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Health Expectations : An International... Jun 2023In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences... (Review)
Review
BACKGROUND
In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences by gender.
OBJECTIVE
To systematically analyse recommendations concerning shared decision-making in CPGs and consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial).
SEARCH STRATEGY
We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8 guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions.
INCLUSION CRITERIA
CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021.
DATA EXTRACTION AND SYNTHESIS
Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed.
MAIN RESULTS
A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12 consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer guidelines (p < .001).
DISCUSSION AND CONCLUSIONS
We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected.
PATIENT OR PUBLIC CONTRIBUTION
The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients' preferences and shared decision-making in cancer care.
Topics: Humans; Male; Sexism; Decision Making, Shared; Consensus; Endometrial Neoplasms; Prostatic Neoplasms
PubMed: 37016907
DOI: 10.1111/hex.13753 -
Annals of Oncology : Official Journal... Jun 2010The preferred and actual participation roles during decision making have been studied over the past two decades; however, there is a lack of evidence on the degree of... (Review)
Review
The preferred and actual participation roles during decision making have been studied over the past two decades; however, there is a lack of evidence on the degree of match between patients' preferred and actual participation roles during decision making. A systematic review was carried out to identify published studies that examined preferred and actual participation roles and the match between preferred and actual roles in decision making among patients with cancer. PubMed (1966 to January 2009), PsycINFO (1967 to January 2009), and CINAHL (1982 to January 2009) databases were searched to access relevant medical, psychological, and nursing literature. Twenty-two studies involving patients with breast, prostate, colorectal, lung, gynecological, and other cancers showed discrepancies between preferred and actual roles in decision making. These groups of patients wanted a more shared or an active role versus a less passive role. Across all cancer types, patients wanted more participation than what actually occurred. Research to date documents a pervasive mismatch between patients' preferred and actual roles during decision making. Yet, there is lack of innovative interventions that can potentially increase matching of patients' preferred and actual role during decision making. Role preferences are dynamic and vary greatly during decision making, requiring regular clinical assessment to meet patients' expectations and improve satisfaction with treatment decisions.
Topics: Decision Making; Delivery of Health Care; Humans; Neoplasms; Patient Participation; Patient Preference; Patient Satisfaction; Physician-Patient Relations
PubMed: 19940010
DOI: 10.1093/annonc/mdp534 -
PloS One 2022Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the...
BACKGROUND
Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care.
METHODS
We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings.
RESULTS
In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making.
CONCLUSION
This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
Topics: Adolescent; Adult; Anxiety Disorders; Decision Making; Decision Making, Shared; Depression; Humans; Mental Health; Patient Participation
PubMed: 35687610
DOI: 10.1371/journal.pone.0268649 -
American Journal of Preventive Medicine Nov 2018Educational interventions can help individuals increase their knowledge of available contraceptive methods, enabling them to make informed decisions and use...
CONTEXT
Educational interventions can help individuals increase their knowledge of available contraceptive methods, enabling them to make informed decisions and use contraception correctly. This review updates a previous review of contraceptive education.
EVIDENCE ACQUISITION
Multiple databases were searched for articles published March 2011-November 2016. Primary outcomes were knowledge, participation in and satisfaction/comfort with decision making, attitudes toward contraception, and selection of more effective methods. Secondary outcomes included contraceptive behaviors and pregnancy. Excluded articles described interventions that had no comparison group, could not be conducted feasibly in a clinic setting, or were conducted outside the U.S. or similar country.
EVIDENCE SYNTHESIS
A total of 24,953 articles were identified. Combined with the original review, 37 articles met inclusion criteria and described 31 studies implementing a range of educational approaches (interactive tools, written materials, audio/videotapes, and text messages), with and without healthcare provider feedback, for a total of 36 independent interventions. Of the 31 interventions for which knowledge was assessed, 28 had a positive effect. Fewer were assessed for their effect on attitudes toward contraception, selection of more effective methods, contraceptive behaviors, or pregnancy-although increased knowledge was found to mediate additional outcomes (positive attitudes toward contraception and contraceptive continuation).
CONCLUSIONS
This systematic review is consistent with evidence from the broader healthcare field in suggesting that a range of interventions can increase knowledge. Future studies should assess what aspects are most effective, the benefits of including provider feedback, and the extent to which educational interventions can facilitate behavior change and attainment of reproductive health goals.
