National Healthcare Quality and Disparities Report
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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
76 to 100 of 583 Research Studies DisplayedBaughman KR, Ludwick R, Jarjoura D
Multi-site study of provider self-efficacy and beliefs in explaining judgments about need and responsibility for advance care planning.
This study’s objective was to examine the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgements about resident need and provider responsibility for initiating ACP conversations. This observational multi-site study anonymously surveyed 348 registered nurses, LPNs, and social workers within 29 SNFs. Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring that ACP occurred. Providers with higher self-efficacy for ACP were more likely to feel responsible for ensuring ACP conversations.
AHRQ-funded; HS022162.
Citation: Baughman KR, Ludwick R, Jarjoura D .
Multi-site study of provider self-efficacy and beliefs in explaining judgments about need and responsibility for advance care planning.
Am J Hosp Palliat Care 2021 Nov;38(11):1276-81. doi: 10.1177/1049909120979977..
Keywords: Care Management, Decision Making
Reese TJ, Del Fiol G, Morgan K
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. This study aimed to design and examine the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
AHRQ-funded; HS026198.
Citation: Reese TJ, Del Fiol G, Morgan K .
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
JMIR Hum Factors 2021 Oct 26;8(4):e28618. doi: 10.2196/28618..
Keywords: Blood Thinners, Medication: Safety, Medication, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Thomson MC, Allen LA, Halpern SD
Framing benefits in decision aids: effects of varying contextualizing statements on decisions about sacubitril-valsartan for heart failure.
The purpose of this study was to further understand benefit framing by testing the impact of a variety of contextualizing statements within a decision aid for the heart failure medication sacubitril-valsartan. Study participants received one of six versions of a decision aid for sacubitril-valsartan. The only factor that differed between the versions was a contextualizing statement. The participants were surveyed regarding their likelihood of taking sacubitril-valsartan at a cost of $50 per month and their perception of the benefit of the drug. The study found that 54% of the 1,873 participants were willing to take the medication at the cost of $50 per month. The researchers compared each of the 5 contextualizing statements with the baseline version; there were no significant differences in the participants’ reported likelihood of taking the medication. Higher income level, higher self-reported health status, and younger age were related with greater likelihood of taking sacubitril-valsartan. The researchers concluded that decision making was not affected by contextualizing statements tested within the decision aid.
AHRQ-funded; HS026081.
Citation: Thomson MC, Allen LA, Halpern SD .
Framing benefits in decision aids: effects of varying contextualizing statements on decisions about sacubitril-valsartan for heart failure.
MDM Policy Pract 2021 Jul-Dec;6(2):23814683211041623. doi: 10.1177/23814683211041623..
Keywords: Decision Making, Heart Disease and Health, Cardiovascular Conditions
Samal L, Fu HN, Camara DS
AHRQ Author: Camara DS, Wang J, Bierman AS
Health information technology to improve care for people with multiple chronic conditions.
The objective of this study was to review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. The investigators concluded that the body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
AHRQ-authored; AHRQ-funded; HS026849; 290201600001B.
Citation: Samal L, Fu HN, Camara DS .
Health information technology to improve care for people with multiple chronic conditions.
Health Serv Res 2021 Oct;56(Suppl 1):1006-36. doi: 10.1111/1475-6773.13860..
Keywords: Chronic Conditions, Health Information Technology (HIT), Evidence-Based Practice, Decision Making, Healthcare Delivery
Dutta S, McEvoy DS, Stump T
Clinical decision support reduces unnecessary tetanus vaccinations in the emergency department.
The authors implemented a clinical decision support alert in the electronic health record that warned providers when ordering a tetanus vaccine if a prior one had been given within 10 years and studied its efficacy to reduce potentially unnecessary vaccines in the ED. They found that a clinical decision support alert that warns ED clinicians that a patient may have an up-to-date tetanus vaccination status reduced potentially unnecessary vaccinations.
AHRQ-funded; HS027170.
Citation: Dutta S, McEvoy DS, Stump T .
Clinical decision support reduces unnecessary tetanus vaccinations in the emergency department.
Ann Emerg Med 2021 Sep;78(3):370-80. doi: 10.1016/j.annemergmed.2021.02.021..
Keywords: Clinical Decision Support (CDS), Decision Making, Vaccination, Health Information Technology (HIT)
De Roo AC, Vitous CA, Rivard SJ
High-risk surgery among older adults: not-quite shared decision-making.
This study explored surgeons’ approaches to decision-making for surgery among adults ≥65 years at high-risk of postoperative complications or death. The authors conducted semistructured in-depth interviews with 46 practicing surgeons across Michigan. They found that although shared decision-making is strongly recommended, surgeons who perform high-risk operations among older adults predominantly focused on assessing risk and setting expectations with patients and families rather than inviting them to actively participate in the decision-making process. Surgeons were also influenced by quality metrics, referrals, and personal experiences.
