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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedBuchanan CL, Morris MA, Matlock D
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
The objective of this study was to understand what families perceive as necessary information to guide decisionmaking in the treatment of children with ureteropelvic junction obstruction (UPJO). The authors conducted semi-structured interviews with parents of children with UPJO. Their findings were organized into three major themes: barriers to meaningful participation in decisionmaking, logistical aspects, and psychosocial aspects. They concluded that these results highlighted the importance of caregivers needing clear and accurate information to engage in meaningful discussions related to surgical decisionmaking regarding UPJO treatment. They recommended patient education and enhanced psychosocial support for more meaningful parental engagement in the surgical decisionmaking process.
AHRQ-funded; HS024597.
Citation: Buchanan CL, Morris MA, Matlock D .
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
PEC Innov 2023 Dec; 2:100142. doi: 10.1016/j.pecinn.2023.100142..
Keywords: Newborns/Infants, Patient Experience, Decision Making, Patient and Family Engagement, Clinician-Patient Communication
Salwei ME, Ancker JS, Weinger MB
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
The authors indicate that widespread use of shared decision making (SDM) in clinical care has been limited even though both the National Academy of Medicine and the American Society of Clinical Oncology recommend SDM methods to improve patient-centered care. The purpose of this commentary is to explore 3 workflow-related barriers to SDM, and to discuss human factors engineering and demonstrate its potential value to decision aid design through a decision-making case study.
AHRQ-funded; HS026395.
Citation: Salwei ME, Ancker JS, Weinger MB .
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
J Natl Cancer Inst 2023 Nov 8; 115(11):1271-77. doi: 10.1093/jnci/djad133..
Keywords: Decision Making, Cancer, Patient-Centered Healthcare
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Decision Making
Opel DJ, Vo HH, Dundas N
Validation of a process for shared decision-making in pediatrics.
The purpose of this study was to explore a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves assessing whether the decision includes greater than 1 medically reasonable choice; 2) if one choice has a favorable medical benefit-burden ratio compared to other choices; and 3) parents' preferences regarding the choices; and 4) calibrating the SDM approach based on other applicable characteristics of the decision. The researchers videotaped a sample of pediatric inpatient and outpatient engagements at a United States children's hospital. Clinicians within craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine service categories were eligible for participation. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. The researchers conducted individual post-encounter interviews with clinician and parent participants used video-stimulated recall to stimulate reflection of decision-making that took place during the engagement. The study included 30 videotaped encounters and 53 interviews and discovered that clinicians' and parents' experiences of decision-making confirmed each SDM step. There were differences in the interpretation of each step and, depending on specific decisional contexts, a need for flexibility in implementing the process.
AHRQ-funded; HS026994.
Citation: Opel DJ, Vo HH, Dundas N .
Validation of a process for shared decision-making in pediatrics.
Acad Pediatr 2023 Nov-Dec; 23(8):1588-97. doi: 10.1016/j.acap.2023.01.007..
Keywords: Decision Making, Children/Adolescents
Gore Moses R, Nieters A, Valentine rKD
Performance of the shared decision-making process scale for use in evaluation of hereditary cancer genetic testing decisions.
This study’s objective was to evaluate the feasibility, acceptability, reliability, and validity of the four-item Shared Decision Making (SDM) Process Scale for use in for hereditary cancer genetic testing decision-making. Participants were patients from a large hereditary cancer genetics practice who responded to an online survey following pre-test genetic counseling; the survey included the SDM Process Scale and the SURE scale. The SDM Process Scale showed feasibility, acceptability, and retest reliability, but not convergent validity with decisional conflict. The authors concluded that their findings provided evidence for use of this scale to measure patient perceptions of SDM in pre-test counseling.
AHRQ-funded; HS025718.
Citation: Gore Moses R, Nieters A, Valentine rKD .
Performance of the shared decision-making process scale for use in evaluation of hereditary cancer genetic testing decisions.
J Genet Couns 2023 Oct; 32(5):957-64. doi: 10.1002/jgc4.1704..
Keywords: Decision Making, Cancer, Genetics
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Valentine KD, Vo H, Mancini B
Shared decision making for elective surgical procedures in older adults with and without cognitive insufficiencies.
