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1.
Development of a model to guide decision making in amyotrophic lateral sclerosis multidisciplinary care 下载免费PDF全文
Anne Hogden PhD David Greenfield PhD Peter Nugus PhD Matthew C Kiernan PhD 《Health expectations》2015,18(5):1769-1782
Background
Patients with amyotrophic lateral sclerosis (ALS) face numerous decisions for symptom management and quality of life. Models of decision making in chronic disease and cancer care are insufficient for the complex and changing needs of patients with ALS .Objective
The aim was to examine the question: how can decision making that is both effective and patient‐centred be enacted in ALS multidisciplinary care?Setting and participants
Fifty‐four respondents (32 health professionals, 14 patients and eight carers) from two specialized ALS multidisciplinary clinics participated in semi‐structured interviews. Interviews were transcribed, coded and analysed thematically.Results
Comparison of stakeholder perspectives revealed six key themes of ALS decision making. These were the decision‐making process; patient‐centred focus; timing and planning; information sources; engagement with specialized ALS services; and access to non‐specialized services. A model, embedded in the specialized ALS multidisciplinary clinic, was derived to guide patient decision making. The model is cyclic, with four stages: ‘Participant Engagement’; ‘Option Information’; ‘Option Deliberation’; and ‘Decision Implementation’.Discussion
Effective and patient‐centred decision making is enhanced by the structure of the specialized ALS clinic, which promotes patients'' symptom management and quality of life goals. However, patient and carer engagement in ALS decision making is tested by the dynamic nature of ALS, and patient and family distress. Our model optimizes patient‐centred decision making, by incorporating patients'' cyclic decision‐making patterns and facilitating carer inclusion in decision processes.Conclusions
The model captures the complexities of patient‐centred decision making in ALS. The framework can assist patients and carers, health professionals, researchers and policymakers in this challenging disease environment. 相似文献2.
Context
Existing measurements of patient preferences cover only a limited range of health information and participation in decision making. A broader approach is necessary to understand the breadth and variations in patient preferences.Objective
To explore the breadth and variances in patient preferences for health information and participation in decision making and to understand the relationship between age and each type of preference.Design
The Health Information Wants Questionnaire (HIWQ) was administered during May–December 2010 to gather data about the information and corresponding decision‐making autonomy participants would want in seven areas: diagnosis, treatment, laboratory tests, self‐care, complementary and alternative medicine (CAM), psychosocial factors and health‐care providers.Setting
A large state university, public libraries and senior centres in Maryland, USA.Participants
A convenience sample of 438 individuals, including 226 undergraduates (mean age = 20; SD = 2.15) and 212 community‐dwelling older adults (mean age = 72; SD = 9.00).Main Outcome Measures
Ratings on the information and decision‐making items of the HIWQ.Results
Participants expressed higher levels of preference for information than for participation in decision making on six of seven subscales. On the psychosocial subscale, they expressed stronger desire for participation in decision making than for information. Age had no predictive effect on the overall preferences or specific preferences for information and participation in decision making about standard treatments and CAM. The predictive effect of age on the other types of preferences varied significantly.Conclusions
Physicians should take into account the breadth and variations in patient preferences. The predictive effect of age on patient preferences varied depending on the specific area of preferences. 相似文献3.
