefits, discussion of related uncertainties, assessment of the patient's understanding and elicitation of the patient's preference. Discussions leading to Decisions included fewer than two of the six described elements of Informed Decision making (mean 1.23, median 1.0), most frequent of these was description of the nature of the Decision (83% of discussion). Discussion of risks and benefits was less frequent (9%), and assessment of understanding was rare (2%). Discussions of management Decisions were generally more substantive than discussions of diagnostic Decisions (p = .05). CONCLUSIONS: Discussions leading to clinical Decisions in these primary care settings did not fulfill the criteria considered integral to Informed Decision making. Physicians frequently described the nature of the Decision, less frequently discussed risks and benefits, and rarely assessed the patient's understanding of the Decision.
John N Lavis - One of the best experts on this subject based on the ideXlab platform.
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what are the best methodologies for rapid reviews of the research evidence for evidence Informed Decision making in health policy and practice a rapid review
Health Research Policy and Systems, 2016Co-Authors: Michelle M Haby, Evelina Chapman, Rachel Clark, Jorge Otavio Maia Barreto, Ludovic Reveiz, John N LavisAbstract:Background Rapid reviews have the potential to overcome a key barrier to the use of research evidence in Decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-Informed Decision making in health policy and practice?
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designing a rapid response program to support evidence Informed Decision making in the americas region using the best available evidence and case studies
Implementation Science, 2015Co-Authors: Michelle M Haby, Evelina Chapman, Rachel Clark, Jorge Otavio Maia Barreto, Ludovic Reveiz, John N LavisAbstract:Background The objective of this work was to inform the design of a rapid response program to support evidence-Informed Decision-making in health policy and practice for the Americas region. Specifically, we focus on the following: (1) What are the best methodological approaches for rapid reviews of the research evidence? (2) What other strategies are needed to facilitate evidence-Informed Decision-making in health policy and practice? and (3) How best to operationalize a rapid response program?
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what supports do health system organizations have in place to facilitate evidence Informed Decision making a qualitative study
Implementation Science, 2013Co-Authors: Moriah E Ellen, John N Lavis, Gregory Leon, Gisele Bouchard, Mathieu Ouimet, Jeremy M GrimshawAbstract:Background: Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform Decision-making. Objectives: The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-Informed Decision-making. Methods: In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results: A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-Informed Decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions: This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in Decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in Decision-making. Some of the identified supports may increase the use of research evidence by Decision-makers, which may then lead to more Informed Decisions, and hopefully to a strengthened health system and improved health.
Harry J. De Koning - One of the best experts on this subject based on the ideXlab platform.
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Informed Decision-making based on a leaflet in the context of prostate cancer screening.
Patient education and counseling, 2019Co-Authors: Tessa Dierks, Monique J Roobol, Eveline A.m. Heijnsdijk, Ida J. Korfage, Harry J. De KoningAbstract:Abstract Objective We aimed to assess to what extent men make Informed choices in the context of prostate cancer screening and how written material contributes to that process. Methods We developed a leaflet describing prostate cancer screening, and a questionnaire consisting of knowledge, attitude, and intended screening uptake components to assess Informed Decision-making. The leaflet and questionnaire were pilot-tested among men of the target population, adapted accordingly, and sent to 761 members of an online research panel. We operationalized whether the leaflet was read as spending one minute on the leaflet page and by a self-reported answer of respondents. Results The response rate was 66% (501/761). The group who read the leaflet (n = 342) correctly answered a knowledge item significantly more often (10.9 versus 8.8; p Conclusion Having read the leaflet could be one of the factors associated with increased levels of knowledge and Informed Decision-making. Practical implications The results of this study showed that increasing knowledge and supporting Informed Decision-making with written material are feasible in prostate cancer screening.
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Informed Decision-making based on a leaflet in the context of prostate cancer screening.