AHRQ-funded; HS026772; HS000053.
Citation: De Roo AC, Vitous CA, Rivard SJ .
High-risk surgery among older adults: not-quite shared decision-making.
Surgery 2021 Sep;170(3):756-63. doi: 10.1016/j.surg.2021.02.005..
Keywords: Elderly, Surgery, Decision Making, Patient and Family Engagement
Sella T, Poorvu PD, Ruddy KJ
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
The diagnosis and treatment of breast cancer can have profound effects on a young woman's family planning and fertility, particularly among women with hormone receptor-positive breast cancer. In this paper the authors discuss the Young Women's Breast Cancer Study, a multicenter cohort of women aged 40 years or younger and newly diagnosed with breast cancer from 2006 to 2016. The investigators concluded that concern about fertility was a contributor to adjuvant ET decisions among a substantial proportion of young breast cancer survivors.
AHRQ-funded; HS023680.
Citation: Sella T, Poorvu PD, Ruddy KJ .
Impact of fertility concerns on endocrine therapy decisions in young breast cancer survivors.
Cancer 2021 Aug 15;127(16):2888-94. doi: 10.1002/cncr.33596..
Keywords: Cancer: Breast Cancer, Cancer, Women, Pregnancy, Decision Making
Dorr DA, D'Autremont C, Pizzimenti C
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
This study examined guideline-based high blood pressure (HBP) and hypertension recommendations and evaluated the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources-based, patient-facing clinical decision support HBP application. Findings showed that data quality from the electronic health record required to implement recommendations for HBP was highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.
AHRQ-funded; HS026849.
Citation: Dorr DA, D'Autremont C, Pizzimenti C .
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
Appl Clin Inform 2021 Aug;12(4):710-20. doi: 10.1055/s-0041-1732401..
Keywords: Blood Pressure, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Information Technology (HIT)
Marin JR, Rodean J, Mannix RC
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
The objective of this study was to examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) were associated with lower head computed tomography (CT) use. The investigators concluded that clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Mannix RC .
Association of clinical guidelines and decision support with CT use in pediatric mild traumatic brain injury.
J Pediatr 2021 Aug;235:178-83.e1. doi: 10.1016/j.jpeds.2021.04.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Brain Injury, Guidelines, Evidence-Based Practice, Imaging
Djulbegovic B, Hozo I, Li SA
Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations.
This study’s goal was to identify the key determinants of clinical guideline development. This study used a web-based survey of 12 panels of 153 “voting” members who issued 2941 recommendations and a qualitative analysis of 13 panels of 311 attendees. When intervention’s benefits outweigh harms compared with no recommendations: the probability of issuing strong recommendations in favor of intervention was 0.22 when certainty of evidence (CoE) was very low; 0.5 when low; 0.74 when moderate, and 0.85 when high. No other factor significantly affected recommendations. Panelists spent over 50% of their time debating CoE with the chairs and co-chairs dominating discussion.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Li SA .
Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations.
J Clin Epidemiol 2021 Aug;136:1-9. doi: 10.1016/j.jclinepi.2021.02.025..
Keywords: Evidence-Based Practice, Guidelines, Research Methodologies, Decision Making
Krein SL, Harrod M, Weston LE
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.
Researchers compared peripherally inserted central catheters (PICCs)-related processes across hospitals with different insertion delivery models. They concluded that vascular access nurses play critical roles in all aspects of PICC-related care. Further, there is variation in PICC decision-making, care and maintenance, and patient education across hospitals.
AHRQ-funded; HS025891.
Citation: Krein SL, Harrod M, Weston LE .
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.
BMJ Qual Saf 2021 Aug;30(8):628-38. doi: 10.1136/bmjqs-2020-011987..
Keywords: Inpatient Care, Decision Making, Patient Safety, Hospitals
Schulz GL, Patterson Kelly K, Armer J
Uncovering family treatment decision-making processes: the value and application of case study methods to family research.
Research on how and why family processes influence phenomena is essential to advancing many areas of science. Case study methods offer an approach that overcomes some of the sampling and analysis obstacles researchers face when studying families. This article aimed to illustrate the benefits of case study methods for studying complex family processes using an example from treatment decision-making in sickle cell disease.
Citation: Schulz GL, Patterson Kelly K, Armer J .
Uncovering family treatment decision-making processes: the value and application of case study methods to family research.
J Fam Nurs 2021 Aug;27(3):191-98. doi: 10.1177/1074840720987223..