Paul C. Schroy MD MPH III Sarah E. Caron MPH Bonnie J. Sherman PhD Timothy C. Heeren PhD Tracy A. Battaglia MD MPH 《Health expectations》2015,18(5):1327-1338
Background
Shared decision making (SDM) related to test preference has been advocated as a potentially effective strategy for increasing adherence to colorectal cancer (CRC) screening, yet primary care providers (PCPs) are often reluctant to comply with patient preferences if they differ from their own. Risk stratification advanced colorectal neoplasia (ACN) provides a rational strategy for reconciling these differences.Objective
To assess the importance of risk stratification in PCP decision making related to test preference for average‐risk patients and receptivity to use of an electronic risk assessment tool for ACN to facilitate SDM.Design
Mixed methods, including qualitative key informant interviews and a cross‐sectional survey.Participants
PCPs at an urban, academic safety‐net institution.Main Measures
Screening preferences, factors influencing patient recommendations and receptivity to use of a risk stratification tool.Key Results
Nine PCPs participated in interviews and 57 completed the survey. Despite an overwhelming preference for colonoscopy by 95% of respondents, patient risk (67%) and patient preferences (63%) were more influential in their decision making than patient comorbidities (31%; P < 0.001). Age was the single most influential risk factor (excluding family history), with <20% of respondents choosing factors other than age. Most respondents reported that they would be likely to use a risk stratification tool in their practice either ‘often’ (43%) or sometimes (53%).Conclusions
Risk stratification was perceived to be important in clinical decision making, yet few providers considered risk factors other than age for average‐risk patients. Providers were receptive to the use of a risk assessment tool for ACN when recommending an appropriate screening test for select patients. 相似文献4.
Comparing the nine‐item Shared Decision‐Making Questionnaire to the OPTION Scale – an attempt to establish convergent validity 下载免费PDF全文
Isabelle Scholl PhD Dipl.‐Psych Levente Kriston PhD Dipl.‐Psych Jörg Dirmaier PhD Dipl.‐Psych Martin Härter MD PhD Dipl.‐Psych 《Health expectations》2015,18(1):137-150
Background
While there has been a clear move towards shared decision‐making (SDM) in the last few years, the measurement of SDM‐related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects.Objective
To test convergent validity of the nine‐item Shared Decision‐Making Questionnaire (SDM‐Q‐9) by comparing it to the OPTION Scale.Design
Cross‐sectional study.Setting and participants
Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study.Methods
Consultations were evaluated using the OPTION Scale. Patients completed the SDM‐Q‐9 after the consultation. First, the internal consistency of both scales and the inter‐rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM‐Q‐9, correlation between the patient (SDM‐Q‐9) and expert ratings (OPTION Scale) was calculated.Results
A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM‐Q‐9 and limited internal consistency of the OPTION Scale. Inter‐rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance.Discussion
By the use of the OPTION Scale convergent validity of the SDM‐Q‐9 could not be established. Several possible explanations for this result are discussed.Conclusion
This study shows that the measurement of SDM remains challenging. 相似文献5.
Susana Garcia‐Gutierrez MD PhD Jose M. Quintana MD PhD Urko Aguire MSc Irantzu Barrio MSc Carlota Las Hayas PhD Nerea Gonzalez PhD IRYSS‐Cataract Group 《Health expectations》2014,17(6):765-775
Background
To date, factors that influence satisfaction with cataract surgery have not been broadly explored.Objective
To identify variables related to patient satisfaction after cataract extraction by phacoemulsification and to determine the relationship between satisfaction and visual acuity (VA) and visual function (VF).Design
Prospective cohort study.Setting
Five hospitals belonging to the Basque Health Care Service.Participants
4335 consecutive patients undergoing cataract extraction.Interventions
Clinical data on vision were collected before the intervention and 6 weeks afterwards. Before cataract extraction, patients answered a global question about their expectations for the procedure, answered three questions related to specific activities (reading, going out and recognizing people, and doing housework) and completed the Visual Function‐14 (VF‐14) and Short‐Form‐36 (SF‐36) instruments. Three months after cataract extraction, they again completed the VF‐14 and SF‐36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities.Main outcome measures
Three months after cataract extraction, they again completed the VF‐14 and SF‐36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities.Results
Pre‐intervention VA and VF‐14 scores and their post‐intervention changes were associated with both global satisfaction and satisfaction with the ability to perform specific activities. Unresolved ocular complications were related to global satisfaction with cataract extraction (OR 95% = 0.39(0.27, 0.55), P < 0.001). Both the mental and physical component scales of the SF‐36 were related to global satisfaction. A group of patients were not satisfied with the intervention in spite of achieving similar vision‐related improvements as patients who were quite satisfied with the procedure.Conclusion
Satisfaction with cataract extraction is related to clinical outcomes and is also associated with patients'' expectations of their improvement in visual function. 相似文献6.
Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women 下载免费PDF全文
Amie Steel MPH Grad Cert Ed BHSc Jon Adams PhD MA BA David Sibbritt PhD MMedStats BMath Alex Broom PhD MA BA Cindy Gallois PhD MA BS FASSA MAPsS Jane Frawley MClSci GradCertAppSc BHSc 《Health expectations》2015,18(5):1633-1644
Background
Despite high rates of women''s use of intrapartum pain management techniques, little is known about the factors that influence such use.Objective
Examine the determinants associated with women''s use of labour pain management.Design
Cross‐sectional survey of a substudy of women from the ‘young’ cohort of the Australian Longitudinal Study of Women''s Health (ALSWH).Setting and participants
Women aged 31–35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).Main variables studied
Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants'' attitudes and beliefs related to both CAM and maternity care were also included in the analysis.Main outcome measures
The outcome measures examined were the use of both pharmacological and non‐pharmacological pain management techniques (NPMT).Results
Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS).Discussion and conclusions
The effect of key determinants on women''s use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options. 相似文献7.
Assessments of the extent to which health‐care providers involve patients in decision making: a systematic review of studies using the OPTION instrument 下载免费PDF全文
Nicolas Couët Sophie Desroches Hubert Robitaille Hugues Vaillancourt Annie Leblanc Stphane Turcotte Glyn Elwyn France Lgar 《Health expectations》2015,18(4):542-561
Background
We have no clear overview of the extent to which health‐care providers involve patients in the decision‐making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this.Objective
To systematically review studies that used the OPTION instrument to observe the extent to which health‐care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation.Search strategy
We conducted online literature searches in multiple databases (2001–12) and gathered further data through networking.Inclusion criteria
(i) OPTION scores as reported outcomes and (ii) health‐care providers and patients as study participants. For analysis, we only included studies using the revised scale.Data extraction
Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting.Main results
We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient‐involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0–100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15).Conclusions
Whatever the clinical context, few health‐care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this. 相似文献8.
Background
Family history is often referred to as a family tree in casual everyday conservations, but it carries a different connotation in medicine. This study is the first to investigate people''s understanding of ‘family medical history’ and the concept of ‘family’ in the context of inherited cancer.Methods
Three hundred and nine staff at the Faculty of Medicine and Health, University of Leeds completed an online web survey.Results
Not all respondents understood or knew what makes a family history of cancer. Only 54% knew exactly the type of information required to make a family history. Apart from blood relatives, adopted and step‐siblings, step parents, in‐laws, spouses, friends and colleagues were also named as ‘family’ for family history taking. Personal experience of living with cancer and academic qualification were not significant in influencing knowledge of family history.Conclusions
There is misunderstanding and poor knowledge of family history of cancer and the type of information required to make a family history even in a sample of people teaching and researching medicine and health issues. Public understanding of the value of family medical history in cancer prevention and management is important if informed clinical decisions and appropriate health care are to be delivered. 相似文献9.
Rhian Parker PhD Laura Forrest PhD James McCracken PG Dip Ian McRae PhD 《Health expectations》2014,17(5):733-740
Background
Nurses are becoming increasingly important as providers of primary health care in Australia. In November 2010, Medicare provider rights and Pharmaceutical Benefits Scheme rights for nurse practitioners, working in private practice and in collaboration with a medical practitioner, were introduced in Australia. Although international evidence suggests that nurse practitioners would be appropriate and acceptable providers of care at the first point of contact, such as primary health care, there is little Australian evidence about what care consumers are willing to accept from nurse practitioners.Objectives
To ascertain what care Australian health‐care consumers would accept from nurse practitioners in this setting.Participants
Australian adults over 18 years of age.Methods
National Survey delivered online. Information about the survey was disseminated through a media campaign, stakeholder engagement and through the health‐care consumer networks nationally.Results
The total number of respondents that started the survey was n = 1883. Ninety‐five percentage (n = 1784) of respondents completed the survey. The majority of respondents were women, aged 25–54 years, had completed tertiary education and had an annual household income of more than A$80 000. The majority of the respondents (n = 1562, 87%) said they would be prepared to see a nurse practitioner for some of their primary health‐care needs.Conclusions
The findings of this study suggest consumers are accepting of a range of activities undertaken by nurse practitioners in primary health care and this has relevance for primary health‐care workforce mix and organization, particularly for areas that are underserved by medical practitioners. 相似文献10.