The purpose of this study was to examine surgical decision-making processes of older adults with and without cognitive insufficiencies and to evaluate the psychometric properties of the shared decision making (SDM) Process scale. Participants were eligible patients aged 65 or older who were scheduled for a preoperative appointment before elective surgery; a baseline phone survey was administered a week before the visit and a follow-up survey 3 months later to assess decision regret. Survey responses indicated that patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The authors concluded that the SDM Process scale was an acceptable, reliable, and valid measure of shared decision making.
AHRQ-funded; HS025718.
Citation: Valentine KD, Vo H, Mancini B .
Shared decision making for elective surgical procedures in older adults with and without cognitive insufficiencies.
Med Decis Making 2023 Aug; 43(6):656-66. doi: 10.1177/0272989x231182436..
Keywords: Decision Making, Elderly, Surgery
Foraker R, Phommasathit C, Clevenger K
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
The purpose of this study was to collect patients' and clinicians' perspectives on barriers and facilitators for implementing BREASTChoice, a web-based breast reconstruction decision aid, into the clinical workflow. From August 2020 to April 2021, the researchers conducted 12 qualitative interviews with patients and clinicians from two Midwestern medical specialty centers. The study found patients and clinicians agreed that BREASTChoice could provide benefits in a number of areas including: 1) BREASTChoice could assist patients make more informed decisions about their reconstruction and improve preparation for their first plastic surgery appointment; 2) BREASTChoice could improve communication and processes if the patient could view the tool at home and/or in the waiting room; 3) Clinicians recommended the information from BREASTChoice about patients' risks and preferences could be included in the patient's chart or the clinician electronic health record (EHR) inbox for access during the consultation; 5) Patients and clinicians indicated that the BREASTChoice tool does not require much time for the patient to use, efficiently fills gaps in knowledge, includes helpful information. Patients did report requiring time to properly read and digest the information.
AHRQ-funded; HS026699.
Citation: Foraker R, Phommasathit C, Clevenger K .
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
BMC Med Inform Decis Mak 2023 Jul 28; 23(1):140. doi: 10.1186/s12911-023-02236-x..
Keywords: Decision Making, Women, Cancer: Breast Cancer, Cancer
Reale C, Salwei ME, Militello LG
Decision-making during high-risk events: a .systematic literature review.
Researchers conducted a systematic literature review to identify empiric research papers that examined how trained professionals made naturalistic decisions under pressure. Using structured qualitative analysis methods, they extracted key themes: decision-making strategy, time pressure, stress, uncertainty, and errors. The studies explored different aspects of decision-making across multiple domains. Analytical strategies were also prominent. The researchers concluded that improved understanding of these decisional factors can inform evidence-based enhancements in training, technology, and process design.
AHRQ-funded; HS026158; HS026395; HS029042.
Citation: Reale C, Salwei ME, Militello LG .
Decision-making during high-risk events: a .systematic literature review.
Journal of Cognitive Engineering and Decision Making 2023 Jun; 17(2):188-212. doi: 10.1177/15553434221147415..
Keywords: Decision Making
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Decision Making, Hospitalization
Sloane JF, Donkin C, Newell BR
Managing interruptions to improve diagnostic decision-making: strategies and recommended research agenda.
This article presented a modified model of interruptions to visualize the interruption process and to illustrate where potential interventions could be implemented. The authors considered empirically tested strategies from health care and cognitive psychology to lay the groundwork for additional research to mitigate effects of interruptions during diagnostic decision-making. Strategies to minimize the negative impacts of interruptions as well as strategies to prevent interruptions were highlighted, and the authors built upon these strategies to propose research priorities within the field of diagnostic safety.
AHRQ-funded; 233201500022I.
Citation: Sloane JF, Donkin C, Newell BR .
Managing interruptions to improve diagnostic decision-making: strategies and recommended research agenda.
J Gen Intern Med 2023 May; 38(6):1526-31. doi: 10.1007/s11606-022-08019-w..
Keywords: Diagnostic Safety and Quality, Decision Making
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
AHRQ-funded; HS026081.
Citation: Rao Rao, Akrobetu DJ, Dickert NW .
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
Djulbegovic 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