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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 572 Research Studies DisplayedDjulbegovic B, Hozo I, Lizarraga D
Decomposing clinical practice guidelines panels' deliberation into decision theoretical constructs.
The creation of clinical practice guidelines (CPG) is hindered by the absence of a clear and transparent structure for integrating key components needed to develop practice recommendations. The purpose of the study was to compare the American Society of Hematology (ASH) CPG panel's deliberations for managing pulmonary embolism (PE) to relevant decision-theoretic constructs to evaluate the concordance between panel recommendations and explicit decision modeling. Five constructs were identified, with three employed to rephrase the panel's recommendations: 1) a standard, expected utility threshold (EUT) decision model; 2) an acceptable regret threshold model (ARg) for determining the acceptable frequency of false negative (FN) or false positive (FP) recommendations, and 3) fast-and-frugal tree (FFT) decision trees for devising a comprehensive strategy for PE management. The researchers compared four management approaches: withholding testing versus D-dimer → computerized pulmonary angiography (CTPA) ('ASH-Low') versus CTPA → D-dimer ('ASH-High') versus treatment without testing. The study found that various models yielded diverse recommendations. For instance, EUT suggested that testing should be withheld for prior PE probability <0.13%, a clinically implausible threshold up to 15 times (2/0.13) lower than the ASH guidelines threshold for excluding PE (at post probability of PE ≤2%). Only three models concurred that the 'ASH low' strategy should be applied to pretest PE probabilities between 0.13% and 13.27% and that the 'ASH high' approach should be utilized in a narrow range of prior PE probabilities between 90.85% and 93.07%. For all other prior PE probabilities, selecting one model did not guarantee consistency with other models
AHRQ-funded; HS024917
Citation: Djulbegovic B, Hozo I, Lizarraga D .
Decomposing clinical practice guidelines panels' deliberation into decision theoretical constructs.
J Eval Clin Pract 2023 Apr;29(3):459-71. doi: 10.1111/jep.13809.
Keywords: Guidelines, Evidence-Based Practice, Decision Making
Vo H, Valentine KD, Barry MJ
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
The objectives of this study were to examine the reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. Researchers conducted a secondary data analysis of more than 6,000 participants who made decisions about breast, colon, or prostate cancer screening or taking medication for menopause, depression, hypertension or high cholesterol. They concluded that the SDM Process scale demonstrated construct validity and retest reliability.
AHRQ-funded; HS025718.
Citation: Vo H, Valentine KD, Barry MJ .
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
Patient Educ Couns 2023 Mar;108:107617. doi: 10.1016/j.pec.2022.107617.
Keywords: Decision Making, Cancer, Medication, Screening
Shear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Rosenberg SM, Zheng Y, Gelber S
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
The purpose of this study was to describe oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer to inform strategies to improve adherence. The researchers identified 693 women with hormone receptor-positive, stage I to III breast cancer enrolled in a cohort of women diagnosed with breast cancer at 40 years or less, assessed ET decision-making and identified variables related with non-initiation/non-persistence and to assess the relationship between non-persistence and recurrence. The study found that by 18 months, 9% had not initiated ET. Black women had a greater chances and women with a college degree had lower chances of non-initiation. Of the 607 women who initiated, 20% were non-persistent. The researchers specified that younger age, being married or partnered, and indicating greater weight issues were related with higher chances of non-persistence. Having received chemotherapy and higher burdens of hot flashes and vaginal symptoms were related with lower odds of non-persistence. Women who initiated therapy had an increased likelihood of reporting shared decision-making than non-initiators (57% vs. 38%), and women who were non-persistent were less likely to report high confidence with the decision than women who were persistent (40% vs. 63%).
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Zheng Y, Gelber S .
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
Breast Cancer Res Treat 2023 Feb; 197(3):547-58. doi: 10.1007/s10549-022-06810-1..
Keywords: Cancer: Breast Cancer, Cancer, Women, Decision Making, Patient Adherence/Compliance
Tierney WM, Henning JM, Altillo BS
User-centered design of a clinical tool for shared decision-making about diet in primary care.
