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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.
Results1 to 25 of 554 Research Studies Displayed
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.
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.
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.
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.
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
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.
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.
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.
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
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.
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.
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.
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)
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
Citation: Hinson JS, Klein E, Smith A . Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions. NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Decision Making
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
Citation: Nanji KC, Garabedian PM, Langlieb ME . Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial. J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords: Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Decision Making
Tyler A, Dempsey A, Spencer S
Do the guidelines apply?-A multisite, combined stakeholder qualitative case study to understand care decisions in bronchiolitis.
Researchers sought an improved understanding of factors that influence care decisions across multiple stakeholders and diverse settings in order to develop effective strategies to de-implement unnecessary testing and treatment for bronchiolitis. A qualitative case study was conducted across two geographically distinct university affiliated children's hospitals, including semistructured interviews and focus groups with patient participants. The researchers found that, incongruent with provider and care team perceptions, parents reported that they desire an evidence-based, less-is-more approach to bronchiolitis care.
Citation: Tyler A, Dempsey A, Spencer S . Do the guidelines apply?-A multisite, combined stakeholder qualitative case study to understand care decisions in bronchiolitis. Acad Pediatr 2022 Jul;22(5):806-17. doi: 10.1016/j.acap.2021.08.003..
Keywords: Children/Adolescents, Respiratory Conditions, Decision Making, Guidelines, Evidence-Based Practice
Dullabh P, Sandberg SF, Heaney-Huls K
AHRQ Author: Berliner E, Dymek C, Harrison MI, Swiger J
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
This AHRQ-authored horizon scan identified challenges and opportunities for advancing patient-centered clinical decision support (PC CDS) and future directions for PC CDS. The authors engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. They quantitatively analyzed literature and interview transcripts and mapped the findings to the 4 phases translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Twelve challenges were identified for PC CDS development with lack of patient input identified as a critical challenge. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. They also found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in the understanding of PC CDS’ impact.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Sandberg SF, Heaney-Huls K . Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan. J Am Med Inform Assoc 2022 Jun 14;29(7):1233-43. doi: 10.1093/jamia/ocac059.
Keywords: Clinical Decision Support (CDS), Patient-Centered Healthcare, Health Information Technology (HIT), Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice
Gallo T, Heise CW, Woosley RL
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
The purpose of this study was to assess provider actions taken in response to a Clinical decision support (CDS) advisory for Torsade de pointes (TdP) that uses a modified Tisdale QT risk score and presents single click management options. The researchers implemented an inpatient TdP risk advisory across a large, 30 hospital health care system. The CDS advisory was programmed to appear when prescribers attempted to order medications with a known risk of TdP in a patient. The CDS advisory displayed patient-specific information and offered related management options including canceling the requested medication and ordering relevant protocols. The study found that 7794 TdP risk advisories were issued during an 8-month period. The most frequent advisory trigger was antibiotics (33.1%.) The most frequent action taken as a result of the advisory was ordering an ECG (20.3%). Incoming medication orders were canceled in 10.2% of the advisories. The researchers concluded that a single-click, modified Tisdale QT risk score-based CDS resulted in a high action/response rate.
Citation: Gallo T, Heise CW, Woosley RL . Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes. J Am Heart Assoc 2022 Jun 7;11(11):e024338. doi: 10.1161/jaha.122.024338..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions
Dullabh P, Heaney-Huls K, Hovey L
The technology landscape of patient-centered clinical decision support - where are we and what is needed?
This paper explores the technology landscape for patient-centered clinical decision support (PC CDS) and what has come out of Patient Centered Outcomes Research (PCOR) and health care delivery system transformation efforts. The authors explore what is needed to make it more shareable, standards-based, and publicly available with the goal of improving patient care and clinical outcomes. Three sources of information were used: (1) a 22-member technical expert panel; (2) a literature review of peer-reviewed and grey literature; and (3) key informant interviews with PC CDS stakeholders. Ten salient technical considerations that span all phases of PC CDS development were identified. Although significant progress has been made, challenges remain.
Citation: Dullabh P, Heaney-Huls K, Hovey L . The technology landscape of patient-centered clinical decision support - where are we and what is needed? Stud Health Technol Inform 2022 Jun 6;290:350-53. doi: 10.3233/shti220094..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Patient-Centered Outcomes Research, Decision Making
Tsang M, DeBoer RJ, Garrett SB
Decision-making about clinical trial options among older patients with metastatic cancer who have exhausted standard therapies.
The purpose of this study was to examine the potential reasons for and responses to older adults’ under enrollment in phase 1 cancer clinical trials. The researchers conducted 101 in-depth qualitative interviews with 39 adults aged 65 and older with advanced cancer and asked about their experiences with the trials. The data was analyzed to identify the participants’ understanding of clinical research, their perceptions of early phase trials, and their experiences with enrollment in the trials. The study found that participants over the age of 70 were less enthusiastic about participation in clinical trials, although they did not mention age as a limitation to participation. Findings indicated that participation in clinical trials was an interactive, ongoing process, in which older adults relied on their oncologist for guidance and discussion. The researchers concluded that older adults rely on their oncologist to navigate the perceived complexities of phase 1 trial enrollment, and that acknowledgement of those complexities via shared decision-making can help prevent under-enrollment.
