30,517 research outputs found
Developing and user-testing Decision boxes to facilitate shared decision making in primary care - a study protocol
<p>Abstract</p> <p>Background</p> <p>Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users.</p> <p>Methods/Design</p> <p>We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable), and will include new themes suggested by the data (inductive analysis). Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings.</p> <p>Discussion</p> <p>This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It is the first step in the development and implementation of a new tool that should facilitate decision making in clinical practice.</p
Occupational therapists’ views of using a virtual reality interior design application within the pre-discharge home visit process
This article has been made available through the Brunel Open Access Publishing Fund.Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment, to enable patients to function independently after hospital-home discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualise changes prior to implementing them. Customised VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration if developed effectively and integrated into the PHV process. Objective: To explore the perceptions of occupational therapists with regards to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilising the think-aloud protocol and subsequent semi-structured interviews were carried out with seven Occupational Therapists who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centring around the parameters that impact upon the acceptance, adoption and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communications and patient involvement, and improved patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully, however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customisations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context
Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study
Background: Decision boxes (Dboxes) provide clinicians with research evidence about management options for
medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare
clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators
to using the Dbox information in clinical practice.
Methods: We used a mixed methods study with sequential explanatory design. We recruited family physicians,
residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions
by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive
impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their
patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following
the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators
to explore contextual factors influencing the use of the Dbox information.
Results: One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they
reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they
would use this information for their patients. Of those who would use the information for their patients, 89%
expected it would benefit their patients, especially in that it would allow the patient to make a decision more in
keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in
practice (mean 5.6 ± 1.2, scale 1–7, with 7 being “high”), and their intention was significantly related to social
norm, perceived behavioural control, and attitude according to the TPB (P < 0.0001). In focus groups, clinicians
mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate
the use of the Dbox information. Some participants would have liked a clear “bottom line” statement for each Dbox and
access to printed Dboxes in consultation rooms.
Conclusions: Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in
practic
Indigenous voices in climate change adaptation
AbstractThis project investigated how the deep knowledge of the Yorta Yorta people can be used to strengthen their participation and influence in the complex national and regional processes that determine how their traditional lands, which are in the highly-contested Murray-Darling Basin, are managed, leading to improved adaptation decisions both for the Yorta Yorta and the wider community.Through discussions with the Yorta Yorta over several years, the approach developed for the project was the creation of a Geographical Information System (GIS) mapping framework containing both Yorta Yorta knowledge and more conventional knowledge. GIS allows for mapping and layering of different types of data, allowing the Yorta Yorta to access and present their knowledge in ways that relate to Western decision-making processes. To do this, the project had four components:1. Development and testing of protocols and methodology for the collection and protection of Yorta Yorta knowledge. This was carried out through an intergenerational process, whereby Yorta Yorta youth were trained in cultural data collection techniques, and they interviewed Elders to capture the knowledge.2. Building of a GIS framework to integrate both the Yorta Yorta knowledge and more conventional data about the climate, hydrology and biodiversity of the Yorta Yorta area. For the first time this pulled together all of the conventional information normally used as a basis for natural resource management decisions. In addition, because the GIS database has been created and is owned by the Yorta Yorta means that they have something of value to bring to the discussions, so that they are able to participate in those discussions on equal terms.3. Exploration of the views of the broader community in the region regarding management of the region and adaptation alternatives through a stakeholder consultation process. The consultation identified the potential for greater use of science as a neutral arbiter in issues such as management of the Murray-Darling Basin, but even more important is the need for genuine, deep, open-minded dialogue with the community at all stages of decision-making, particularly at an early stage before proposals are put forward and views become entrenched.4. Identification of broader lessons for improving adaptation of First Nations communities in Australia from the experience of the Yorta Yorta and other communities around the country, through a national workshop. The key conclusion of the workshop was the urgent need to empower First Nation communities to make their own assessments and decisions on the best ways for them to respond to climate change.The project raised community awareness and knowledge and energised the Yorta Yorta youth to take an interest in their history and culture, and in the climate challenges facing their community. Overall the project has been a successful pilot demonstration of the utility of a GIS database to integrate Indigenous and conventional knowledge for better natural resource management outcomes and the project has increased the knowledge and capacity of the Yorta Yorta to engage in effective natural resource management and decision-making.Please cite this report as:Griggs, D, Lynch, A, Joachim, L, Zhu, X, Adler, C, Bischoff-Mattson, Z, Wang, P, Kestin, T 2013 Indigenous voices in climate change adaptation: Addressing the challenges of diverse knowledge systems in the Barmah-Millewa, National Climate Change Adaptation Research Facility, Gold Coast, pp.71AbstractThis project investigated how the deep knowledge of the Yorta Yorta people can be used to strengthen their participation and influence in the complex national and regional processes that determine how their traditional lands, which are in the highly-contested Murray-Darling Basin, are managed, leading to improved adaptation decisions both for the Yorta Yorta and the wider community.Through discussions with the Yorta Yorta over several years, the approach developed