Stop the silent misdiagnosis: patients' preferences matter

Mulley, Albert G.; Trimble, Chris; Elwyn, Glyn

doi:10.1136/bmj.e6572

Cited by 530 publications

(430 citation statements)

References 15 publications

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“…As a consequence, we need guidelines on how and when individual biomarkers (or a combination of them) should and should not be used as they represent unnecessary costs, based on demographic, clinical, logistical and economical variables. The process of shared decision making [47] might also be considered as relevant in using biomarkers for the diagnosis of MCI due to AD. Last, the current survey was based on visually rating of amyloid-PET; we anticipate that quantitative measures of ligand uptake will be increasingly used in the coming years.…”

Section: Discussionmentioning

confidence: 99%

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

Bocchetta

Galluzzi

Kehoe

et al. 2014

Alzheimer's & Dementia

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We investigated the use of Alzheimer's disease (AD) biomarkers in European Alzheimer's Disease Consortium centers and assessed their perceived usefulness for the etiologic diagnosis of mild cognitive impairment (MCI). We surveyed availability, frequency of use, and confidence in diagnostic usefulness of markers of brain amyloidosis (amyloid positron emission tomography [PET], cerebrospinal fluid [CSF] Ab42) and neurodegeneration (medial temporal atrophy [MTA] on MR, fluorodeoxyglucose positron emission tomography [FDG-PET], CSF tau). The most frequently used biomarker is visually rated MTA (75% of the 37 responders reported using it "always/ frequently") followed by CSF markers (22%), FDG-PET (16%), and amyloid-PET (3%). Only 45% of responders perceive MTA as contributing to diagnostic confidence, where the contribution was rated as "moderate". Seventy-nine percent of responders felt "very/extremely" comfortable delivering a diagnosis of MCI due to AD when both amyloid and neuronal injury biomarkers were abnormal (P , .02 versus any individual biomarker). Responders largely agreed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative AD signature.

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Section: Discussionmentioning

confidence: 99%

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

Bocchetta

Galluzzi

Kehoe

et al. 2014

Alzheimer's & Dementia

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“…Katz et al [17] reported that patients with lower levels of health literacy tend to ask fewer questions regarding aspects of medical care, but that study was limited in size and generalizability because most patients were black women. Asking questions and engaging in shared decision-making are important to limit the potential for misdiagnosis of patient preferences [28], particularly in hand surgery, where even with traumatic injuries (like distal biceps rupture, clavicle fracture, and distal radius fracture), treatment is discretionary, directed primarily at quality of life, and therefore is highly preference-sensitive.…”

Section: Introductionmentioning

confidence: 99%

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

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Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

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“…This focus could include some reflection on both the ethical and instrumental rationale for shared decision making-that it treats patients with respect, harnesses multiple stakeholders' perspectives and expertise, and is responsive to patient values. Co-creation could therefore be presented as central to ensuring that health care is effective and valuable in terms that matter to health professionals, patients, and other stakeholders [8]. There could also be some emphasis on the practices of shared decision making, including perhaps the communication challenges of working with patients who might resist taking an active role in decision making.…”

Section: Teaching and Enacting Co-creation In Medical Schoolsmentioning

confidence: 99%

Co-Creating an Expansive Health Care Learning System

Cribb

Owens

Singh

2017

AMA Journal of Ethics

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How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of cocreation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations. We therefore suggest that the development of what we call an "expansive health care learning system" is crucial for supporting learners in meeting the challenges of establishing genuinely co-creative health care systems. IntroductionCo-creation means bringing together health professionals, patients, providers, and other key stakeholders to jointly address health care problems [1]. If this is to be feasible, then clinicians (and other stakeholders) need to be prepared for co-creation, which would entail ambitious changes to health professions education. That, at least, is what we intend to argue in this article, and, in so doing, we also hope to indicate the breadth and depth of the relevant ambition for medical education. We define what is needed as an "expansive health care learning system" that challenges traditional conceptions of, and boundaries between, teachers and learners and theoretical and practical expertise [2].

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Stop the silent misdiagnosis: patients' preferences matter

Cited by 530 publications

References 15 publications

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

The use of biomarkers for the etiologic diagnosis of MCI in Europe: An EADC survey

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Co-Creating an Expansive Health Care Learning System

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