"Why is the Doctor a Man?" Reactions of Older Adults to a Virtual Training Doctor

Shared decision making (SDM) is increasingly considered as the best way to reach a treatment decision in a clinical environment. However, the use of SDM in practice can be obstructed by a number of factors, such as time constraints or lack of applicability due to patient characteristics. Our project, PrepDoc, explores how a Virtual Training Doctor (VTD) can help patients overcome some of these obstacles to experiencing effective SDM during doctor's visits. In this paper, we report on user studies conducted with 19 participants in Scotland aged 65+. The goal of these studies was to identify the reactions of this audience to the PrepDoc system, evaluate its suitability within Scotland, and elicit suggestions to improve it. Our findings revealed that the idea of empowering people to participate in SDM using a virtual agent was positively received by all participants. However, the reactions to how this idea was implemented in the PrepDoc system varied greatly across participants. Based on this, our paper outlines recommendations for enhancing the user experience with VTDs, accommodating individual differences of older adults, and accounting for the national context

<b>Dataset for The influence of health literacy, anxiety and education on shared decision making with older adults, mediated by patient participation: a video observational study</b>

Objective: To explore the influence of the personal characteristics of older adults with multiple chronic conditions (MCCs) on perceived shared decision making (SDM) and decisional conflict. Methods: In a video-observational study (N=213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. Results: The mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β .01, p< .001) was significantly associated with participation in the SDM process. Education (β=-2.43, p=.05) and anxiety (β=-.26, p=.058) had a marginally significant direct effect on the patients’ perceived level of SDM. Education (β=12.12, p=.002), health literacy (β=-.70, p=.005) and anxiety (β=1.19, p=.004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. Conclusion: Health literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict.</p

A training simulation for practicing shared decision making for older patients

We describe the design of a product that supports older patients in preparing themselves for a consultation with a health-care professional. The product focuses on shared-decision making, and supports multi-modal interaction. Users can interact with the product through speech, text, and mouse. The product has been designed and evaluated in several co-creation sessions

A training simulation for practicing shared decision making for older patients

We describe the design of a product that supports older patients in preparing themselves for a consultation with a health-care professional. The product focuses on shared-decision making, and supports multi-modal interaction. Users can interact with the product through speech, text, and mouse. The product has been designed and evaluated in several co-creation sessions

Recommendations of older adults on how to use the PROM 'TOPICS-MDS' in healthcare conversations: A Delphi study

Contains fulltext : 219491.pdf (publisher's version ) (Open Access

Shared decision-making for nonoperative management versus operative management of hip fractures in selected frail older adults with a limited life expectancy:a protocol for a nationwide implementation study

Background and purpose Recent research has highlighted non-operative management (NOM) as a viable alternative for frail older adults with hip fractures in the final phase of life. This study aims to guide Dutch physicians and hospitals nationwide in a standardised implementation of shared decision-making regarding surgery or NOM in selected frail older adults with a hip fracture. Methods and analysis The patient population for implementation includes frail older adults aged ≥70 years with an acute proximal femoral fracture, nursing home care or a similar level of care elsewhere and at least one additional criterion (ie, malnutrition, severe mobility impairment or ASA≥4). The 2-year implementation study will be conducted in four phases. In phases 1 and 2, barriers and facilitators for implementation will be identified and an implementation protocol, educational materials and patient information will be developed. Phase 3 will involve an implementation pilot in 14 hospitals across the Netherlands. The protocol and educational material will be improved based on healthcare provider and patient experiences gathered through interviews. Phase 4 will focus on upscaling to nationwide implementation and the effect of the implementation on NOM rate will be measured using data from the Dutch Hip Fracture Audit. Ethics and dissemination The study was exempted by the local Medical Research Ethics Committee (MEC-2023-0270, 10 May 2023) and Medical Ethics Committee United (W23.083, 26 April 2023). The study’s results will be submitted to an open access international peer-reviewed journal. Its protocols, tools and results will be presented at several national and international academic conferences of relevant orthogeriatric (scientific) associations.</p

The development of the evidence-based SDM(MCC) intervention to improve shared decision making in geriatric outpatients: the DICO study

Contains fulltext : 217429.pdf (publisher's version ) (Open Access

Clinicians' views on conversations and shared decision making in diagnostic testing for Alzheimer's disease: The ABIDE project

This study explores clinicians' views on and experiences with when, how, and by whom decisions about diagnostic testing for Alzheimer's disease are made and how test results are discussed with patients. Following a preparatory focus group with 13 neurologists and geriatricians, we disseminated an online questionnaire among 200 memory clinic clinicians. Respondents were 95 neurologists and geriatricians (response rate 47.5%). Clinicians (74%) indicated that decisions about testing are made before the first encounter, yet they favored a shared decision-making approach. Patient involvement seems limited to receiving information. Clinicians with less tolerance for uncertainty preferred a bigger say in decisions (P < .05). Clinicians indicated to always communicate the diagnosis (94%), results of different tests (88%-96%), and risk of developing dementia (66%). Clinicians favor patient involvement in deciding about diagnostic testing, but conversations about decisions and test results can be improved and supporte

Patients' and caregivers' views on conversations and shared decision making in diagnostic testing for Alzheimer's disease: The ABIDE project

Introduction This study aims to assess patients' and caregivers' views on and experiences with (1) decisions about diagnostic testing for Alzheimer's disease (AD) and (2) receiving test results. Methods We conducted separate focus groups with patients from three hospitals who underwent diagnostic testing for AD (N = 11) and their caregivers (N = 11). Audio recordings were transcribed verbatim and analyzed using MaxQDA. Results Patients and caregivers preferred and perceived active involvement in decision making, but the decision to initiate diagnostic testing seems to be made before the clinician-patient encounter. Patients and caregivers indicate that decisions are driven by a strong need to explain the patient's symptoms. They missed information on why different diagnostic tests were used, what the results of these tests were, and to what extent these results were (ab)normal. Discussion The decision-making process around diagnostic testing for AD and the information provision before and after diagnostic testing could be improved

The development of the evidence-based SDMMCC intervention to improve shared decision making in geriatric outpatients: The DICO study

Background: Shared decision making (SDM) contributes to personalized decisions that fit the personal preferences of patients when choosing a treatment for a condition. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Methods: Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research in a co-creation process with end users, we developed training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility, the intervention was implemented in a pilot study (N = 108) in two outpatient geriatric clinics of an academic and a non-academic teaching hospital in Amsterdam, the Netherlands. Results: Key elements of the training for geriatricians include developing skills to involve older adults with MCC and informal caregivers in SDM and following the six-step 'Dynamic model for SDM with frail older patients', as well as learning how to explore personal goals related to quality of life and how to form a partnership with the patient and the informal caregiver. Key elements of the preparatory tool for patients include an explicit invitation to participate in SDM, nomination that the patient's own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, the invitation of informal caregivers to share their concerns was also a key element. Conclusions: Through a process of co-creation, both training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end users and based on the 'Dynamic model of SDM with frail older patients'