Toma de decisiones compartidas en oncología

Shared decision-making (SDM) arises in contexts where patients and health professionals must make decisions about screening tests or treatments without a single or “best” option. Decision Aids (DAs) are created to facilitate the SDM process. They are interventions designed to help people participate in decision making between various screening tests and therapeutic options, providing information about options and patient’s health outcome status. Using Das increases patients’ knowledge regarding their health status, decreases decisional conflict, reduces the proportion of people who were passive in decision-making and reduces the proportion of people who remained undecided post-intervention. Nevertheless, despite the apparent positive effects of DAs in many health care specialties, including oncology, a standard use has not been yet reached. Therefore, it is essential to explore desired level involvement of patients and health professionals in SDM process, and identify potential barriers and facilitators influencing implementation of Das in our context.El concepto de “toma de decisiones compartidas” (TDC) surge en contextos donde pacientes y profesionales sanitarios han de tomar decisiones sobre pruebas diagnósticas o tratamientos en los que no se dispone de una única o “mejor” opción. Para facilitar la TDC se han diseñado las Herramientas de Ayuda para la Toma de Decisiones (HATD), definidas como intervenciones que permiten apoyar a las personas para tomar decisiones entre varias opciones diagnósticas o terapéuticas, proporcionando información acerca de las opciones y resultados esperados sobre el estado de salud de una persona. El uso de las HATD produce un aumento del conocimiento de los pacientes en relación con su condición de salud, disminuye el conflicto decisional, reduce la proporción de personas pasivas en el proceso de toma de decisiones y disminuye el número de personas que permanecen indecisas. No obstante, a pesar de los aparentes efectos positivos de las HATD en muchas áreas de atención sanitaria, incluyendo oncología, aún no se ha alcanzado la normalización de su uso en la asistencia sanitaria. Por tanto, resulta esencial explorar el nivel deseado de implicación de los pacientes y profesionales sanitarios en el proceso de TDC, así como identificar las posibles barreras y facilitadores que influyen en la implementación de estas HATD en nuestro contexto

Promoción de la participación ciudadana en cuidados de salud a través de PyDEsalud.com

ResumenEste proyecto apoya la iniciativa, promovida por el Sistema Nacional de Salud en España, de facilitar materiales informativos, en formato impreso o interactivo, que impulsen la participación ciudadana en las decisiones y los cuidados de salud. Se presenta la recientemente creada Plataforma Web PyDEsalud.com, dirigida a personas afectadas por enfermedades crónicas de gran impacto socioeconómico, como son el cáncer de mama, la depresión o la diabetes. Siguiendo una metodología científica de trabajo, esta Plataforma incluye tres módulos de servicios informativos (Experiencias de pacientes, Toma de decisiones compartida y Necesidades de investigación), dirigidos a promocionar la educación sanitaria de pacientes y familiares.AbstractThis project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients’ experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families

Toma de decisiones compartidas en oncología

Shared decision-making (SDM) arises in contexts where patients and health professionals must make decisions about screening tests or treatments without a single or “best” option. Decision Aids (DAs) are created to facilitate the SDM process. They are interventions designed to help people participate in decision making between various screening tests and therapeutic options, providing information about options and patient’s health outcome status. Using Das increases patients’ knowledge regarding their health status, decreases decisional conflict, reduces the proportion of people who were passive in decision-making and reduces the proportion of people who remained undecided post-intervention. Nevertheless, despite the apparent positive effects of DAs in many health care specialties, including oncology, a standard use has not been yet reached. Therefore, it is essential to explore desired level involvement of patients and health professionals in SDM process, and identify potential barriers and facilitators influencing implementation of Das in our context

Transcranial Magnetic Stimulation for the Treatment of Cocaine Addiction: A Systematic Review

