Effects of Decision Aids for Menorrhagia on Treatment Choices, Health Outcomes, and Costs

Kennedy, Amy; Sculpher, Mark; Coulter, Angela; Dwyer, Nuala; Rees, Margaret; Abrams, Keith R.; Horsley, S. D.; Cowley, Deborah S.; Kidson, C.; Kirwin, C.; Naish, Caroline; Stirrat, Gordon M.

doi:10.1001/jama.288.21.2701

Cited by 216 publications

(202 citation statements)

References 38 publications

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“…26 The current study adds to the body of evidence in favour of decision aids as a costsaving option; 17,19,24,25 it finds that a decision aid appears to minimise costs and is cost effective in the area of vaccination uptake.…”

Section: Comparison With Existing Literaturementioning

confidence: 71%

“…There is relatively little existing literature on the cost effectiveness of decision aids; in addition, their cost effectiveness in comparison with usual care has not been investigated for childhood immunisation decisions. Most of the studies undertaken have investigated the cost of decision aids in contexts other than vaccination; [17][18][19][20][21][22][23][24][25] only one study has considered cost effectiveness 26 and that concerned modes of delivery in pregnancy. A systematic review of the impact of decision aids on costs savings 27 has…”

Section: Introductionmentioning

confidence: 99%

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Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care

et al. 2014

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Section: Comparison With Existing Literaturementioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care

et al. 2014

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“…Seventy-six percent of patients who preferred shared decision-making had lower scores on the DASH questionnaire compared with those who preferred a fully active or fully passive role [9]. There is some evidence that decision aids can help patients achieve their preferred role in decision-making [14,19]. In general, patients who actively contribute to their health care have better functional outcome, choose less invasive treatments, and are more satisfied with their options [5,8,11,18].…”

Section: Discussionmentioning

confidence: 99%

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

Hageman

Reddy

Makarawung

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions. Questions/purposes (1) Do patients with nontraumatic conditions have different preferences for shared decisionmaking when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decisionmaking? Methods In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity. Results There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, À0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decisionmaking. More educated patients preferred a more active role in decision-making (beta = À0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making. Conclusions Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.

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“…Numerous randomized trials support their effectiveness in outpatient care. [41][42][43][44][45][46][47][48] By informing patients prior to communication they also improve time efficiency for clinicians. Decision aids have only recently begun to be studied for older and more seriously ill patients.…”

Section: -31mentioning

confidence: 99%

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

Hanson¹,

Winzelberg²

2013

Journal of Palliative Medicine

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Older patients and their families desire control over health decisions in serious illness. Experts recommend discussion of prognosis and goals of care prior to decisions about treatment. Having achieved longevity, older persons often prioritize other goals such as function, comfort, or family support-and skilled communication is critical to shift treatment to match these goals. Shared decision making is the ideal approach in serious illness. Older patients desire greater family involvement; higher rates of cognitive impairment mean greater dependency on surrogates to make decisions. Despite the importance of communication, fewer than half of older patients or families recall treatment discussions with clinicians, and poor quality communication adversely affects family satisfaction and patient outcomes. Direct audiorecording of clinical encounters and longitudinal studies of communication and treatment decisions have yielded important insights into the quality of clinical communication. Current clinical practice rarely meets standards for shared decision making. Innovative methods to record and use patient preferences show promise to overcome the limitations of traditional advance directives. Decision aids, intensive clinician training, and structured interpersonal communication interventions have all been shown to be effective to improve the quality of communication and decision making. Priorities for geriatric palliative care research, building on these insights, now include empirical testing of communication approaches for surrogates and for diverse populations, exploration of meaningful ways to communicate prognosis, and expansion of intervention research.What Defines Quality in Health Care Communication?

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Effects of Decision Aids for Menorrhagia on Treatment Choices, Health Outcomes, and Costs

Abstract: Neither intervention had an effect on health status. Providing women with information alone did not affect treatment choices; however, the addition of an interview to clarify values and elicit preferences had a significant effect on women's management and resulted in reduced costs.

Cited by 216 publications

References 38 publications

Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care

Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

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