Shared decision‐making behaviours in health professionals: a systematic review of studies based on the Theory of Planned Behaviour 下载免费PDF全文
Philippe Thompson‐Leduc MSc Marla L. Clayman PhD MPH Stéphane Turcotte MSc France Légaré MD PhD CCMF FCMF 《Health expectations》2015,18(5):754-774
Background
Shared decision making (SDM) requires health professionals to change their practice. Socio‐cognitive theories, such as the Theory of Planned Behaviour (TPB), provide the needed theoretical underpinnings for designing behaviour change interventions.Objective
We systematically reviewed studies that used the TPB to assess SDM behaviours in health professionals to explore how theory is being used to explain influences on SDM intentions and/or behaviours, and which construct is identified as most influential.Search strategy
We searched PsycINFO, MEDLINE, EMBASE, CINAHL, Index to theses, Proquest dissertations and Current Contents for all years up to April 2012.Inclusion criteria
We included all studies in French or English that used the TPB and related socio‐cognitive theories to assess SDM behavioural intentions or behaviours in health professionals. We used Makoul & Clayman''s integrative SDM model to identify SDM behaviours.Data extraction and synthesis
We extracted study characteristics, nature of the socio‐cognitive theory, SDM behaviour, and theory‐based determinants of the SDM behavioural intention or behaviour. We computed simple frequency counts.Main results
Of 12 388 titles, we assessed 136 full‐text articles for eligibility. We kept 20 eligible studies, all published in English between 1996 and 2012. Studies were conducted in Canada (n = 8), the USA (n = 6), the Netherlands (n = 3), the United Kingdom (n = 2) and Australia (n = 1). The determinant most frequently and significantly associated with intention was the subjective norm (n = 15/21 analyses).Discussion
There was great variance in the way socio‐cognitive theories predicted SDM intention and/or behaviour, but frequency of significance indicated that subjective norm was most influential. 相似文献11.
Den‐Ching A. Lee B App Sc Grad Dip Lesley Day PhD Keith Hill PhD Lindy Clemson PhD Fiona McDermott PhD Terry P. Haines PhD 《Health expectations》2015,18(5):1593-1609
Objective
To identify from the older adults'' perspective, the factors associated with discussion about falls with their general practitioners and other health professionals and the factors associated with initiation of these discussions. We explored the content of and barriers to discussion about falls.Methods
A prospective cohort study where a baseline cross‐sectional survey was followed by a survey 1 year later. Survey domains were drawn from constructs of behavioural change models. Data from 245 older community dwellers in Victoria, Australia, in the follow‐up survey were used for this study. Survey format consisted of yes and no responses, Likert scale and open/closed‐ended responses.Results
Few older adults talked with and initiated a talk with their health‐care providers about falls in the follow‐up period. Multiple regression showed anxiety or depression [OR = 2.78, 95% CI (1.21–6.41)], chronic medical conditions such as diabetes [OR = 2.71, 95% CI (1.19–6.17)] and having a self‐reported fall in the last 12 months [OR = 4.26, 95% CI (2.16–8.41)] were associated with discussion of falls with general practitioners. Higher perception of risk of sustaining a serious injury from falling [OR = 1.49 (1.03–2.13)] was associated with discussion about falls with other health professionals. Participants discussed various topics of falls with their health‐care providers. Different barriers to discussion about falls were identified.Conclusion
Health‐care providers should routinely discuss falls prevention with older adults. Dissemination of evidence‐based advice and followed up with referral during consultations, particularly in general practitioners could advance falls prevention practice. The results could help to develop a conceptual framework to predict the likelihood of falls discussion. 相似文献12.