Keywords: Decision Making, Research Methodologies
Shi Y, Amill-Rosario A, Rudin RS
Barriers to using clinical decision support in ambulatory care: do clinics in health systems fare better?
In this study, the investigators quantified the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examined whether CDS utilization and barriers differed based on clinics' affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic.
AHRQ-funded; HS024067.
Citation: Shi Y, Amill-Rosario A, Rudin RS .
Barriers to using clinical decision support in ambulatory care: do clinics in health systems fare better?
J Am Med Inform Assoc 2021 Jul 30;28(8):1667-75. doi: 10.1093/jamia/ocab064..
Keywords: Clinical Decision Support (CDS), Decision Making, Ambulatory Care and Surgery, Health Information Technology (HIT), Health Systems
Murad MH, Chang SM, Fiordalisi CV
AHRQ Author: Chang SM
Improving the utility of evidence synthesis for decision makers in the face of insufficient evidence.
The authors identified and suggested strategies to make insufficient evidence ratings in systematic reviews more actionable. A workgroup comprising members from AHRQ’s Evidence-Based Practice Program convened throughout 2020. They identified five strategies for supplementing systematic review findings when evidence on benefits or harms is expected to be, or found to be, insufficient: 1) reconsider eligible study designs, 2) summarize indirect evidence, 3) summarize contextual and implementation evidence, 4) consider modelling, and 5) incorporate unpublished health system data in the evidence synthesis. While these strategies may not increase the strength of evidence, they may improve the utility of reports for decision makers.
AHRQ-authored; AHRQ-funded; 290201700003C; 290201500013I; 290201500008I; 290201500007I; 290201500011I; 290201500010I; 290201500002I; 290201500005I; 290201500012I; 290201500006I.
Citation: Murad MH, Chang SM, Fiordalisi CV .
Improving the utility of evidence synthesis for decision makers in the face of insufficient evidence.
J Clin Epidemiol 2021 Jul;135:170-75. doi: 10.1016/j.jclinepi.2021.02.028..
Keywords: Evidence-Based Practice, Decision Making, Patient-Centered Outcomes Research
Murray DJ, Boulet JR, Boyle WA
Competence in decision making: setting performance standards for critical care.
Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. In this study, the investigators hypothesized that simulation could be used effectively to assess decision-making competence.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boulet JR, Boyle WA .
Competence in decision making: setting performance standards for critical care.
Anesth Analg 2021 Jul 1;133(1):142-50. doi: 10.1213/ane.0000000000005053..
Keywords: Critical Care, Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Lumpkin ST, Harvey E, Mihas P
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Researchers investigated effective strategies to reduce unplanned post-discharge health care visits following colorectal surgery (CRS). They found that interview participants voiced clear mental algorithms about when to visit an emergency department, identified facilitators and barriers to optimal health care use, and identified tangible targets for health care utilization reduction efforts. The researchers concluded that efforts should be directed at improving post-discharge communication and care coordination in order to reduce CRS patients' high-resource health care utilization.
AHRQ-funded; HS026363.
Citation: Lumpkin ST, Harvey E, Mihas P .
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Qual Health Res 2021 Jul;31(9):1582-95. doi: 10.1177/10497323211002479..
Keywords: Decision Making, Digestive Disease and Health, Surgery
Campbell NL, Holden RJ, Tang Q
Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults.
This study tested the effectiveness of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults. Ten primary care clinics within Eskenazi Health in Indianapolis were selected to test the intervention. The intervention included provider- and patient-focused components. The provider-focused component was a computerized decision support system alerting the presence of a high-risk anticholinergic and offering dose- and indication-specific alternatives; while the patient-focused component was a story-based video providing education and modeling an interaction with a healthcare provider. The intervention occurred from April 2019 through March 2020. A total of 552 older adults had primary care visits during the study period. Only 3 out of 259 provider-focused alerts led to a medication change. Of the 276 staff alerts, 4.7% were confirmed to activate the patient-focused intervention.
AHRQ-funded; P30HS024384.
Citation: Campbell NL, Holden RJ, Tang Q .
Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults.
J Am Geriatr Soc 2021 Jun;69(6):1490-99. doi: 10.1111/jgs.17121..
Keywords: Elderly, Medication, Primary Care, Clinical Decision Support (CDS), Decision Making
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
AHRQ-funded; HS026116.
Citation: Manges KA, Wallace AS, Groves PS .
