Efficacy of a patient decision aid for improving person-centered decision-making by older adults with obstructive sleep apnea

Fung, Constance H.; Martin, Jennifer L.; Liang, Li-Jung; Col, Nananda F.; Patterson, Emily S.; Josephson, Karen R.; Mitchell, Michael N.; Sanchez, Maria C.; Aysola, Ravi; Song, Yeonsu; Dzierzewski, Joseph M.; Huang, David; Zeidler, Michelle; Alessi, Cathy A.

doi:10.5664/jcsm.8798

Cited by 13 publications

(12 citation statements)

References 22 publications

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“…18,19 A randomized controlled trial of adults over 60 years-old showed that a decision aid program to engage patients in OSA therapy increased knowledge about treatment options, lowered DC, and allowed for greater preparedness for decision-making. 20 Our study demonstrates the need for interventions that can reduce decisional conflict and promote equitable knowledge about OSA treatment efficacy, risks, and benefits. Prior work on decision aids for adults with sleep apnea has largely been centered on patients with newly diagnosed OSA, and there remains a need for similar tools for patients considering alternative treatments.…”

Section: Discussionmentioning

confidence: 79%

“…Specifically with regards to OSA, randomized controlled trials of parents of children with OSA have demonstrated that use of decision aids lowers DC and increases adherence to CPAP treatment 18,19 . A randomized controlled trial of adults over 60 years‐old showed that a decision aid program to engage patients in OSA therapy increased knowledge about treatment options, lowered DC, and allowed for greater preparedness for decision‐making 20 …”

Section: Discussionmentioning

confidence: 99%

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Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations

et al. 2021

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Objectives: Numerous therapies exist for adult obstructive sleep apnea (OSA), creating potential for patient decisional conflict (DC) that impacts treatment adherence and post-treatment regret. We evaluated the prevalence of elevated DC in OSA patients presenting for positive airway pressure (PAP) alternative therapies and identified gaps in available resources about OSA therapies.Study Design: Cross-sectional study. Methods: A cross-sectional study was performed based on questionnaires completed by adult OSA patients presenting to an academic sleep surgery clinic from March to October 2020. Surveys examined sleep symptoms, sleep apnea treatment history, goals of therapy, and the SURE checklist, a validated 4-item DC screening scale. Additional qualitative data about OSA decision tool needs were queried with structured interviews in a smaller subset of patients.Results: Among 100 respondents, 60 were open to multiple treatment options, whereas 22 were not interested in surgical treatment. Eighty-one respondents (81%) had elevated DC (SURE score < 4). High DC was not associated with CPAP history, OSA severity, or daytime sleepiness (Epworth Sleepiness Scale score ≥ 10). Elevated DC was related to uncertainty regarding optimal treatment choice in 54% of respondents (n = 54), and lack of knowledge regarding risks and benefits of each treatment option in 71% (n = 71). Common themes identified in 9 interviewed patients suggested helpful resources should ideally compare treatment modalities and educate on surgery details, efficacy, and recovery.Conclusions: The majority of OSA patients presenting to sleep surgery clinics have elevated decisional conflict influenced by limited knowledge about options and the risks and benefits of each therapy. There is a need for decision tools that can reduce decisional conflict and promote equitable knowledge about PAP alternative OSA treatments.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations

et al. 2021

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“…47 The PDA can also significantly improve patients’ ability to analyze the advantages and disadvantages of nutritional interventions, reduce their blindness and uncertainty, increase their participation in the decision-making process, and help them prepare for decision-making. 48 The decision conflict was significantly reduced because the patients felt informed about the pros and cons of nutrition modification, felt uncertain about the options, felt supported in making decisions, and had clear values of their own. However, we did not find any difference in anxiety after the use of the PDA in our study, which is consistent with the finding of Cox.…”

Section: Discussionmentioning

confidence: 99%

Development and Pilot-Testing of a Patient Decision-Making Aid for Nutrition in Age-Related Macular Degeneration

