The Use of a Decision Board to Elicit Brazilian Patients' and Physicians' Preferences for Treatment: the Case of Lupus Nephritis

Objectives: To find preferences for treatment expressed by lupus patients and physicians (who were asked to assume they have lupus) and to explore if certain variables explain these preferences. Methods: One hundred seventy-two patients and 202 physicians were interviewed using a lupus nephritis decision board that describes the treatment options and their potential benefits and risks. Clinical and sociodemographic variables were collected. Participants were asked to indicate their preferred treatment and provide justification for their choice. Descriptive statistics, t tests, and Pearson's chi-square tests were used to determine the significance of differences in the decisions made by the two groups. A logistic regression model determined which factors contributed to treatment decisions. Results: the average age of study participants was 34 +/- 8 years for patients and 31 +/- 7 years for physicians. Sixty-eight percent of patients and 96% of physicians (P < 0.001) selected the oral option. Patients and physicians justified their choice of treatment using different arguments (P < 0.001 in each case). Logistic regression showed that risk potential (P < 0.001) and a history of joint involvement (P = 0.011) were the arguments used most often to explain a patient's decision and the risk of side effects was most relevant among physicians (P < 0.001). Conclusions: Using a decision board, patients and physicians were found to have different preferences for treatment when faced with the same treatment options. Further, the variables that influence their preferences are different.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ Fed Sao Carlos, Dept Med, BR-13565905 Sao Carlos, SP, BrazilMcMaster Univ, Hamilton, ON, CanadaUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Evaluation of the sociodemographic, clinical-laboratorial and therapeutic profile of rheumatoid arthritis patients who participated of research projects in the Escola Paulista de Medicina in the last 25 years

OBJECTIVE: To analyse the clinical, laboratory, treatment and social progress of patients with rheumatoid arthritis (RA) who attend at Escola Paulista de Medicina (EPM-UNIFESP), Brazil, submitted to researching theses from 1979 to September, 2004. PATIENTS AND METHODS: 65 researches theses were reviewed and 26 were selected according inclusion/exclusion criterias. Inclusion: researches which analysed outpatients with RA belonging to EPM ambulatory. Exclusion: researches which included outpatients from other institutions or diseases. Classifications of the studies: a) period of conclusion: I (1979-1984); II (1985-1989); III (1990-1994); IV (1995-1999); V (2000-2004); b) type of the study: laboratory; rehabilitation; radiology; epidemiology; quality of life; health economics. RESULTS: Twenty six thesis out of 65 were suitable for analysis there was a predominance of basic research (7 thesis) on the first three periods, followed by reabilitation research (6 thesis) and measurement of quality of life (5 thesis). Concerning demographic data, patients were in average, 52 years old with prevalence of white females. High levels of schooling were noted for the last periods analysed. Patients functinal class were evaluated in 11 studies, with a predominance of functinal class II. Therapeutic strategies for the treatment of RA have changed significantly, showing DMARDs in the therapeutic options. CONCLUSIONS: The demographic, clinical, laboratory, and therapeutic characteristics changed along time and type of this study developed. Initially there was a preference for NSAIDs, and nowadays for DMARDs.OBJETIVO: descrever o perfil sociodemográfico, clínico-laboratorial e terapêutico dos pacientes com artrite reumatóide (AR) do ambulatório de reumatologia da Escola Paulista de Medicina (EPM-UNIFESP) que participaram de teses de pós-graduação no período de 25 anos, compreendido entre 1979 e 2004. PACIENTES E MÉTODOS: teses que avaliaram pacientes com AR da EPM. Exclusão: teses que incluíram pacientes de outras instituições ou com outras doencas. Classificação dos estudos: conforme o período de conclusão - I (1979-1984); II (1985-1989); III (1990-1994); IV (1995-1999); V (2000-2004) - e tipo de estudo (pesquisa básica; reabilitação; radiologia; qualidade de vida; epidemiologia e economia de saúde). RESULTADOS: Foram selecionadas 26 de 65 teses. Houve um predomínio de pesquisa básica (7 teses) nos três primeiros períodos, seguidos por reabilitação (6 teses) e de qualidade de vida (5 teses). Demografia: média de idade de 52 anos, predomínio do sexo feminino e raça branca. A escolaridade, avaliada em 5 estudos (qualidade de vida e economia de saúde), apresentou nível médio e superior de ensino nos últimos períodos. A classificação funcional (CF) foi pesquisada em 11 estudos, com maior prevalência da CF II. Tratamento: predomínio do uso de antiinflamatórios não-esteroidais (AINEs) e corticóides nos períodos I a III e, nos períodos III e V, de drogas modificadoras de atividade de doença (DMARDs), especialmente de metotrexato (MTX). CONCLUSÕES: observou-se alteração no nível de escolaridade e predomínio dos estudos de pesquisa básica, reabilitação e qualidade de vida. Houve preferência inicial pelos AINEs e, atualmente, pelos DMARDs.UNIFESP-EPMSociedade Brasileira de ReumatologiaUNIFESP, EPMSciEL