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Decision Making, Hospitals
Long S, Thomas GW, Karam MD
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
This study introduces and evaluates a novel Image-based Decision Error Analysis (IDEA) score that captures performance during fluoroscopically assisted wire navigation. Findings showed that the fluoroscopic images obtained in the course of placing a guide wire contained a rich amount of information related to surgical skill. The IDEA scoring provided a basis for evaluating the competence of a resident. The score can be used to assess skill at key timepoints throughout residency, such as when rotating onto/off of a new surgical service and before performing certain procedures in the operating room, or as a tool for debriefing/providing feedback after a procedure is completed.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Karam MD .
Surgical skill can be objectively measured from fluoroscopic images using a novel image-based Decision Error Analysis (IDEA) score.
Clin Orthop Relat Res 2021 Jun;479(6):1386-94. doi: 10.1097/corr.0000000000001623..
Keywords: Orthopedics, Surgery, Decision Making, Medical Errors, Adverse Events, Imaging
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords: Children/Adolescents, Surgery, Caregiving, Decision Making, Clinician-Patient Communication, Communication, Provider: Physician, Provider
Greenberg JK, Otun A, Nasraddin A
Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis.
This paper discusses the development of an evidence-based clinical decision support (CDS) for management of children with minor head trauma (MHT) and evaluates the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure. Semi-structured qualitative focus group interviews were conducted with 28 physicians and four information technology specialists between March and May 2020. Five primary themes were identified through inductive thematic analysis: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported CDS use to determine an appropriate level-of-care. However, some had mixed feelings regarding how the tool could best be used by neurosurgeons versus non-neurosurgeons. Feedback helped refine the tool content and highlighted potential technical and workflow barriers to address prior to implementation.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Nasraddin A .
Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis.
BMC Med Inform Decis Mak 2021 May 19;21(1):161. doi: 10.1186/s12911-021-01522-w.
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Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT), Evidence-Based Practice, Decision Making
Chu S, Bruin MJ, McKinney WT
Design of a patient-centered decision support tool when selecting an organ transplant center.
Patients in the US in need of a life-saving organ transplant must complete a long process of medical decisions, and a first step is to identify a transplant center to complete an evaluation. This study described a patient-centered process of testing and refinement of a new website (www.transplantcentersearch.org) that was developed to provide data to patients who are seeking a transplant center.
AHRQ-funded; HS026379; HS024527.
Citation: Chu S, Bruin MJ, McKinney WT .
Design of a patient-centered decision support tool when selecting an organ transplant center.
PLoS One 2021 May 17;16(5):e0251102. doi: 10.1371/journal.pone.0251102..
Keywords: Transplantation, Patient-Centered Healthcare, Decision Making, Health Information Technology (HIT)
Wallner LP, Banerjee M, Reyes-Gastelum D
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
The use of radioactive iodine (RAI) for low-risk thyroid cancer is common, and variation in its use exists, despite the lack of benefit for low-risk disease and potential harms and costs. The objective of this study was to simultaneously assess patient- and physician-level factors associated with patient-reported receipt of RAI for low-risk thyroid cancer. The investigators concluded that physician perspectives and attitudes about using RAI, as well as patient volume, influenced RAI use for low-risk thyroid cancer.
AHRQ-funded; HS024512.
Citation: Wallner LP, Banerjee M, Reyes-Gastelum D .
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
J Clin Endocrinol Metab 2021 May 13;106(6):e2402-e12. doi: 10.1210/clinem/dgab139..
Keywords: Cancer, Practice Patterns, Decision Making, Risk
Ridgway JP, Robicsek A, Shah N
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
The weighted incidence syndromic combination antibiogram (WISCA) is an antimicrobial stewardship tool that utilizes electronic medical record data to provide real-time clinical decision support regarding empiric antibiotic prescription in the hospital setting. The aim of this study was to determine the impact of WISCA utilization for empiric antibiotic prescription on hospital length of stay (LOS).
AHRQ-funded; HS022283.
Citation: Ridgway JP, Robicsek A, Shah N .
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
Clin Infect Dis 2021 May 4;72(9):e265-e71. doi: 10.1093/cid/ciaa1048..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Schaffhausen CR, Bruin MJ, Chu S
Designing a liver transplant patient and family decision support tool for organ offer decisions.
For liver transplant candidates on the waiting list, deciding to accept a donor organ with known or potential risk factors can be stressful and can lead to declined offers. Current education for patients and family often takes place during transplant evaluations and can be overwhelming and result in low retention and poor understanding of donor quality. In this study, the investigators sought to understand provider experiences when counseling patients about donor risks and donor offers.
AHRQ-funded; HS026379; HS024527.
Citation: Schaffhausen CR, Bruin MJ, Chu S .
Designing a liver transplant patient and family decision support tool for organ offer decisions.
Transplant Direct 2021 May;7(5):e695. doi: 10.1097/txd.0000000000001140..
Keywords: Transplantation, Decision Making, Education: Patient and Caregiver