Guo¹,

Wan²,

Zhang³

et al. 2022

PPA

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Objective We described the development and pilot-testing of an application based patient decision-making aid (PDA) for nutrition in age-related macular degeneration (AMD). Alpha-testing and beta-testing were performed to explore the PDA’s usability, acceptability, and comprehensibility in the design stage and in “real-life” conditions. Methods A nutrition PDA was developed in this study by a multidisciplinary steering committee that consisted of ophthalmologists, nurses, nutritionists, and methodologists using a systematic development process. The PDA was based on a smartphone native installation and a free-to-use app. First, based on information from literature reviews and focus group interviews for needs assessment, we developed a decision aid prototype. Second, we conducted the alpha testing to explore the acceptability, usability, and comprehensibility of the PDA prototype among 18 AMD patients. Third, a before/after study was conducted to assess changes in the attitudes, risk perceptions, intentions, knowledge, decisional conflicts, and decision self-efficacy of 33 AMD patients. Results The alpha test proved that the nutrition PDA is acceptable and usable. In the beta test, after the AMD participants used the PDA, their scores for knowledge [mean = 13.3, standard deviation (SD) = 2.92], attitude (mean = 18.97, SD = 2.19), decision self-efficacy (mean = 23.94, SD = 6.04), and preparation significantly increased (mean = 26.30, SD = 4.90), and their score for decisional conflict significantly decreased (mean = 10.15, SD = 3.66). There was no significant difference in anxiety (mean = 2.64, SD = 1.08) before and after the use of the PDA. The mean score in the system usability scale was above 70 (mean = 72.61; SD = 5.38), which indicates the good usability of the PDA. With regard to the PDA acceptability, the scores for satisfaction with its comprehensibility, satisfaction with its attractiveness, and satisfaction with its emotional support were 5.49 (SD = 1.03), 5.30 (SD = 1.40), and 4.91(SD = 1.07), respectively, which show its adequate acceptability. Conclusion Our study showed that the nutrition PDA was an acceptable and suitable instrument for AMD patients and fit the values of all its stakeholders. This study is an important step in supporting shared decision-making, which has the potential to provide a more patient-centered and value-based nutrition health system for individuals with different types of AMD.

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“…Person-centered care requires a collaborative approach to align individual values with attainable outcomes that often require an understanding of a patient's decisional conflict, health literacy, and preparedness for decision-making. 34 Patient and physician priorities require time and expertise to align in older adults with complex co-morbidities, yet investigators often neglect these factors in reporting the application of an intervention and implementation strategy in research. 35 Memory and communication impairments associated with Alzheimer's dementia and related disorders also create obstacles to both research consent and patientreported outcomes, so implementation researchers need to accommodate those challenges.…”

Section: Stari Outcomesmentioning

confidence: 99%

Around the EQUATOR with clinician‐scientists transdisciplinary aging research (Clin‐STAR) principles: Implementation science challenges and opportunities

Carpenter

Southerland

Lucey

et al. 2022

J American Geriatrics Society

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The Institute of Medicine and the National Institute on Aging increasingly understand that knowledge alone is necessary but insufficient to improve healthcare outcomes. Adapting the behaviors of clinicians, patients, and stakeholders to new standards of evidence‐based clinical practice is often significantly delayed. In response, over the past twenty years, Implementation Science has developed as the study of methods and strategies that facilitate the uptake of evidence‐based practice into regular use by practitioners and policymakers. One important advance in Implementation Science research was the development of Standards for Reporting Implementation Studies (StaRI), which provided a 27‐item checklist for researchers to consistently report essential elements of the implementation and intervention strategies. Using StaRI as a framework, this review discusses specific Implementation Science challenges for research with older adults, provides solutions for those obstacles, and opportunities to improve the value of this evolving approach to reduce the knowledge translation losses that exist between published research and clinical practice.

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Efficacy of a patient decision aid for improving person-centered decision-making by older adults with obstructive sleep apnea

Cited by 13 publications

References 22 publications

Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations

Characterizing Decisional Conflict in Patients Presenting to Sleep Surgery Clinic and an Exploration of Resource Limitations

Development and Pilot-Testing of a Patient Decision-Making Aid for Nutrition in Age-Related Macular Degeneration

Around the EQUATOR with clinician‐scientists transdisciplinary aging research (Clin‐STAR) principles: Implementation science challenges and opportunities

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