Is the Give Youth a Voice questionnaire an appropriate measure of teen‐centred care in paediatric oncology: a Rasch measurement theory analysis 下载免费PDF全文
Anne F Klassen DPhil Stefan J. Cano PhD Roona Sinha MD Areej Shahbaz BHSc Robert Klaassen MD David Dix MBChB 《Health expectations》2015,18(5):1686-1697
Background
Adolescents have their own views about the cancer care they receive and how they feel they are treated, but their opinions are rarely solicited.Objective
To determine whether the 56‐item Give Youth a Voice (GYV‐56), its subscales and its 20‐item short‐form, are clinically meaningful and psychometrically sound instruments that can be used to measure teen‐centred care (TCC) in paediatric oncology.Design
Qualitative interviews and a questionnaire survey.Setting and participants
Qualitative interviews with 38 childhood cancer survivors. GYV‐56 data collected from 200 paediatric cancer patients and survivors.Main outcome measure
The GYV‐56, which measures the following four aspects of service delivery: Supportive and respectful relationships; Information sharing and communication; Supporting independence; and Teen‐centred services.Results
Qualitative data provided broad support for the TCC conceptual framework and GYV‐56 items. After post‐hoc reduction of the response options from 7 to 3 (to correct for disordered thresholds), fit to the Rasch model was good, most items showed acceptable fit residuals and chi‐square P‐values, scale reliability were supported and item locations defined a continuum for TCC that was well‐targeted to the sample. By calibrating the items for each subscale and the short‐form to the full scale, the scores obtained on each measure are directly comparable.Conclusion
Our study found initial support for use of the GYV with a reduced response option format for examining TCC in the adolescent oncology patients. in this paediatric population. Further research using the GYV is needed to elaborate upon our findings. 相似文献13.
Vincent C. H. Chung BCM PhD Polly H. X. Ma MPH Chun Hong Lau MSSc PhD Samuel Y. S. Wong MPH MD Eng Kiong Yeoh MBBS FHKAM Sian M. Griffiths MB BChir FFPH 《Health expectations》2014,17(5):622-636
Background
Health‐care professionals worldwide have started to appreciate patients'' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.Objective
This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.Search strategy
Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.Inclusion criteria
Quantitative, qualitative or mixed‐method research that aimed to investigate Chinese patients'' perception of, and perspectives on, TCM was included.Data extraction and synthesis
For each study included, texts under the headings of ‘results’ or ‘findings’ were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.Main results
Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed‐method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.Discussion and conclusions
Future research should explore how variation in health systems may influence patients'' perception of CAM in different countries. 相似文献14.
Will the introduction of non‐invasive prenatal testing for Down's syndrome undermine informed choice? 下载免费PDF全文
Caroline Silcock DPsych Lih‐Mei Liao PhD Melissa Hill PhD Lyn S. Chitty MRCOG PhD 《Health expectations》2015,18(5):1658-1671
Objective
To investigate whether the introduction of non‐invasive pre‐natal testing for Down''s syndrome (DS) has the potential to undermine informed choice.Participants
Three hundred and ninety‐three health professionals; 523 pregnant women.Methods
A cross‐sectional questionnaire study across nine maternity units and three conferences in the UK designed to assess opinions regarding test delivery and how information should be communicated to women when offered Down''s syndrome screening (DSS) or diagnosis using invasive (IDT) or non‐invasive testing (NIPT).Results
Both pregnant women and health professionals in the NIPT and DSS groups were less likely than the IDT group to consider that testing should take place at a return visit or that obtaining written consent was necessary, and more likely to think testing should be carried out routinely. Compared to health professionals, pregnant women expressed a stronger preference for testing to occur on the same day as pre‐test counselling (P = 0.000) and for invasive testing to be offered routinely (P = 0.000). They were also more likely to indicate written consent as necessary for DSS (P = 0.000) and NIPT (P < 0.05).Conclusions
Health professionals and pregnant women view the consenting process differently across antenatal test types. These differences suggest that informed choice may be undermined with the introduction of NIPT for DS into clinical practice. To maintain high standards of care, effective professional training programmes and practice guidelines are needed which prioritize informed consent and take into account the views and needs of service users. 相似文献15.
Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study 下载免费PDF全文
Maria Grandahl RN MMSc Tanja Tydén PhD RNM Maria Gottvall RN Ragnar Westerling PhD MD Marie Oscarsson PhD RNM 《Health expectations》2015,18(3):344-354
Background
Many Western countries have cervical cancer screening programmes and have implemented nation‐wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.Objective
To explore immigrant women''s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.Design
An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.Setting and participants
Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.Results
Four themes emerged: (i) deprioritization of women''s health in home countries, (ii) positive attitude towards the availability of women''s health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check‐ups.Conclusion
The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health‐care providers. Therefore, information needs to be in different languages and provided through different sources. Health‐care professionals should also consider immigrant women''s difficulties concerning cultural norms and pay attention to their experiences. 相似文献16.
Rex C.‐C. Huang MS Anssi Auvinen PhD Matti Hakama PhD Teuvo L. J. Tammela PhD Martti Ala‐Opas PhD Mikael Leppilahti PhD Timo Vornanen MD Hsiu‐Hsi Chen PhD 《Health expectations》2014,17(6):776-783
Background
Patient preference for the choice of treatment modality for prostate cancer has increasingly gained attention.Objective
To assess the impact of client‐oriented decision on long‐term mortality, disease progression and biochemical failure compared with standard treatment protocol (TP).Methods
With data from a Finnish multicentre, randomized controlled trial with two arms [104 in the enhanced patient participation (EPP) arm and 106 in the TP arm], disease‐specific and disease‐free survival, biochemical failure with elevated prostate‐specific antigen (PSA) level and disease progression were compared between the two arms using Wilcoxon test and also Cox proportional hazards regression model.Results
Patients in the EPP arm had a higher risk of death by 37% [HR, 1.37 (0.87–2.17)] compared with those in the TP arm. Patients in the EPP arm were at increased risk of having biochemical failure by 14% [HR, 1.14 (0.72–1.79)] and for having disease progression by 2% [HR, 1.02 (0.61–1.70)] compared with those in the TP arm. All the differences were non‐significant.Conclusions
Patients actively involved in the choice of treatment had higher risk of prostate cancer death but only slightly increased risk of biochemical failure and clinical disease progression. These findings would provide a good reference when patient autonomy for the choice of treatment modality is addressed. 相似文献17.
Choosing vs. allocating: discrete choice experiments and constant‐sum paired comparisons for the elicitation of societal preferences 下载免费PDF全文
Chris D. Skedgel MDE Allan J. Wailoo PhD Ron L. Akehurst BSc Hon MFPHM 《Health expectations》2015,18(5):1227-1240
Background
There is growing evidence of a reluctance to allocate health care solely on the basis of maximizing quality‐adjusted life years (QALYs). Stated preference methods can be used to elicit preferences for efficiency vs. equity in the allocation of health‐care resources.Objective
To compare discrete choice experiment (DCE) and constant‐sum paired comparison (CSPC) methods for eliciting societal preferences.Methods
Over a series of choice pairs, DCE respondents allocated a fixed budget to one preferred group and CSPC respondents allocated budget percentages between the groups. Questionnaires were compared in terms of completion rates, preference consistency, dominant preferences and derived attribute importance.Results
There was no significant difference in the proportions that rated the questionnaires somewhat or extremely difficult, but a significantly greater proportion completed the DCE compared to the CSPC. Preference consistency was also higher in the DCE. The incidence of dominant preferences, including for aggregate QALYs, was low and not significantly different between questionnaires. Similarly, no CSCP respondents equalized budgets or outcomes in every task. Final health state was the most important attribute in both questionnaires, but the rankings diverged for the other attributes. Notably, the total patients'' treated attribute was important in the CSPC but insignificant in the DCE, perhaps reflecting a ‘prominence effect’.Conclusions
Despite lower completion rates and preference consistency, CSPC may offer advantages over DCE in eliciting preferences over the distribution of resources and/or outcomes as well as attribute levels, avoiding extreme ‘all‐or‐nothing’ distributions and possibly aligning respondent attention more closely with a societal perspective. 相似文献18.
