Clinician Adoption of US Peanut Introduction Guidelines—A Case for Conditional Recommendations and Contextual Considerations to Empower Shared Decision-Making

Shaker, Marcus; Abrams, Elissa M.; Greenhawt, Matthew

doi:10.1001/jamanetworkopen.2020.11535

Cited by 16 publications

(2 citation statements)

References 8 publications

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“…10,36,37 Furthermore, when considering a myriad of options patients and clinicians face every day in terms of evaluation, diagnosis, and management, SDM can provide a partnership to navigate the right care for each patient. 10,35,38,39 Timely Across North America there is inequitable distribution of timely care. Patients living in large urban centers with socioeconomic advantages in both Canada and the United States wait less than rural and socially deprived counterparts.…”

Section: Effectivementioning

confidence: 99%

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

Abrams

Singer

Shaker

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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The coronavirus disease 2019 pandemic has forever changed how we view health care service delivery. Although there are undoubtedly some unintended consequences that will result from current health care service reallocation, it provides a unique opportunity to consider how to deliver quality care currently, and after the pandemic. In the context of lessons learned, moving forward some of what was previously routine could remain reserved for more exceptional circumstances. To determine what is "routine," what is "essential," and what is "exceptional," it is necessary to view medical decisions within the paradigm of highquality care. The Institute for Healthcare Improvement definition of the dimensions of quality is based on whether the care is safe, effective, patient-centered, timely, efficient, and equitable. This type of stewardship has been applied to many interventions already deemed unnecessary by organizations such as the Choosing Wisely initiative, but the coronavirus disease 2019 pandemic provides a lens from which to consider other aspects of care. The following will provide examples from Allergy/Immunology that outline how we can reconsider what quality means in the postecoronavirus disease health care system.

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Section: Effectivementioning

confidence: 99%

What the COVID-19 Pandemic Can Teach Us About Resource Stewardship and Quality in Health Care

Abrams

Singer

Shaker

et al. 2021

The Journal of Allergy and Clinical Immunology: In Practice

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“… 1 – 3 , 5 – 9 With the advent of food oral immunotherapy (OIT), SDM has taken an even more central role in food allergy management. 10 – 13 …”

mentioning

confidence: 99%

Shared decision-making, communicating risk, and food allergy in 2023

Shaker

2023

Journal of Food Allergy

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Background: Across the practice of allergy and clinical immunology, disruptive innovations have accelerated the adoption of shared decision-making (SDM) to improve the health of patients and populations, particularly with regard to food allergy prevention and management of food allergy and anaphylaxis. Methods: A narrative review was performed to describe recent innovations in shared decision-making, risk communication, and food allergy. Results: Several challenges, primarily related to the coronavirus disease 2019 (COVID-19) pandemic and misinformation campaigns, have catalyzed adaptations to evolve clinical care. Recent pressures have facilitated the rapid adoption of telemedicine. In 2023, many allergist/immunologists routinely incorporate both in-person and virtual visits to contextually deliver value-based care to each patient. SDM may occur in a hybrid model that incorporates both in-person and virtual encounters, with many patients experiencing benefit from a combination approach. This may be facilitated by leveraging previsit web-based SDM tools. Whether in person or by telemedicine, effective risk communication to avoid cognitive overload while appreciating population variation in numeracy is key to competent implementation of SDM. Misinformation continues to disproportionately harm patients who belong to groups that encourage denial of evidence-based medical recommendations and COVID-19 vaccination intent correlating with sociopolitical factors. Still, strategies to address misinformation that leverage empathy, respect, and expertise can help to mitigate these effects. Physician wellness is a key component to realization of the Quadruple Aim of health care, and the use of positive framing and appreciative inquiry can help to optimize outcomes and improve value in health care. Conclusion: SDM is an important component to consider when incorporating recent innovations in allergy and clinical immunology care, particularly in the setting of contextual and conditional medical recommendations. Effective risk communication is critical to SDM that is truly reflective of patient goals and preferences, and can be facilitated through in-person encounters, telemedicine, and hybrid models. It is important to foster physician wellness as a component of the Quadruple Aim, particularly in the recent pandemic climate of misinformation and denial of evidence-based medicine within large groups of society.

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