Qualitätsentwicklung in Studium und Lehre durch Design-Based Research

Design-Based Research (DBR) is a methodology to improve the quality of learning and teaching in education. After identifying and analysing a problem, a prototyp solution is developed, tested and refined in practice in iterative cycles. Design principles are produced to enhance solution implementation. We present four DBR projects from different disciplines and discuss the generalizability of the results and their relevance for the quality development in higher education. We identified a potential for generalizability in all projects, further evaluation steps are missing. A lack of resources or structural changes within the presented projects may lead to an early termination without a final design refinement and an implementation of design principles.Design-Based Research (DBR) ist eine Methodologie zur Verbesserung der Qualität von Lernen und Lehren. Das zyklisch-iterative Vorgehen zielt auf die Lösung eines konkreten Bildungsproblems und die Ableitung generalisierbarer Erkenntnisse in Form von Design-Prinzipien. Vier DBR-Projekte aus unterschiedlichen Fachdisziplinen werden vorgestellt und die Frage der Generalisierbarkeit der Projekterkenntnisse und deren Relevanz für die Qualitätsentwicklung von Studium und Lehre diskutiert. In allen Projekten zeigt sich ein Generalisierungspotenzial, es fehlen weitere Evaluationsschritte. Mangelnde Ressourcen oder strukturelle Veränderungen führten zur Beendigung einiger DBR-Projekte vor abschließender Designanpassung und Erprobung

Informed Decision-Making with and for People with Dementia—Efficacy of the PRODECIDE Education Program for Legal Representatives: A Randomized Controlled Trial (PRODECIDE-RCT) and Process Evaluation

Legal representatives take a major role in healthcare decisions with and for people with dementia, but only a minority has a qualification in this field. The aim was to evaluate the efficacy of the PRODECIDE education program for legal representatives. In a prospective randomized controlled trial, legal representatives (volunteers and professionals, representing at least one person with dementia) were allocated (1:1 computer-generated block randomization) to the intervention (PRODECIDE education program) and control (standard care) groups. The primary outcome measure was knowledge, operationalized as the understanding of decision-making processes and in setting realistic expectations. Only data entry and analyses were blinded. A process evaluation in a mixed methods design was performed. We enrolled 218 legal representatives, and 216 were included in the primary analysis (intervention n = 109, control n = 107). The percentage of correct answers in the knowledge test post intervention was 69.0% in the intervention and 43.4% in the control group (difference 25.6%; CI 95%, 21.3 to 29.8; p p < 0.001) more correct answers. The PRODECIDE education program can improve the knowledge of legal representatives, an important prerequisite for evidence-based, informed decision-making

Exploring the information needs of patients with osteoarthritis of the knee: a content analysis of Facebook group posts

Abstract Background End-stage osteoarthritis of the knee (OAK) is often treated by total knee arthroplasty (TKA). This intervention can significantly improve quality of life. However, many patients are dissatisfied with the outcome of surgery. One of the factors related to dissatisfaction is the of lack integration of patients’ preferences, habits and values that are not addressed by physicians. To develop realistic expectations, affected patients need evidence-based information. Our aim was to explore the information needs of patients with OAK to support the development of decision aids and consent forms to promote informed decision-making. Additionally, we investigated whether the information needs during the Covid-19 pandemic differ from those before the pandemic. Methods The qualitative research design included a social media analysis of Facebook groups. Facebook groups were selected according to the following criteria: Thematic relevance, English or German language, at least one new post per week, from period before and after the start of the Covid-19 pandemic in March 2020. Thematically relevant group posts were analysed according to the content-structuring content analysis of Kuckartz using MaxQDA. Results Out of 448 identified Facebook groups, we screened seven for relevant posts and a total of 77 posts out of 6 groups were selected. The following eight categories were derived during the coding process: access to health care, disease information, TKA indication and contraindication, TKA outcome and quality of life, information needs regarding conservative therapy, strain, attitude towards TKA and attitude towards conservative therapy. The analysis showed that patients with OAK need information about the benefits and risks of TKA and conservative therapies. Conclusion This study provides information on the information needs of patients with OAK in order to decide between TKA or conservative therapy. Patients need information about treatment options in due consideration of their immediate living situation to be reliably able to assess potential outcomes. Such Information about TKA should enable patients to assess the individual prognosis with comprehensible and relevant outcome measures. Also, they should be formulated with the living environment of the patients in mind and be linked to possible fears and negative previous experiences with treatments