THEME INFORMATION
This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
Topics: Centers for Disease Control and Prevention, U.S.; Contraception; Contraception Behavior; Contraceptive Agents; Decision Making; Family Planning Services; Health Education; Health Knowledge, Attitudes, Practice; Humans; United States; United States Dept. of Health and Human Services
PubMed: 30342633
DOI: 10.1016/j.amepre.2018.07.012 -
International Journal of Environmental... May 2020The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between...
The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between low- and high-level youth players; (ii) analyze the variations of decision-making processes between different age groups; and (iii) analyze the effects of decision-making training-based programs on youth players. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this systematic review searched for studies on PubMed, ScienceDirect, Academic Search Complete, SPORTDiscus, and Taylor & Francis Online. The search returned 6215 papers. After screening the records against set criteria, 26 articles were fully reviewed. From the included studies, 9 were focused on comparing the decision-making process between low- and high-level players, 6 compared the decisions made by players from different age categories, and 11 analyzed the effects of decision-making-based training programs on youth players. Comparisons between high- and low-level players suggested that high-level and most talented players present a greater accuracy in the cognitive and executive answers to the game as well as being more adjustable to more complex situations. Considering the comparisons between age groups, a tendency of older players to execute more accurate decisions in the game and to have better tactical knowledge and behavior was observed. Finally, the effects of decision-making training programs suggest a beneficial effect employing practical scenarios (mainly based on small-sided and conditioned games), primarily improving passing decisions and execution. However, the benefits of interventions using videos are not clear.
Topics: Adolescent; Athletic Performance; Child; Decision Making; Humans; Youth Sports
PubMed: 32471126
DOI: 10.3390/ijerph17113803 -
International Journal of Environmental... Jul 2019: Over recent years, the use of decision aids to promote shared decision-making have been examined. Studies on patient education and on continuing medical education for...
: Over recent years, the use of decision aids to promote shared decision-making have been examined. Studies on patient education and on continuing medical education for physicians are less common. This review analyzes intervention and evaluation studies on patient education and continuing medical education which aim to enhance shared decision-making. The following study parameters are of interest: Study designs, objectives, numbers of participants in the education courses, interventions, primary results, and quality of the studies. : We systematically searched for suitable studies in two databases (Pubmed and the Cochrane Database of Systematic Reviews) from the beginning of April through to mid-June 2016. : 16 studies from a total of 462 hits were included: Three studies on patient education and 13 studies on continuing medical education for physicians. Overall, the study parameters were heterogeneous. Major differences were found between the courses; how the courses were conducted, their length, and participants. : The differences found in the studies made it difficult to compare the interventions and the results. There is a need for studies that systematically evaluate and further develop interventions in this area to promote shared decision-making.
Topics: Decision Making; Decision Support Techniques; Education, Medical, Continuing; Humans; Patient Education as Topic; Patient Participation
PubMed: 31336828
DOI: 10.3390/ijerph16142482 -
PloS One 2017With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With rising healthcare costs comes an increasing demand for evidence-informed resource allocation using economic evaluations worldwide. Furthermore, standardization of costing and reporting methods both at international and national levels are imperative to make economic evaluations a valid tool for decision-making. The aim of this review is to assess the availability and consistency of costing evidence that could be used for decision-making in Austria. It describes systematically the current economic evaluation and costing studies landscape focusing on the applied costing methods and their reporting standards. Findings are discussed in terms of their likely impacts on evidence-based decision-making and potential suggestions for areas of development.
METHODS
A systematic literature review of English and German language peer-reviewed as well as grey literature (2004-2015) was conducted to identify Austrian economic analyses. The databases MEDLINE, EMBASE, SSCI, EconLit, NHS EED and Scopus were searched. Publication and study characteristics, costing methods, reporting standards and valuation sources were systematically synthesised and assessed.
RESULTS
A total of 93 studies were included. 87% were journal articles, 13% were reports. 41% of all studies were full economic evaluations, mostly cost-effectiveness analyses. Based on relevant standards the most commonly observed limitations were that 60% of the studies did not clearly state an analytical perspective, 25% of the studies did not provide the year of costing, 27% did not comprehensively list all valuation sources, and 38% did not report all applied unit costs.