for the project was the creation of a Geographical Information System (GIS) mapping framework containing both Yorta Yorta knowledge and more conventional knowledge. GIS allows for mapping and layering of different types of data, allowing the Yorta Yorta to access and present their knowledge in ways that relate to Western decision-making processes. To do this, the project had four components:Development and testing of protocols and methodology for the collection and protection of Yorta Yorta knowledge. This was carried out through an intergenerational process, whereby Yorta Yorta youth were trained in cultural data collection techniques, and they interviewed Elders to capture the knowledge.Building of a GIS framework to integrate both the Yorta Yorta knowledge and more conventional data about the climate, hydrology and biodiversity of the Yorta Yorta area. For the first time this pulled together all of the conventional information normally used as a basis for natural resource management decisions. In addition, because the GIS database has been created and is owned by the Yorta Yorta means that they have something of value to bring to the discussions, so that they are able to participate in those discussions on equal terms.Exploration of the views of the broader community in the region regarding management of the region and adaptation alternatives through a stakeholder consultation process. The consultation identified the potential for greater use of science as a neutral arbiter in issues such as management of the Murray-Darling Basin, but even more important is the need for genuine, deep, open-minded dialogue with the community at all stages of decision-making, particularly at an early stage before proposals are put forward and views become entrenched.Identification of broader lessons for improving adaptation of First Nations communities in Australia from the experience of the Yorta Yorta and other communities around the country, through a national workshop. The key conclusion of the workshop was the urgent need to empower First Nation communities to make their own assessments and decisions on the best ways for them to respond to climate change.The project raised community awareness and knowledge and energised the Yorta Yorta youth to take an interest in their history and culture, and in the climate challenges facing their community. Overall the project has been a successful pilot demonstration of the utility of a GIS database to integrate Indigenous and conventional knowledge for better natural resource management outcomes and the project has increased the knowledge and capacity of the Yorta Yorta to engage in effective natural resource management and decision-making
The European Institute for Innovation through Health Data
The European Institute for Innovation through Health Data (i~HD, www.i-hd.eu) has been formed as one of the key sustainable entities arising from the Electronic Health Records for Clinical Research (IMI-JU-115189) and SemanticHealthNet (FP7-288408) projects, in collaboration with several other European projects and initiatives supported by the European Commission. i~HD is a European not-for-profit body, registered in Belgium through Royal Assent. i~HD has been established to tackle areas of challenge in the successful scaling up of innovations that critically rely on high-quality and interoperable health data. It will specifically address obstacles and opportunities to using health data by collating, developing, and promoting best practices in information governance and in semantic interoperability. It will help to sustain and propagate the results of health information and communication technology (ICT) research that enables better use of health data, assessing and optimizing their novel value wherever possible. i~HD has been formed after wide consultation and engagement of many stakeholders to develop methods, solutions, and services that can help to maximize the value obtained by all stakeholders from health data. It will support innovations in health maintenance, health care delivery, and knowledge discovery while ensuring compliance with all legal prerequisites, especially regarding the insurance of patient's privacy protection. It is bringing multiple stakeholder groups together so as to ensure that future solutions serve their collective needs and can be readily adopted affordably and at scale
Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D).
Funder: Wellcome TrustINTRODUCTION: Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS: The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION: Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER: researchregistry5041
Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children's and Young People's Mental Health: Mixed Methods Pilot Randomized Controlled Trial
BACKGROUND: Interventions to involve parents in decisions regarding children's and young people's mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. OBJECTIVE: This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children's and young people's mental health. METHODS: A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children's and young people's mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents' anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial. RESULTS: Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50% (6/12) of the sites successfully recruited participants, and only 38% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention. CONCLUSIONS: Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/14571
The development of a web- and a print-based decision aid for prostate cancer screening
Background Whether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences about PCa screening. Further, only one DA has utilized an interactive web-based format, which allows for an expansion and customization of the material. We describe the development of two DAs, a booklet and an interactive website, each with a values clarification component and designed for use in diverse settings.
Methods We conducted two feasibility studies to assess men\u27s (45-70 years) Internet access and their willingness to use a web- vs. a print-based tool. The booklet was adapted from two previous versions evaluated in randomized controlled trials (RCTs) and the website was created to closely match the content of the revised booklet. Usability testing was conducted to obtain feedback regarding draft versions of the materials. The tools were also reviewed by a plain language expert and the interdisciplinary research team. Feedback on the content and presentation led to iterative modifications of the tools.
Results The feasibility studies confirmed that the Internet was a viable medium, as the majority of men used a computer, had access to the Internet, and Internet use increased over time. Feedback from the usability testing on the length, presentation, and content of the materials was incorporated into the final versions of the booklet and website. Both the feasibility studies and the usability testing highlighted the need to address men\u27s informed decision making regarding screening.
Conclusions Informed decision making for PCa screening is crucial at present and may be important for some time, particularly if a definitive recommendation either for or against screening does not emerge from ongoing prostate cancer screening trials. We have detailed our efforts at developing print- and web-based DAs to assist men in determining how to best meet their PCa screening preferences. Following completion of our ongoing RCT designed to test these materials, our goal will be to develop a dissemination project for the more effective tool
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