Citation: Tsang M, DeBoer RJ, Garrett SB . Decision-making about clinical trial options among older patients with metastatic cancer who have exhausted standard therapies. J Geriatr Oncol 2022 Jun;13(5):594-99. doi: 10.1016/j.jgo.2022.01.012..
Keywords: Elderly, Cancer, Decision Making, Quality of Life
Greenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
Citation: Greenberg JK, Olsen MA, Johnson GW . Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries. Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Decision Making
Dullabh P, Heaney-Huls K, Lobach DF
AHRQ Author: Lomotan E, Swiger J, Harrison MI, Dymek C
The technical landscape for patient-centered CDS: progress, gaps, and challenges.
The purpose of this study was to evaluate the technical landscape for patient-centered clinical decision support (PC CDS) methods to assess the gaps in making PC CDS more standard-based, publicly available, and with greater shareability. The researchers utilized qualitative data from a literature review, a panel of technical experts, and interviews with 18 CDS stakeholders to identify 7 technical considerations that span 5 phases of the development of PC CDS. The authors concluded that while there has been progress in the technical landscape, the field of CDS must focus on improving a number of CDS methods and processes, including standards for translating clinical guidelines into patient-centered clinical decision support, procedures to collect, standardize, and incorporate health data generated by patients, and other CDS processes.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls K, Lobach DF . The technical landscape for patient-centered CDS: progress, gaps, and challenges. J Am Med Inform Assoc 2022 May 11;29(6):1101-05. doi: 10.1093/jamia/ocac029..
Keywords: Clinical Decision Support (CDS), Decision Making, Patient-Centered Healthcare, Health Information Technology (HIT)
Rice H, Garabedian PM, Shear K
Clinical decision support for fall prevention: defining end-user needs.
The purpose of this study was to identify patient and primary care staff needs for development of a tool that will generate clinical decision support (CDS) to prevent falls and injuries in older adults. Community-dwelling patients aged 60 and over and primary care clinic staff were eligible to participate in the study; all were affiliated with the University of Florida Health Archer Family Health Care primary care clinic and the Brigham & Women's Hospital-affiliated primary care clinics. Through qualitative interviews with patients (n=18) and primary care clinic staff (n=24) user needs were identified and then categorized into the following themes: evidence-based safe exercises; expert guidance; individualized resources; in-person assessment of patient condition; motivational tools; patient understanding of fall risk; personal support networks; systematic communication and workload burden. The study concluded that personalized, actionable, and evidence-based clinical decision support may be able to address some of the many gaps that exist in fall prevention management in older adults.
Citation: Rice H, Garabedian PM, Shear K . Clinical decision support for fall prevention: defining end-user needs. Appl Clin Inform 2022 May;13(3):647-55. doi: 10.1055/s-0042-1750360..
Keywords: Elderly, Falls, Prevention, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Kurasz AM, Smith GE, Curiel RE
Patient values in healthcare decision making among diverse older adults.
This study investigated the types of values that culturally diverse older adults incorporate in medical decision making. Focus groups were held with 49 individuals, 49% with mild cognitive impairment, and 51% Hispanic. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation. A wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own were expressed. Participants also emphasized that values are individual-specific, influenced by aging, and change throughout life.
Citation: Kurasz AM, Smith GE, Curiel RE . Patient values in healthcare decision making among diverse older adults. Patient Educ Couns 2022 May;105(5):1115-22. doi: 10.1016/j.pec.2021.08.031..
Keywords: Elderly, Decision Making, Racial / Ethnic Minorities
Rosenberg SM, Gierisch JM, Revette AC
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
This study investigated the impact of a ductal carcinoma in situ (DCIS) diagnosis by engaging self-identified patients regarding their experience. Findings showed that, in a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty.
Citation: Rosenberg SM, Gierisch JM, Revette AC . "Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ. Cancer 2022 Apr 15;128(8):1676-83. doi: 10.1002/cncr.34126..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Healthcare, Clinician-Patient Communication, Patient and Family Engagement, Communication
Viglianti EM, Ervin JN, Newton CA
Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.
Investigators sought to understand intensivist perceptions of the appropriateness of time-limited trials (TLTs), a strategy to align life-sustaining care with patient goals and values in the midst of clinical uncertainty. They conducted semi-structured interviews with intensivists, revealing that having clarity about patient goals and clinical endpoints facilitated successful TLTs while lack of an evidenced-based framework was a barrier. More than half of the physicians who responded had conducted or participated in a TLT.
Citation: Viglianti EM, Ervin JN, Newton CA . Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres. BMJ Open 2022 Apr 4;12(4):e059325. doi: 10.1136/bmjopen-2021-059325..
Keywords: Intensive Care Unit (ICU), Critical Care, Decision Making
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
Citation: Jacobsohn GC, Leaf M, Liao F . Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments. Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)