Quality of COVID-19 vaccine informed consent forms - study protocol

Seit kurzem besteht die Möglichkeit einer Corona-Virus-Impfung. In Deutschland gibt es keine Impfpflicht. Den Bürger*innen wird das Recht auf eine informierte Entscheidung zugesprochen. Ärzt*innen sind verpflichtet vor der Durchführung von invasiven Maßnahmen, die informierte Zustimmung der Patient*innen einzuholen. Diese besteht in der Regel aus einem mündlichen Aufklärungsgespräch und wird auf einem schriftlichen Aufklärungsbogen dokumentiert. Bisherige Forschungsergebnisse deuten darauf hin, dass relevante Informationen in Aufklärungsbögen fehlen, die eine informierte Entscheidung ermöglichen. Das Studienprotokoll beschreibt das methodische Vorgehen für die systematische Suche nach Aufklärungsbögen über die Corona-Virus-Impfung und deren kritische Bewertung. Die Ergebnisse können Implikationen für die Optimierung der Aufklärungsbögen liefern, um Bürger*innen eine informierte Entscheidung für oder gegen die Corona-Virus-Impfung zu ermöglichen

Informed consent for total knee arthroplasty : exploration of patient`s information acquisition and decision-making processes : a qualitative study

Background: Total knee arthroplasty (TKA) is an option for the treatment of knee osteoarthritis (OA). Patients have high expectations regarding the benefits of the actual operation. Patients can seek a second opinion on the indication for TKA. In a study, less than half of recommended TKAs were confirmed by the second opinion and conservative treatments are not fully utilized. Informed consent forms that are used in Germany usually do not meet the requirements to support informed decision-making. Our aim was to describe the process from the diagnosis of knee OA through the decision-making process to the informed consent process for TKA, and to understand when, how, and by whom decisions are made. Moreover, we wanted to describe patients' information needs and preferences about knee OA and its treatment, including TKA, and find out what information is provided. We also wanted to find out what information was important for decision-making and identify barriers and facilitators for the optimal use of evidence-based informed consent forms in practice. Methods: We chose a qualitative approach and conducted semi-structured interviews with patients who were going to receive, have received, or have declined TKA, and with general practitioners (GP), office-based as well as orthopaedists and anaesthesiologists in clinics who obtain informed consent. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. Results: We conducted interviews with 13 patients, three GPs, four office-based orthopaedists and seven doctors in clinics who had obtained informed consent. Information needs were modelled on subjective disease theory and information conveyed by the doctors. Patients in this sample predominantly made their decisions without having received sufficient information. Trust in doctors and experiences seemed to be more relevant in this sample than fact-based information. Office-based (GPs, orthopaedists) and orthopaedists in clinics had different understandings of their roles and expectations in terms of providing information. Conclusions: We were able to identify structural barriers and assumptions that hinder the implementation of evidence-based informed consent forms

Informed consent for total knee arthroplasty: exploration of patient`s information acquisition and decision-making processes—a qualitative study

Abstract Background Total knee arthroplasty (TKA) is an option for the treatment of knee osteoarthritis (OA). Patients have high expectations regarding the benefits of the actual operation. Patients can seek a second opinion on the indication for TKA. In a study, less than half of recommended TKAs were confirmed by the second opinion and conservative treatments are not fully utilized. Informed consent forms that are used in Germany usually do not meet the requirements to support informed decision-making. Our aim was to describe the process from the diagnosis of knee OA through the decision-making process to the informed consent process for TKA, and to understand when, how, and by whom decisions are made. Moreover, we wanted to describe patients' information needs and preferences about knee OA and its treatment, including TKA, and find out what information is provided. We also wanted to find out what information was important for decision-making and identify barriers and facilitators for the optimal use of evidence-based informed consent forms in practice. Methods We chose a qualitative approach and conducted semi-structured interviews with patients who were going to receive, have received, or have declined TKA, and with general practitioners (GP), office-based as well as orthopaedists and anaesthesiologists in clinics who obtain informed consent. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. Results We conducted interviews with 13 patients, three GPs, four office-based orthopaedists and seven doctors in clinics who had obtained informed consent. Information needs were modelled on subjective disease theory and information conveyed by the doctors. Patients in this sample predominantly made their decisions without having received sufficient information. Trust in doctors and experiences seemed to be more relevant in this sample than fact-based information. Office-based (GPs, orthopaedists) and orthopaedists in clinics had different understandings of their roles and expectations in terms of providing information. Conclusions We were able to identify structural barriers and assumptions that hinder the implementation of evidence-based informed consent forms