CONCLUSION
There are substantial inconsistencies in the costing methods and reporting standards in economic analyses in Austria, which may contribute to a low acceptance and lack of interest in economic evaluation-informed decision making. To improve comparability and quality of future studies, national costing guidelines should be updated with more specific methodological guidance and a national reference cost library should be set up to allow harmonisation of valuation methods.
Topics: Austria; Decision Making; Health Care Costs; Humans; Publications; Research Report
PubMed: 28806728
DOI: 10.1371/journal.pone.0183116 -
Journal of Medical Internet Research Jan 2016Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids.
OBJECTIVE
The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making.
METHODS
Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making.
RESULTS
Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support.
CONCLUSIONS
Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.
Topics: Adult; Computers; Decision Making; Decision Support Techniques; Humans; Multimedia; Online Systems; Social Support; Systems Integration
PubMed: 26813512
DOI: 10.2196/jmir.4982 -
Patient Education and Counseling Nov 2023Risk communication (RC), as part of shared decision making, is challenging with people with limited health literacy (LHL). We aim to provide an overview of strategies to... (Review)
Review
OBJECTIVES
Risk communication (RC), as part of shared decision making, is challenging with people with limited health literacy (LHL). We aim to provide an overview of strategies to communicate benefits and harms of diagnostic and treatment options to this group.
METHODS
We systematically searched PubMed, Embase, Cinahl and PsycInfo. We included 28 studies on RC in informed/shared decision making without restriction to a health setting or condition and using a broad conceptualization of health literacy. Two researchers independently selected studies and one researcher performed data extraction. We descriptively compared findings for people with LHL towards recommendations for RC.
RESULTS
Health literacy levels varied in the included studies. Most studies used experimental designs, primarily on visual RC. Findings show verbal RC alone should be avoided. Framing of risk information influences risk perception (less risky when positively framed, riskier when negatively framed). Most studies recommended the use of icon arrays. Graph literacy should be considered when using visual RC.
CONCLUSIONS
The limited available evidence suggests that recommended RC strategies seem mainly to be valid for people with LHL, but more research is required.
PRACTICE IMPLICATIONS
More qualitative research involving people with LHL is needed to gain further in-depth insights into optimal RC strategies.
PROTOCOL REGISTRATION
PROSPERO ID 275022.
Topics: Humans; Health Literacy; Decision Making, Shared; Qualitative Research; Communication; Patients; Decision Making
PubMed: 37619376
DOI: 10.1016/j.pec.2023.107944 -
JAMA Internal Medicine Jul 2015Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this... (Review)
Review
IMPORTANCE
Serious illness impairs function and threatens survival. Patients facing serious illness value shared decision making, yet few decision aids address the needs of this population.
OBJECTIVE
To perform a systematic review of evidence about decision aids and other exportable tools that promote shared decision making in serious illness, thereby (1) identifying tools relevant to the treatment decisions of seriously ill patients and their caregivers, (2) evaluating the quality of evidence for these tools, and (3) summarizing their effect on outcomes and accessibility for clinicians.
EVIDENCE REVIEW
We searched PubMed, CINAHL, and PsychInfo from January 1, 1995, through October 31, 2014, and identified additional studies from reference lists and other systematic reviews. Clinical trials with random or nonrandom controls were included if they tested print, video, or web-based tools for advance care planning (ACP) or decision aids for serious illness. We extracted data on the study population, design, results, and risk for bias using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Each tool was evaluated for its effect on patient outcomes and accessibility.
FINDINGS
Seventeen randomized clinical trials tested decision tools in serious illness. Nearly all the trials were of moderate or high quality and showed that decision tools improve patient knowledge and awareness of treatment choices. The available tools address ACP, palliative care and goals of care communication, feeding options in dementia, lung transplant in cystic fibrosis, and truth telling in terminal cancer. Five randomized clinical trials provided further evidence that decision tools improve ACP documentation, clinical decisions, and treatment received.
CONCLUSIONS AND RELEVANCE
Clinicians can access and use evidence-based tools to engage seriously ill patients in shared decision making. This field of research is in an early stage; future research is needed to develop novel decision aids for other serious diagnoses and key decisions. Health care delivery organizations should prioritize the use of currently available tools that are evidence based and effective.
Topics: Catastrophic Illness; Critical Illness; Decision Making; Humans; Randomized Controlled Trials as Topic
PubMed: 25985438
DOI: 10.1001/jamainternmed.2015.1679