This study described how the authors engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. The goal is to help prevent clinician burnout and career dissatisfaction brought on by poorly designed health information technology. Individual clinician and patient interviews were conducted to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. Participants were primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. Three iterations of design and review were conducted with substantial evolution of the program’s content, format, and flow of information. The amount of information was fine-tuned so it would be just the right amount displayed to facilitate shared dietary goal setting.
AHRQ-funded; HS027660.
Citation: Tierney WM, Henning JM, Altillo BS .
User-centered design of a clinical tool for shared decision-making about diet in primary care.
J Gen Intern Med 2023 Feb; 38(3):715-26. doi: 10.1007/s11606-022-07804-x..
Keywords: Patient-Centered Healthcare, Decision Making, Primary Care
Zisman-Ilani Y, Thompson KD, Siegel LS
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
The purpose of this multi-site cluster randomised controlled trial was to test the impact of standard Crohn's disease care and compare with the impact of shared decision making (SDM) on the provider’s choice of therapy, quality of decisions, and provider trust. A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, from 14 diverse gastroenterology practices in the US, participated in the study. 99 of those participants received the intervention and 59 received standard care. The study found that participants in the intervention group chose combination therapy more frequently, had a significantly lower decisional conflict, and had greater trust in their provider.
AHRQ-funded; HS021747.
Citation: Zisman-Ilani Y, Thompson KD, Siegel LS .
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
Aliment Pharmacol Ther 2023 Jan;57(2):205-14. doi: 10.1111/apt.17286..
Keywords: Digestive Disease and Health, Chronic Conditions, Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication
Rao BR, Jung EH, Dickert NW
Getting cost discussions right: nudging patients to avoid cognitive pitfalls.
The purpose of this article was to discuss the challenges of high out-of-pocket medication costs and their negative impact on healthcare, patient behavior, and access to quality care. The authors report that integrating cost information into medical decisions can be a useful tool for improving patient outcomes, but there are several cognitive biases that can skew patients' decisions in different directions. The article emphasizes the need for using nudge strategies as a focused counterweight to address out-of-pocket costs and other complex medical decisions. The authors explain that nudges involving manipulations in framing and choice architecture can be harnessed to impact decisions in a predictable way without restricting options or changing economic incentives. The article suggests several nudge strategies that clinicians can employ to help patients make better decisions and avoid cognitive pitfalls in shared decision-making discussions related to out-of-pocket costs.
AHRQ-funded; HS028558.
Citation: Rao BR, Jung EH, Dickert NW .
Getting cost discussions right: nudging patients to avoid cognitive pitfalls.
Circ Cardiovasc Qual Outcomes 2023 Jan; 16(1):e009447. doi: 10.1161/circoutcomes.122.009447..
Keywords: Healthcare Costs, Decision Making, Clinician-Patient Communication, Communication
Dalton AF, Golin CE, Morris C
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
This research studied the effects of a patient decision aid on preferences for colorectal cancer (CRC) screening among adults aged 76 to 84 years. Participants were recruited from 14 community-based primary care practices who were not up to date with screening and had an appointment within 6 weeks. They were randomized to receive the intervention or control. Among the 424 participants, mean age was 76.8, 248 were women, and 333 were White. There were no statistically significant differences found in patient preferences between the health groups. Additional studies that are appropriately powered were recommended.
AHRQ-funded; HS021133.
Citation: Dalton AF, Golin CE, Morris C .
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2022 Dec;5(12):e2244982. doi: 10.1001/jamanetworkopen.2022.44982..
Keywords: Elderly, Decision Making, Screening, Cancer: Colorectal Cancer, Cancer
Schumacher JR, Zahrieh D, Chow S
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
This paper describes the protocol for a multisite randomized trial to test the impact of a newly developed decision aid to increase socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. The study will be conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). A stepped-wedge design with clinics will be randomized to the time of transition from usual care to the decision aid arm. Study participants will be female, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection will include a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. A subset of patients, surgeons, and clinic stakeholders will participate in interviews and focus groups.
