Use of a Decision Aid to Improve Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial

Montori, Víctor M.; Shah, Nilay D.; Pencille, Laurie; Branda, Megan E.; Houten, Holly K. Van; Swiglo, Brian A.; Kesman, Rebecca L.; Tulledge–Scheitel, Sidna M.; Jaeger, Thomas M.; Johnson, Ruth E.; Bartel, Gregory A.; Melton, L. Joseph; Wermers, Robert A.

doi:10.1016/j.amjmed.2011.01.013

Cited by 172 publications

(226 citation statements)

References 24 publications

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“…The best estimates indicate an increase of ≈3 minutes in the average length of the clinical encounter, which is similar to the time spent in SDM in the studies our group has conducted in fast-paced environments such as primary care and the emergency department, as well as specialty settings. 14,15,19,57,58 There are insufficient data on SDM for AF in community practices to produce estimates specific to this issue. Larger trials can help assess patient and setting subgroups in which the effect of SDM could be different.…”

Section: Future Studiesmentioning

confidence: 99%

“…Decision aids take many forms but often demonstrate statistical information based on current evidence in easy-to-understand pictographs (Figure 2). [24][25][26][27] Decision aids communicate reliable estimates of the probability of patient-important outcomes such as quality of life, survival, stroke, and life-threatening bleeding, enabling patients to more accurately understand their personal risks when participating in treatment decisions. It is worth noting that these aids are distinct from standard informational materials because they are designed for interactive use to personalize the risk and benefits of various treatment options.…”

Section: Decision Aidsmentioning

confidence: 99%

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Shared Decision Making in Atrial Fibrillation

et al. 2014

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You are seeing Mr Roberts, a 69-year-old retired office manager referred from the emergency department for treatment of atrial fibrillation (AF). He presented the previous night to the emergency department with shortness of breath and palpitations and was found to be in AF with a rapid ventricular response and a heart rate of 140 bpm. He was treated with intravenous diltiazem and spontaneously converted to sinus rhythm. He was then discharged from the emergency department with an outpatient cardiology appointment. He has a background history of hypertension but no other cardiac disease. His only medication is a thiazide diuretic. On questioning, he reports experiencing several episodes of palpitations over the last 2 to 3 years; typically, these are brief and self-limited. His transthoracic echocardiogram, thyroid studies, and electrolytes are all within normal limits. His ECG shows sinus rhythm with no other significant abnormality. His CHADS 2 score is 1 and CHA 2 DS 2 -Vasc score is 2. He has a family history of gastrointestinal hemorrhage-associated death and is uncomfortable about long-term anticoagulation. Additionally, he is reluctant about taking a daily medication plus his blood pressure pill. How might you present current best practice while ensuring that his treatment program is consistent with his goals, values, and preferences? Introduction AF is the most common arrhythmia requiring treatment, affecting ≈5 million Americans, with the prevalence expected to double by 2050.1-3 AF accounts for more than a third of all hospitalizations for cardiac rhythm disturbances. Hospitalization for AF has risen dramatically over the past 20 years and is projected to continue to rise as the population ages. 4 Importantly, AF is associated with a doubling in patient-matched and adjusted mortality.5 Atrial fibrillation can range from completely asymptomatic to highly symptomatic and can negatively affect patients' quality of life if left untreated. 6 Studies have demonstrated significant gaps in AF patient's knowledge about their condition, as well as knowledge of the risks and benefits of the treatment they are currently taking for their AF despite their disease being treated for several years. 7A landmark study in 2007 observed multidisciplinary groups of clinicians and patients discussing AF management and noted that all groups recognized the difficulties in managing the disease, but no group agreed with the other on the optimal way to improve patient care.8 A meta-synthesis of qualitative studies from 2012 examined the perspectives of both clinicians and patients and found that patients often experienced a paternalistic model of decision making, whereas clinicians involved in these same conversations reported that a shared decision making (SDM) model was used. 9 This discordance has been reported by other studies and indicates that patients wish for more information about their treatment options and that clinician bias and practice style, not patient preferences, influenced the outcome of starting oral anticoagul...

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Section: Future Studiesmentioning

confidence: 99%

Section: Decision Aidsmentioning

confidence: 99%

Shared Decision Making in Atrial Fibrillation

et al. 2014

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“…✓ ✓ Engaging patients in SDM adds, on average, 3.5 min to clinical consultations. 9,25 Much like the introduction of other process improvement interventions, there are competing priorities that vie for clinicians' time, and interventions at the organizational and health policy level may be necessary for SDM to be prioritized over the status quo.…”

mentioning

confidence: 99%

“…The following suggestions are a result of in-depth qualitative interviews of clinicians who used 3 of the in-visit decision aids that were developed at Mayo Clinic and tested in trials. 9,25,32 First, enthusiasm for the decision aids frequently revolved around risk quantification. Clinicians expressed the belief that risk communication is a core aspect of their job, and a decision aid with individualized risk estimates generated from a validated risk instrument helped them engage more authoritatively in discussions with their patients.…”

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confidence: 99%

Implementation of Shared Decision Making in Cardiovascular Care

Hess

Coylewright

Frosch

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…[23][24][25][26][27][28] Although conjoint analysis has thus far been used as an analytical technique to determine treatment preferences, our results offer a potential new use for conjoint analysis as a practical decision support mechanism. As much as patients are helped by the process of defining their values and goals, if this information can then be provided to the physician caring for these patients, physicians can gain a better understanding of patient goals and hopefully better orient their discussion and treatment options toward individual patients' values.…”

Section: Discussionmentioning

confidence: 87%

Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making

Hampson¹,

Allen

Gaither³

et al. 2017

Urology

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OBJECTIVE To determine whether the use of a choice-based conjoint analysis (CA) exercise decreased patients’ decisional conflict about treatment preferences for surgical management of urethral stricture disease. Understanding patient preferences for treatment decisions assists in shared decision-making and emphasizes patient-centered outcomes. CA offers a method to understand what risks patients are willing to take for what gains. METHODS The CA methodology was used by providing participants with case-based choices to elucidate the relative importance that individuals place on various treatment aspects. Patients’ decisional conflict regarding surgery for urethral stricture was assessed before and after the CA exercise to assess the impact the exercise had on their decisional conflict. RESULTS Completion of the CA exercise resulted in a significant decrease in decisional conflict (P < .001). The majority (59.5%) of participants with decisional conflict before the CA exercise experienced a decrease in decisional conflict afterwards, with only a minority (16.5%) experiencing new decisional conflict after the exercise. Participants felt the choice-based CA exercise was helpful in deciding what was important in making treatment decisions (70%) and in expressing their priorities and treatment preferences (82%). The number needed to counsel to achieve a decrease in decisional conflict was 1.69 and to achieve no decisional conflict was 3.65. CONCLUSION Choice-based CA improves patients’ ability to express their treatment preferences and decreases decisional conflict. CA may be a new tool that physicians and patients can use to aid in shared decision-making with a focus on patient-centered outcomes.

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Use of a Decision Aid to Improve Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial

Cited by 172 publications

References 24 publications

Shared Decision Making in Atrial Fibrillation

Shared Decision Making in Atrial Fibrillation

Implementation of Shared Decision Making in Cardiovascular Care

Patient-centered Treatment Decisions for Urethral Stricture: Conjoint Analysis Improves Surgical Decision-making

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