Informed decision-making with and for people with dementia – efficacy of the PRODECIDE education program for legal representatives: protocol of a randomized controlled trial (PRODECIDE-RCT)

Abstract Background In Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity. Although these representatives only rarely are qualified in healthcare, they nevertheless play decisive roles in the decision-making processes for people with dementia. Previously, we developed an education program (PRODECIDE) to address this shortcoming and tested it for feasibility. Typical, autonomy-restricting decisions in the care of people with dementia—namely, using percutaneous endoscopic gastrostomy (PEG) or physical restrains (PR), or the prescription of antipsychotic drugs (AP)—were the subject areas trained. The training course aims to enhance the competency of legal representatives in informed decision-making. In this study, we will evaluate the efficacy of the PRODECIDE education program. Methods A randomized controlled trial with a six-month follow-up will be conducted to compare the PRODECIDE education program with standard care, enrolling legal representatives (N = 216). The education program lasts 10 h and comprises four modules: A, decision-making processes and methods; and B, C and D, evidence-based knowledge about PEG, PR and AP, respectively. The primary outcome measure is knowledge, which is operationalized as the understanding of decision-making processes in healthcare affairs and in setting realistic expectations about benefits and harms of PEG, PR and AP in people with dementia. Secondary outcomes are sufficient and sustainable knowledge and percentage of persons concerned affected by PEG, FEM or AP. A qualitative process evaluation will be performed. Additionally, to support implementation, a concept for translating the educational contents into e-learning modules will be developed. Discussion The study results will show whether the efficacy of the education program could justify its implementation into the regular training curricula for legal representatives. Additionally, it will determine whether an e-learning course provides a valuable backup or even alternative learning strategy. Trial registration TRN: ISRCTN17960111 , Date: 01/06/2017

GenDivInfo

This project is developing a concept for the creation of medical guidelines and science-based decision aids for laypersons that take into account the various aspects of sex/gender and diversity in people. Medical guidelines are intended to support healthcare professionals in making decisions, e.g. about different treatment alternatives. At present, guideline development processes do not generally result in science-based decision aids that are understandable to laypeople and support the patients in making the relevant decisions about their health. Furthermore, sex/gender- and diversity-specific aspects are not sufficiently taken into account in existing guidelines. In the "GenDivInfo" project, the methods for developing medical guidelines with the highest methodological standard (S3) are to be further developed in order to provide sex/gender diversity-appropriate guidelines and corresponding decision aids for laypersons. The methods can be transferred to other guideline processes in the future

Evaluating student’s ability to assess treatment claims : validating a German version of the Claim Evaluation Tools

Background: The Claim Evaluation Tools measure the ability to assess claims about treatment effects. The aim of this study was to adapt the German item sets to the target group of secondary school students (aged 11 to 16 years, grade 6 to 10) and to validate them accordingly. The scale’s reliability and validity using Rasch’s probabilistic test theory should be determined. Methods: We conducted a sequential mixed-method study comprising three stages: contextualisation and adaption of the items (stage 1), piloting of the item sets using qualitative interviews (stage 2) and a construct validation by testing the unidimensional Rasch scalability for each item set after data collection in one secondary school in Germany and two secondary schools in Austria. We explored summary and individual fit statistics and performed a distractor analysis (stage 3). Results: Secondary school students (n = 6) and their teachers (n = 5) participated in qualitative interviews in Germany. The qualitative interviews identified the need for minor modifications (e.g. reducing thematic repetitions, changing the order of the items). The data of 598 German and Austrian secondary school students were included to test for Rasch scalability. Rasch analyses showed acceptable overall model fit. Distractor analyses suggested that model fit could be improved by simplifying the text in the scenarios, removing and editing response options of some items. Conclusion: After the revision of some items, the questionnaires are suitable to evaluate secondary school students’ ability to assess health claims. A future goal is to increase the pool of items being translated and tested