What do people appreciate in physicians' communication? An international study with focus groups using videotaped medical consultations 下载免费PDF全文
Maria A. Mazzi MSc Michela Rimondini PhD Myriam Deveugele PhD Christa Zimmermann PhD Francesca Moretti PhD Liesbeth van Vliet PhD Giuseppe Deledda MSc Ian Fletcher PhD Jozien Bensing PhD 《Health expectations》2015,18(5):1215-1226
Background
The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication.Objective
To give voice to the lay people perspective on what constitutes ‘good communication’ by evoking their reactions to variations in physician communication.Design
Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender‐specific focus groups who were balanced in age groups.Setting and participants
Two hundred and fifty‐nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6–8 persons each.Main variables studied
Comments on doctors'' behaviours were classified by the GULiVer framework in terms of contents and preferences.Results
Participants prevalently discussed ‘task‐oriented expressions’ (39%: competency, self‐confident, providing solutions), ‘affective oriented/emotional expressions'' (25%: empathy, listening, reassuring) and ‘process‐oriented expressions'' (23%: flexibility, summarizing, verifying). ‘Showing an affective attitude’ was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by ‘providing solution’ (85%). Among disfavoured behaviour, repetitions (88%), ‘writing and reading’ (54%) and asking permission (42%) were found.Conclusions
Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is ‘good communication’ for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines. 相似文献19.
Sawako Okamoto Kazuo Kawahara MD PhD Atsushi Okawa MD PhD Yujiro Tanaka MD PhD 《Health expectations》2015,18(5):826-838
Background
Second opinion (SO) is widely recognized in Japan, but we do not know how patients view and use SO.Objectives
To investigate optimum seeking of SO in Japan''s universal health‐care system.Design, participants, and methods
Survey of patients at Tokyo Medical and Dental University Hospital. Of 365 responses, 67 had experienced SO with standardized protocol at SO Clinic; 82 had obtained SO elsewhere without instruction; 216 had never sought SO.Main outcome measures
Views of values and risks of SO.Results
Second opinion patients with standardized protocol better understood their illness, treatment options, individualized plan, and uncertainty in medicine, and also reported improved decision making compared with SO patients without the protocol (P < 0.05). However, more than half of respondents misunderstood SO as a way to change doctors or treatment. Second opinion respondents (n = 149) had a propensity to request treatment changes (P < 0.1) and more than one‐third (n = 82) did not tell SO doctor they were being treated by another doctor. The absolute majority of non‐SO patients would seek SO for a serious illness but would hesitate to tell their doctors.Discussion and conclusion
Respondents recognized value of SO to improve understanding and decision making. This study also found risks in SO misuse which may be reinforced by Japan''s cultural tendencies and universal health‐care system. Our findings suggest steps to increase the benefit of SO: ensure involvement of original doctor, instruct patients about SO and help them organize their thinking before SO and facilitate patients'' return to the treating doctor for discussion and decision making. 相似文献20.
Assessing knowledge and attitudes towards screening among users of Faecal Immunochemical Test (FIT) 下载免费PDF全文
Maaike J. Denters MD Marije Deutekom MD PhD Marie‐Louise Essink‐Bot MD PhD Patrick M. Bossuyt MD PhD Paul Fockens MD PhD Evelien Dekker MD PhD 《Health expectations》2015,18(5):839-849