AHRQ-funded; HS025194.
Citation: Schumacher JR, Zahrieh D, Chow S .
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
BMJ Open 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895..
Keywords: Cancer: Breast Cancer, Cancer, Patient and Family Engagement, Decision Making, Patient-Centered Healthcare, Surgery, Women
Schuttner L, Lee JR, Hockett Sherlock S
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
The purpose of this study was to explore primary care physician (PCP) perspectives on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and higher psychosocial complexity. Between May and July 2020 the researchers utilized semi-structured telephone interviews with 23 PCPs in patient-centered medical home teams in a nationally integrated health system in the United States. The study found three major themes: (1) The personal values of patients were rarely directly discussed in routine clinical encounters but informed more typically discussed constructs of patient preferences, goals, and priorities; (2) Patient preferences, goals, and priorities were sources of conflicting perspectives about care plans between healthcare teams, patients, and families; (3) Physicians used direct strategies to communicate and negotiate about patient preferences, goals, and priorities when developing care plans. The researchers concluded that during clinical decision-making for complex patients with multimorbidity, primary care physicians perceive patient values, preferences, health priorities and goals as influential.
AHRQ-funded; HS026369.
Citation: Schuttner L, Lee JR, Hockett Sherlock S .
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
Risk Manag Healthc Policy 2022 Nov 16; 15:2135-46. doi: 10.2147/rmhp.S380021..
Keywords: Primary Care, Provider: Physician, Decision Making, Chronic Conditions
Valentine KD, Lipstein EA, Vo H
Pediatric caregiver version of the Shared Decision Making Process Scale: validity and reliability for ADHD treatment decisions.
This study’s goal was to examine the validity and reliability of a scale for a shared decision making (SDM) Process scale in attention-deficit/hyperactivity disorder (ADHD) treatment decisions. This cross-sectional survey included 498 caregivers of children aged 5-13 diagnosed with ADHD who had made a decision about ADHD medication in the last 2 years. Surveys included the adapted SDM Process scale, decisional conflict, decision regret, and decision involvement. The scale was found to be acceptable and reliable. Scores demonstrated convergent validity, as they were higher for those without decisional conflict than those with decisional conflict and higher for caregivers who stated they made the decision with the provider than those who made the decision themselves. Higher scores were related to less regret, though the magnitude of the relationship was small.
AHRQ-funded; HS025718.
Citation: Valentine KD, Lipstein EA, Vo H .
Pediatric caregiver version of the Shared Decision Making Process Scale: validity and reliability for ADHD treatment decisions.
Acad Pediatr 2022 Nov-Dec;22(8):1503-09. doi: 10.1016/j.acap.2022.07.014..
Keywords: Children/Adolescents, Behavioral Health, Decision Making, Patient-Centered Healthcare
Ng MY, Kapur S, Blizinsky KD
The AI life cycle: a holistic approach to creating ethical AI for health decisions.
This article provides an overview of the reimagined artificial intelligence (AI) lifecycle to create ethical AI for health decisions. The lifecycle is data creation, data acquisition, model development, model evaluation, and model deployment. AI biases in each phase are described and recommendations are made to address each one.
AHRQ-funded; HS027434.
Citation: Ng MY, Kapur S, Blizinsky KD .
The AI life cycle: a holistic approach to creating ethical AI for health decisions.
Nat Med 2022 Nov;28(11):2247-49. doi: 10.1038/s41591-022-01993-y..
Keywords: Health Information Technology (HIT), Decision Making
Gomez Lumbreras A, Reese TJ, Del Fiol G
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
This study evaluated a tool called DDInteract that was developed to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. The study used case vignettes with physicians and patients on warfarin to conduct simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Participants completed a postsession interview and SDM process survey, including the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). A total of 12 physician-patient dyads were used, with over 91% of the patients over 50 and 75% had been taking warfarin for over 2 years. Most participants rated DDInteract higher than usual care (UC) and would be willing to use the tool for an interaction involving warfarin and NSAIDs.