Decision aid for prostate cancer screening in Brazil

OBJECTIVE To present the development and validation processes of a decision aid for prostate cancer screening in Brazil. METHODS Study with qualitative-participatory design for the elaboration of a decision aid for prostate cancer screening, with the participation of a group of men and physicians inserted in primary health care in 11 Brazilian states. Evidence synthesis, field testing, and use in clinical scenarios were performed to adapt the content, format, language, and applicability towards the needs of the target audience in the years 2018 and 2019. The versions were subsequently evaluated by the participants and modified based on the data obtained. RESULTS We elaborated an unprecedented tool in Brazil, with information about the tests used in the screening, comparison of their possible benefits and harms and a numerical infographic with the consequences of this practice. We verified the decision aid usability to assist in the communication between the doctor and the man in the context of primary health care, besides identifying the need for greater discussion about sharing decisions in clinical scenarios. CONCLUSION The tool was easy to use, objective, and has little interference in consultation time. It is a technical-scientific material, produced by research, with the participation of its main target audience and which is available free of charge for use in Brazilian clinical scenarios.OBJETIVO Apresentar o processo de desenvolvimento e validação de uma ferramenta de apoio à decisão para o rastreamento do câncer de próstata no Brasil. MÉTODOS Estudo com desenho qualitativo-participativo para elaboração de uma ferramenta de apoio à decisão para o rastreamento do câncer de próstata, com a participação de um grupo de homens e médicos inseridos na atenção primária à saúde de 11 estados brasileiros. Realizou-se síntese de evidências, teste de campo e utilização nos cenários clínicos, de modo a adaptar o conteúdo, formato, linguagem e a aplicabilidade às necessidades do público-alvo nos anos de 2018 e 2019. As versões foram avaliadas de forma subsequente pelos participantes, sendo modificada a partir dos dados obtidos. RESULTADOS Foi elaborada uma ferramenta inédita no Brasil, com informações sobre os exames utilizados no rastreamento, comparação dos seus possíveis benefícios e malefícios e um infográfico numérico com as consequências dessa prática. Verificou-se utilidade da ferramenta para auxiliar na comunicação entre o médico e o homem no contexto da atenção primária à saúde, além de identificar a necessidade de maior discussão sobre o compartilhamento das decisões nos cenários clínicos. CONCLUSÃO A ferramenta foi avaliada como de fácil utilização, objetiva e com pouca interferência no tempo de consulta. É um material técnico-científico, produzido por meio de pesquisa, com a participação do seu principal público-alvo e que se encontra disponível gratuitamente para utilização nos cenários clínicos do Brasil

Global epidemiology of hip fractures: a study protocol using a common analytical platform among multiple countries

INTRODUCTION: Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. METHODS AND ANALYSIS: This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. ETHICS AND DISSEMINATION: Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences

Decision board and willingness to pay to mesure lupus nephritis treatment preference

BV UNIFESP: Teses e dissertaçõe

Revisões sistemáticas e metanálises na reumatologia

O conhecimento científico tem crescido exponencialmente, fazendo com que médicos e tomadores de decisão estejam inundados de informações, necessitando integrá-las de modo consistente. A fim de otimizar as tomadas de decisão, os estudos de revisão, caracterizados como revisão sistemática e metanálise, estabelecem tais consistências e avaliam se seus resultados podem ser extrapolados para a população em geral ou a um paciente em particular. Este artigo propõe a revisão de conceitos gerais envolvendo tais estudos, enfatizando suas propriedades metodológicas para usá-las na prática clínica

Apoios de decisão: instrumento de auxílio à medicina baseada em preferências. Uma revisão conceitual Decision aids: an instrument to eliciting patient preference. Current concepts

A necessidade da incorporação das preferências dos pacientes nas tomadas de decisão é uma realidade da assistência médica contemporânea, que caracteriza a medicina baseada em preferências. Os apoios de decisão são instrumentos que surgem como mecanismos de auxílio ao médico a expor riscos e benefícios de uma determinada tomada de decisão, sendo um mecanismo facilitador para a decisão compartilhada. Na literatura médica, particularmente em reumatologia, nota-se um emergente interesse pelo estudo das preferências dos pacientes nos ensaios clínicos. Este artigo de revisão tem por objetivo conceituar e caracterizar os apoios de decisão e suas implicações na pesquisa e prática clínicas, bem como ressaltar os princípios metodológicos necessários para a sua utilização e desenvolvimento.<br>Patient preferences in decision making is one reality of the medical assistance, which characterizes the value based medicine. The decision aids are instruments that appear as support mechanisms for the doctor to exercise this model of decision making. In medical literature, particularly in rheumatology, an emergent interest on patient's preference study is noticed in clinical trials. The aim of this article is to appraise and to characterize the decision aids and its implications in the practical research and clinics, as well as standing out the necessary methodology principles for its use and development