EPOCH&amp;#x00AE; and ePRISM&amp;#x00AE;: A web-based translational framework for bridging outcomes research and clinical practice

Soto, G.E.; Spertus, J.A.

doi:10.1109/cic.2007.4745457

Cited by 10 publications

(11 citation statements)

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“…Existing methods for providing patients with tailored information about their expected treatment outcomes rely on use of published population-level model parameters (Soto and Spertus 2007). A patient's baseline state of disease and demographic factors may be ''plugged in'' to a fitted model to estimate disease risk or expected therapeutic benefit.…”

Section: Introductionmentioning

confidence: 99%

Clinically relevant graphical predictions from Bayesian joint longitudinal-survival models

Hatfield

Carlin

2012

Health Serv Outcomes Res Method

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Recent interest in understanding the effect of interventions on patient-reported outcomes as well as traditional clinical endpoints has led to an expansion of methods for simultaneous modeling of longitudinal and survival data in clinical trials. Such joint models link the multiple outcome measures using an underlying latent structure, typically a collection of individual-level random effects. They can estimate treatment effects separately on different aspects of a disease process, as well as illuminate associations among outcomes and individual variability. In communicating model output to clinicians and patients, it is challenging to convey a meaningful interpretation of multiple treatment effects, complex outcome associations, and important underlying assumptions. This paper presents graphical displays designed to make the output of Bayesian joint models accessible to non-technical audiences, while preserving important methodological features. We emphasize individual-level posterior predictions of longitudinal and survival outcomes, illustrating our methods using patient-reported symptom severity and survival in a clinical trial example.

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Section: Introductionmentioning

confidence: 99%

Clinically relevant graphical predictions from Bayesian joint longitudinal-survival models

Hatfield

Carlin

2012

Health Serv Outcomes Res Method

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“…[17][18][19][20][21][22][23][24][25] Despite their potential to tailor treatment to those who benefit most, these models have not been routinely used to support treatment, partly because of their complexity. To address this challenge, our team created a Web-based tool, ePRISM (Personalized Risk Information Services Manager), 26,27 to generate personalized documents that are embedded with patient-specific outcomes projections from well-validated risk models and has been programmed with a modified version of the StrokeThrombolytic Predictive Instrument model. 28 Before implementing tools to support precision medicine in routine clinical care, it is important to define how best to present the results to patients and providers.…”

Section: S110 Circ Cardiovasc Qual Outcomesmentioning

confidence: 99%

Patient-Centered Decision Support in Acute Ischemic Stroke

Decker

Chhatriwalla

Gialde

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background— National guidelines endorse recombinant tissue-type plasminogen activator (r-tPA) in eligible patients with acute ischemic stroke to improve patients’ functional recovery. However, 23% to 40% of ideal candidates with acute ischemic stroke for reperfusion are not treated, perhaps because of the difficulty in explaining the benefits and risks of r-tPA within the frenetic pace of emergency department care. To support better knowledge transfer and creation of a shared decision-making tool, we conducted qualitative interviews to define the information needs and preferred presentation format for stroke survivors, caregivers, and clinicians considering r-tPA treatment. Methods and Results— A multidisciplinary team used qualitative research methods to identify informational needs and strategies for describing the benefits and risks of r-tPA in a clinical setting. Through focus groups (n=10) of stroke survivors (n=39) and caregivers (n=24) and individual interviews with emergency physicians (n=23) and advanced practice nurses (n=20), several themes emerged. Survivors and caregivers preferred a broader definition of a good outcome (independence, rather than no significant disability), simpler graphs as compared with detailed pictographs, and presentation of both population and individualized benefits (framed positively) and risk of receiving r-tPA. Some physicians expressed skepticism with the data and the ability to present risk/benefit information emergently, whereas other physicians and most advanced practice nurses thought such information would improve care. Physicians stressed the importance of presenting the risk of thrombolytic-related intracranial hemorrhage. Conclusions— This study suggests that a positively framed risk–benefit tool with graphical presentations of general and patient-specific risk estimates could support patients and providers in considering r-tPA for acute ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01864928.

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“…6 e PRISM is a web-based tool that integrates multivariable risk models, using a patient's specific clinical risk factors, within editable documents that can be customized to the consent requirements of individual hospitals. To evaluate e PRISM-generated consent forms on patients' experiences with the process of obtaining informed consent for percutaneous coronary intervention (PCI), we examined patients' reviewing and understanding of consents, knowledge transfer (e.g.…”

mentioning

confidence: 99%

Improving the process of informed consent for percutaneous coronary intervention: Patient Outcomes from the Patient Risk Information Services Manager (ePRISM) study

Spertus

Bach

Bethea

et al. 2015

American Heart Journal

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Background While the process of informed consent is designed to transfer knowledge of the risks and benefits of treatment and to engage patients in shared medical decision-making, this is poorly done in routine clinical care. We assessed the impact of a novel informed consent form for percutaneous coronary intervention (PCI) that is more simply written, includes images of the procedure and embeds individualized estimates of outcomes on multiple domains of successful informed consent and shared decision-making. Methods We interviewed 590 PCI patients receiving traditional consent documents and 527 patients receiving novel ePRISM consents at 9 US centers and compared patients' perceptions, knowledge transfer and engagement in medical decision-making. Heterogeneity across sites was assessed and adjusted for using hierarchical models. Results Site-adjusted analyses revealed more frequent review (72% for ePRISM vs. 45% for original consents) and better understanding of the ePRISM consents (odds ratios (ORs)=1.8–3.0, depending upon the outcome) with marked heterogeneity across sites (median relative difference (MRD) in the ORs of ePRISM's effect = 2–3.2). Patients receiving ePRISM consents better understood the purposes and risks of the procedure (ORs=1.9–3.9, MRDs=1.1–6.2), engaged more in shared decision-making (proportional OR=2.1 [95%CI=1.02–4.4], MRD=2.2) and discussed stent options with their physicians (58% vs. 31%; site-adjusted odds ratio=2.7 [95% CI=1.2, 6.3], MRD=2.6) more often. Conclusions A personalized consent document improved the process of informed consent and shared decision-making. Marked heterogeneity across hospitals highlights that consent documents are but one aspect of engaging patients in understanding and participating in treatment.

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EPOCH® and ePRISM®: A web-based translational framework for bridging outcomes research and clinical practice

Cited by 10 publications

References 1 publication

Clinically relevant graphical predictions from Bayesian joint longitudinal-survival models

Clinically relevant graphical predictions from Bayesian joint longitudinal-survival models

Patient-Centered Decision Support in Acute Ischemic Stroke

Improving the process of informed consent for percutaneous coronary intervention: Patient Outcomes from the Patient Risk Information Services Manager (ePRISM) study

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