Patient decision making in recovering from surgery

Patient work in surgery recovery is fraught with complex judgments and decisions. These decisions are not unlike ones that professionals make that we traditionally study with the Naturalistic Decision Making (NDM) theoretical lens and methods. Similarly, patients are making decisions in naturalistic settings and doing so with the objective of minimizing risk and maximizing safety. What is different is that patients are put in a position to perform complex, high level, high consequence work in the absence of any training, education, or decision support. Using a lived experience, I illustrate that the burden of judgement and decision making in surgery recovery work (e.g., caring for surgical sites, managing drains, managing medications, supporting activities of daily living) can be understood through a macrocognitive paradigm. Thus, the NDM theoretical lens and the associated methods is appropriate to study this problem space

The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety

Patients and families play a role in the safety of care provided across clinical settings, highlighting the need to understand clinician perspectives and experiences related to their engagement. Through a panel discussion entitled, The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety, we elicited clinician perspectives that have implications for human factors relevance in both, research and solution development/evaluation. We provide an overview of the panel including participants, format and content, and the resulting discussion

The Advantages of Using Color to Represent Constraints in Collaborative Planning Representations

The present study concerns the representation of plans that incorporate constraints behind the intended activities for team planning tasks. The experimental task was a modification of a game entitled 10 Days in Africa in which the players must complete a journey through the continent of Africa. Dyad members constructed their own planning representations and determined meeting places collaboratively. We augmented the representation of a timeline with representations for the constraints between adjacent events by using color and text. Although both forms of constraint representation improve performance, color is a perceptual feature that is effective without attentional resources. The presence of color resulted in generally improved process and performance as captured by various measures, including verbal interaction. Our finding is consistent with research on color but at a much larger time scale and in the presence of a more complicated cognitive task. Color facilitates planning strategies by drawing attention to opportunities and supporting the chunking of sub-goals. Representing constraints explicitly via color is advantageous in collaborative planning, by halving completion time and reducing discussion concerning constraint compliance, consistent with the view that discussion compensates for display limitations

The Advantages of Using Color to Represent Constraints in Collaborative Planning Representations

The present study concerns the representation of plans that incorporate constraints behind the intended activities for team planning tasks. The experimental task was a modification of a game entitled 10 Days in Africa in which the players must complete a journey through the continent of Africa. Dyad members constructed their own planning representations and determined meeting places collaboratively. We augmented the representation of a timeline with representations for the constraints between adjacent events by using color and text. Although both forms of constraint representation improve performance, color is a perceptual feature that is effective without attentional resources. The presence of color resulted in generally improved process and performance as captured by various measures, including verbal interaction. Our finding is consistent with research on color but at a much larger time scale and in the presence of a more complicated cognitive task. Color facilitates planning strategies by drawing attention to opportunities and supporting the chunking of sub-goals. Representing constraints explicitly via color is advantageous in collaborative planning, by halving completion time and reducing discussion concerning constraint compliance, consistent with the view that discussion compensates for display limitations

Characterizing experiences of non-medical switching to trastuzumab biosimilars using data from internet-based surveys with US-based oncologists and breast cancer patients.

PurposeTo characterize current experiences with communication and decision-making practices when non-medical switching to a biosimilar trastuzumab is proposed or required by cancer center or insurer.MethodsWe developed and launched 60- and 51-item internet surveys to elicit US breast cancer patient and medical oncologist lived experiences with trastuzumab biosimilars and patient information needs and seeking practices. We recruited participants using social media and administered via REDCap in 2020-2021.Results143 breast cancer patients and 33 medical oncologists completed the surveys. 63.9% patients reported having switched to a trastuzumab biosimilar and 40.8% reported receiving no prior notification about switching. 44% of patients reported learning about biosimilars primarily through self-directed learning and 41% wanting more time to discuss with oncologist. None of the oncologists reported that the decision to switch a patient to a biosimilar was initiated by them, but rather more frequently by the insurer (45.2%). About 54.8% reported not receiving any pharmaceutical manufacturer material related to the selected biosimilar. Patients and oncologists diverged in their responses to items regarding patient opportunities to ask questions, adequacy of resources, effectiveness of treatment, patient worry, and magnitude of change.ConclusionThere is a need for tailored and effective patient and oncologist information and education on trastuzumab biosimilars, along with improved healthcare communication regarding switching. The discrepancy between patient-reported experiences and oncologist perceptions of the patient experience, suggests a lack of adequate information that may be a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship

Implementing an Electronic Patient-Reported Outcome and Decision Support Tool in Early Intervention

Objective: The aim of the study is to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. Methods: An explanatory sequential (quan > QUAL) mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were used to share select quantitative pragmatic trial results (e.g., percentages for perceived helpfulness of implementation strategies) and elicit stakeholder perspectives to contextualize these results. Three study staff deductively coded transcripts to constructs in the Consolidated Framework for Implementation Research (CFIR). Data within CFIR constructs were inductively analyzed to generate themes that were rated by national early childhood advisors for their relevance to longer term implementation. Results: All three stakeholder groups (i.e., families, service coordinators, program leadership) identified thematic supports and barriers across multiple constructs within each of four CFIR domains: (1) Six themes for intervention characteristics, (2) Six themes for process, (3) three themes for inner setting, and (4) four themes for outer setting. For example, all stakeholder groups described the value of the YC-PEM e-PRO in forging connections and eliciting meaningful information about family priorities for efficient service plan development (intervention characteristics). Stakeholders prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes (process); and fostering a positive implementation climate (inner setting). Service coordinators and program leadership further articulated the value of YC-PEM e-PRO results for improving EI access (outer setting). Conclusion: Results demonstrate the YC-PEM e-PRO is an evidence-based intervention that is viable for implementation. Optimizations to its interface are needed before undertaking hybrid type-2 and 3 multisite trials to test these implementation strategies across state and local EI programs with electronic data capture capabilities and diverse levels of organizational readiness and resources for implementation