AHRQ-funded; HS027099.
Citation: Gomez Lumbreras A, Reese TJ, Del Fiol G .
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
JMIR Form Res 2022 Oct 19;6(10):e40018. doi: 10.2196/40018..
Keywords: Decision Making, Medication, Blood Thinners, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication: Safety, Patient Safety
Brodney S, Valentine KD, Vo HA
Measuring shared decision making in younger and older adults with depression.
This study compared shared decision making (SDM) of younger (18-39 years) and older (40-75 years) patients for starting or stopping depression treatment. A panel of 494 respondents completed one of two versions of the SDM Process scale that differed in wording of pros and cons items, and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider, or together). SDM Process scores were higher for younger respondents than older respondents. Higher scores were also associated with no decisional conflict and less decision regret.
AHRQ-funded; HS025718.
Citation: Brodney S, Valentine KD, Vo HA .
Measuring shared decision making in younger and older adults with depression.
Int J Qual Health Care 2022 Oct 12;34(4):mzac076. doi: 10.1093/intqhc/mzac076..
Keywords: Decision Making, Depression, Behavioral Health
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of patient numeracy and graph literacy.
The purpose of this study was to assess the impact of patient health literacy, numeracy, and graph literacy on perceptions of hypertension control using different forms of data visualization. Forms of visualization included data tables, graphs with raw values, and graphs with smoothed values only. Findings showed that judgments about hypertension data presented as a smoothed graph were significantly more positive than judgments about the same data presented as either a data table or an unsmoothed graph. Hypertension data viewed in tabular form was perceived more positively than graphs of the raw data. Data visualization had the greatest impact on participants with high graph literacy.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of patient numeracy and graph literacy.
J Am Med Inform Assoc 2022 Oct 7;29(11):1829-37. doi: 10.1093/jamia/ocac129..
Keywords: Health Literacy, Blood Pressure, Decision Making
Weiner SJ, Schwartz A, Weaver F
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
Researchers sought to determine whether contextualized clinical decision support (CDS) tools in the electronic health record (EHR) improve clinician contextual probing, attention to contextual factors in care planning, and the presentation of contextual red flags. In this randomized clinical trial, they found that contextualized CDS did not improve patients' outcomes but did increase contextualization of their care, suggesting that use of this technology could ultimately help to improve outcomes.
AHRQ-funded; HS025374.
Citation: Weiner SJ, Schwartz A, Weaver F .
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
JAMA Netw Open 2022 Oct;5(10):e2238231. doi: 10.1001/jamanetworkopen.2022.38231..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Decision Making
Ross RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Dorr DA, Richardson JE, Bobo M
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
This study tried to partly address the challenge of developing a patient-facing clinician decision support (CDS) for persistent high blood pressure (HBP). The authors sought to understand provider variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools. They implemented a pilot and final survey for hypertension experts and primary care physicians. Five clinical cases were presented that queried clinicians' attitudes related to actions; variations; prioritization; patient input; importance; and barriers for HBP diagnosis, monitoring, and treatment. Fifteen hypertension experts and 14 providers took the pilot and final versions of the survey. The majority (over 80%) of providers felt the recommendations were important yet found them difficult to follow-up to 90% of the time. Provider perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22 to 100%. Reasons for variation provided included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Respondents were generally positive toward patient use of electronic CDS applications but worried about access to health care, nuance of recommendations, and patient understanding of the tools.
AHRQ-funded; HS26849.
Citation: Dorr DA, Richardson JE, Bobo M .
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
Appl Clin Inform 2022 Oct;13(5):1131-40. doi: 10.1055/a-1926-0199..
Keywords: Blood Pressure, Clinical Decision Support (CDS), Decision Making, Provider: Physician
Storck KE, Gawron LM, Sanders JN
"I just had to pay the money and be supportive": a qualitative exploration of the male-partner role in contraceptive decision-making in Salt Lake City, Utah family planning clinics.