Patient education and counseling, 2019Co-Authors: Tessa Dierks, Monique J Roobol, Eveline A.m. Heijnsdijk, Ida J. Korfage, Harry J. De KoningAbstract:Objective: We aimed to assess to what extent men make Informed choices in the context of prostate cancer screening and how written material contributes to that process. Methods: We developed a leaflet describing prostate cancer screening, and a questionnaire consisting of knowledge, attitude, and intended screening uptake components to assess Informed Decision-making. The leaflet and questionnaire were pilot-tested among men of the target population, adapted accordingly, and sent to 761 members of an online research panel. We operationalized whether the leaflet was read as spending one minute on the leaflet page and by a self-reported answer of respondents. Results: The response rate was 66% (501/761). The group who read the leaflet (n = 342) correctly answered a knowledge item significantly more often (10.9 versus 8.8; p < 0.001) than those who did not read the leaflet (n = 159), and made more Informed choices (73% versus 56%; p = 0.001). There were no significant differences in attitude and intended screening uptake between both groups. Conclusion: Having read the leaflet could be one of the factors associated with increased levels of knowledge and Informed Decision-making. Practical implications: The results of this study showed that increasing knowledge and supporting Informed Decision-making with written material are feasible in prostate cancer screening
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The provision of information and Informed Decision-making on prenatal screening for Down syndrome: A questionnaire- and register-based survey in a non-selected population
Patient education and counseling, 2011Co-Authors: Marleen Schoonen, Marie-louise Essink-bot, Eric A.p. Steegers, Hajo I. J. Wildschut, Ingrid A. Peters, Harry J. De KoningAbstract:Abstract Objective Evaluating the information provision procedure about prenatal screening for Down syndrome, using Informed Decision-making as a quality-indicator. Methods Questionnaire- and register-based surveys. Midwives associated with 59 midwifery practices completed process data for 6435 pregnancies. Pregnant women (n = 510) completed questionnaires on Informed Decision-making. Results Midwives offered information to 98.5% of women; 62.6% of them wished to receive information, of these, 81.9% actually received information. Decision-relevant knowledge was adequate in 89.0% of responding women. Knowledge about Down syndrome was less adequate than knowledge about the screening program. Participants in the screening program had higher knowledge scores on Down syndrome and on the screening program than non-participants. Of the women who intended to participate (35.8%), 3.1% had inadequate knowledge. A total of 75.5% of women made an Informed Decision; 94.3% of women participating in the screening program, and 64.9% of women not participating. Conclusion This quality assurance study showed high levels of Informed Decision-making and a relatively low participation rate in the national screening program for Down syndrome in the Netherlands. Knowledge of the Down syndrome condition needs to be improved. Practice implications This evaluation may serve as a pilot study for quality monitoring studies at a national level.
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Informed Decision making does not affect health-related quality of life in lung cancer screening (NELSON trial).
European journal of cancer (Oxford England : 1990), 2010Co-Authors: Karien A. M. Van Den Bergh, Marie-louise Essink-bot, Rob J. Van Klaveren, Harry J. De KoningAbstract:Background: It is believed that making an Informed Decision about (screening) participation is associated with better health-related quality of life (HRQoL) outcomes. This is the first study in cancer screening to explore this association in subjects participating in a lung cancer computed tomography (CT) screening trial. Methods: Participants that made either an Informed Decision to participate (n = 155) or not (n = 133) were selected for this study. Differences in HRQoL, measured as generic HRQoL (Short Form 12 [SF-12] and EuroQol questionnaire [EQ-5D]), anxiety/distress (State-Trait Anxiety Inventory [STAI-6], Impact of Event Scale [IES] and Consequences of Screening-Lung Cancer [COS-LC]), were tested with Mann-Whitney U tests and ANOVA at three assessment points (when deciding about participation, before trial randomisation and 2 months after receiving the CT result). Results: Subjects who made an Informed Decision to participate had no better scores than those who did not make an Informed Decision for 23 out of 24 HRQoL comparisons, except for a better mean score for mental health (Mental Component Summary (MCS) = 53.9 ± 9.2 versus 51.0 ± 10.1, p = 0.003) before randomisation. For subjects with an indeterminate CT result (n = 64), no significant differences were found between subjects with (n = 35) or without (n = 29) an Informed Decision. Conclusion: Subjects who did not make an Informed Decision to participate in lung cancer CT screening trial did not experience worse HRQoL during screening than subjects who did make an Informed Decision, either in general or after receiving an indeterminate result.