This study explored in contraceptive decision-making using interviews with 30 male-female cis-hetero couples in Salt Lake City. The participants were stratified by sex assigned at birth and current contraceptive method and either long-acting reversible contraception (LARC) vs non-LARC users. Men and women both indicated a strong desire to prevent pregnancy, and felt that men’s actual contributions to decision-making were limited. To many couples, ideal partner support centered around emotional, financial, and logistical support options and placed high importance on interpersonal communication. The decision to use a LARC method did not influence sentiments around male-partner involvement or stated desire for partner involvement.
AHRQ-funded; HS027220.
Citation: Storck KE, Gawron LM, Sanders JN .
"I just had to pay the money and be supportive": a qualitative exploration of the male-partner role in contraceptive decision-making in Salt Lake City, Utah family planning clinics.
Contraception 2022 Sep;113:78-83. doi: 10.1016/j.contraception.2022.04.005..
Keywords: Sexual Health, Decision Making
Miller-Rosales C, Lewis VA, Shortell SM
Adoption of patient engagement strategies by physician practices in the United States.
Researchers analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. They found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. They noted that risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Lewis VA, Shortell SM .
Adoption of patient engagement strategies by physician practices in the United States.
Med Care 2022 Sep;60(9):691-99. doi: 10.1097/mlr.0000000000001748..
Keywords: Patient and Family Engagement, Provider: Physician, Decision Making
Gallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Damberg CL, Tom A, Reid RO
Physician organizations' use of behavioral nudges to influence physician behavior.
The purpose of this mixed-methods study design study was to examine the adoption of behavioral nudges by health system-affiliated physician organizations (POs), determine the types of nudges being used, assess PO leader perceptions of nudge effectiveness, and explore implementation challenges. The researchers collected data from a purposive sample of 30 health system-affiliated POs from 4 states between October 2017 and June 2019. A initial survey asked PO leaders to report their organization's use of 5 categories of nudges to influence primary and specialty physicians' actions. Semi structured phone interviews were then conducted to confirm survey responses, obtain examples of the nudges that POs reported utilizing, explore how nudges were structured, and identify challenges to implementation. The study found that almost all study POs reported utilizing nudges. The types of nudges most typically used were clinical templates, patient action lists, and altered order entry. PO leaders reported that the utilization of nudges was limited, not widespread across the organization, and structured in the form of suggestions and not default actions or hard stops. The researchers concluded that the utilization of nudges continues to be limited in practice.
AHRQ-funded; HS024067.
Citation: Damberg CL, Tom A, Reid RO .
Physician organizations' use of behavioral nudges to influence physician behavior.
Am J Manag Care 2022 Sep;28(9):473-76. doi: 10.37765/ajmc.2022.89223..
Keywords: Provider: Physician, Decision Making
Wernli KJ, Smith RE, Henderson LM
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
The authors evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer. They found that breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women's perceptions of surgical treatment decisions in early survivorship.
AHRQ-funded; HS018366.
Citation: Wernli KJ, Smith RE, Henderson LM .
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
Breast Cancer Res Treat 2022 Aug;194(3):607-16. doi: 10.1007/s10549-022-06648-7..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Outcomes Research
Wasp GT, Knutzen KE, Murray GF
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
This study sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). The authors performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development with a combination of random and purposive sampling. Among 31 randomly sampled dyads with 3 encounters each (93 total), systematic therapy decision making was discussed in 90% encounters. Only 34 oncologists broached limiting therapy, which 27 framed as temporary; nine as completion of a standard regime; and five as permanent discontinuation. Thematic analysis found that that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation.
AHRQ-funded; HS022242.
Citation: Wasp GT, Knutzen KE, Murray GF .
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
JCO Oncol Pract 2022 Aug;18(8):e1357-e66. doi: 10.1200/op.21.00377..
Keywords: Decision Making, Cancer, Clinician-Patient Communication
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
AHRQ-funded; HS027910.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N .
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