Mirjam P. Fransen - One of the best experts on this subject based on the ideXlab platform.
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Knowledge and Informed Decision-Making about Population-Based Colorectal Cancer Screening Participation in Groups with Low and Adequate Health Literacy.
Gastroenterology research and practice, 2016Co-Authors: Marie-louise Essink-bot, Danielle R. M. Timmermans, Ellen Uiters, Evelien Dekker, Mirjam P. FransenAbstract:Objective. To analyze and compare Decision-relevant knowledge, Decisional conflict, and Informed Decision-making about colorectal cancer (CRC) screening participation between potential screening participants with low and adequate health literacy (HL), defined as the skills to access, understand, and apply information to make Informed Decisions about health. Methods. Survey including 71 individuals with low HL and 70 with adequate HL, all eligible for the Dutch organized CRC screening program. Knowledge, attitude, intention to participate, and Decisional conflict were assessed after reading the standard information materials. HL was assessed using the Short Assessment of Health Literacy in Dutch. Informed Decision-making was analyzed by the multidimensional measure of Informed choice. Results. 64% of the study population had adequate knowledge of CRC and CRC screening (low HL 43/71 (61%), adequate HL 47/70 (67%), p > 0.05). 57% were Informed Decision-makers (low HL 34/71 (55%), adequate HL 39/70 (58%), p > 0.05). Intention to participate was 89% (low HL 63/71 (89%), adequate HL 63/70 (90%)). Respondents with low HL experienced significantly more Decisional conflict (25.8 versus 16.1; p = 0.00). Conclusion. Informed Decision-making about CRC screening participation was suboptimal among both individuals with low HL and individuals with adequate HL. Further research is required to develop and implement effective strategies to convey Decision-relevant knowledge about CRC screening to all screening invitees.
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Health literacy and Informed Decision making regarding colorectal cancer screening: a systematic review
European journal of public health, 2015Co-Authors: Iris Van Der Heide, Ellen Uiters, A. Jantine Schuit, Jany Rademakers, Mirjam P. FransenAbstract:Making an Informed Decision about participation in colorectal cancer (CRC) screening may be challenging for invitees with lower health literacy skills. The aim of this systematic review is to explore to what extent the level of a person's health literacy is related to their Informed Decision making concerning CRC screening. We searched for peer-reviewed studies published between 1950 and May 2013 in MEDLINE, EMBASE, SciSearch and PsycINFO. Studies were included when health literacy was studied in relation to concepts underpinning Informed Decision making (awareness, risk perception, perceived barriers and benefits, knowledge, attitude, deliberation). The quality of the studies was determined and related to the study results. The search returned 2254 papers. Eight studies in total were included, among which seven focused on knowledge, four focused on attitudes or beliefs concerning CRC screening, and one focused on risk perception. The studies found either no association or a positive association between health literacy and concepts underpinning Informed Decision making. Some studies showed that higher health literacy was associated with more CRC screening knowledge and a more positive attitude toward CRC screening. The results of studies that obtained a lower quality score were no different than studies that obtained a higher quality score. In order to obtain more insight into the association between health literacy and Informed Decision making in CRC cancer screening, future research should study the multiple aspects of Informed Decision making in conjunction instead of single aspects.
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Ethnic differences in Informed Decision-making about prenatal screening for Down's syndrome
Journal of epidemiology and community health, 2009Co-Authors: Mirjam P. Fransen, Marie-louise Essink-bot, Ineke Vogel, Johan P. Mackenbach, Eric A.p. Steegers, Hajo I. J. WildschutAbstract:Background The aim of this study was to assess ethnic variations in Informed Decision-making about prenatal screening for Down9s syndrome and to examine the contribution of background and Decision-making variables. Methods Pregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the ‘Multidimensional Measure of Informed Choice’ that has been developed and applied in the UK. Results In total, 71% of the Dutch women were classified as Informed Decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation. Conclusion Women from ethnic minority groups less often made an Informed Decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value Informed Decision-making in prenatal screening, what Decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.