Cocaine use disorder; Craving; Non-invasive brain stimulationTrastorn per consum de cocaïna; Ànsia; Estimulació cerebral no invasivaTrastorno por consumo de cocaína; Ansia; Estimulación cerebral no invasivaLong-term cocaine use is associated with cognitive deficits and neuro-psychiatric pathologies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging therapeutic strategy relating to changes in brain activity. It stimulates the prefrontal cortex and is involved in inhibitory cognitive control, decision making and care. This systematic review aims to evaluate and synthesize the evidence on the safety, effectiveness, and cost-effectiveness of rTMS for the treatment of cocaine addiction. A systematic review of the literature was carried out. The following electronic databases were consulted from inception to October 2020: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Web of Science. Randomised controlled trials, non-randomised controlled trials and case-series and full economic evaluations were included. Twelve studies were included. No identified study reported data on cost-effectiveness. Significant results of the efficacy of TMS have been observed in terms of the reduction of craving to consume and the number of doses consumed. No serious adverse effects have been observed. Despite the low quality of the studies, the first results were observed in terms of reduction of cocaine use and craving. In any case, this effect is considered moderate. Studies with larger sample sizes and longer follow-ups are required

Shared decision making in patients with substance use disorders : A one-year follow-up study

Patient-centered care in therapeutic processes has been associated with better clinical outcomes, however, it remains a poorly studied aspect in Substance Use Disorder (SUD). The study aimed to evaluate patient's preferences, perceived participation in treatment decisions and activation level; and how they predict retention, pharmacological adherence and substance use during one-year follow-up. Logistic regression models were used to analyze the association between independent variables, along with a wide number of sociodemographic and clinical covariates, and outcomes. Most patients prefer a shared or passive role when making decisions about their treatment, and showed concordance between their preferred and perceived roles. In the univariate models, perceiving more involvement than desired showed a higher likelihood of treatment discontinuation at 12 months, and substance use at 6 and 12 months. No significant associations were found between the remaining decisional variables or the degree of activation with the assessed outcomes. A majority of SUD patients prefer and perceive to be involved in the decision-making process about their treatment. Patients perceiving more involvement than desired might experience an excess of responsibility that could negatively influence treatment continuation and substance use. Limitations of the study preclude any definitive conclusion, and more research is needed to confirm these results

Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis

[EN]Some challenges faced by people with autism spectrum disorder (ASD) when adapting to a neurotypical environment are related with the risk of suffering a psychiatric disorder. The aim of the present study is to conduct a systematic review on the prevalence of psychiatric disorders in adults with ASD (PROSPERO’s reference number CRD42016041948). Four databases (PubMed, PsycINFO, Web of Science and CINAHL) were used for the electronic search, and six editorials (Science Direct, Wiley, Springer, Taylor & Francis, SAGE Publishing and BioMed Central) were manually searched for studies not previously identified. Study eligibility criteria were observational studies on psychiatric comorbidity in adults (18 years or older) with ASD, based on standard diagnostic classifications (DSM/ICD), reported in English peer-reviewed journals. A total of 1288 and 24 references were identified by electronic and manual searches, respectively. Results showed that attention deficit and hyperactivity disorder is the most prevalent psychiatric disorder in adults with ASD. Mood and anxiety disorders are also very frequent among this population. The lowest comorbidity prevalence rates of all diagnostic categories are the ones related to substance use and eating disorders. These results show a need for a greater production of studies in this field, especially follow-up studies that focus on risk and protective factors for the emergence of psychiatric problems in adults with ASD. For this reason, it is imperative to create specific diagnostic tools that allow the assessment of mental pathology, attending to the particularities of its manifestation in people with ASD

Gender differences in the decision-making process for undergoing total knee replacement

Acord transformatiu CRUE-CSICThis project was supported by Instituto de Salud Carlos III, Ministry of Health, Spain (grant number PI15/01264).Objective: To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). Methods: A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. Results: Women showed less knowledge (MD = −7.68, 95% CI: −13.9, −1.46, p = 0.016), reported less satisfaction (MD = −6.95, 95% CI: −11.7, −2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). Conclusion: The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. Practice implications: A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases

Sociodemographic and clinical predictors of adherence to antidepressants in depressive disorders: a systematic review with a meta-analysis

Introduction: Current evidence reveals concerning rates of non-adherence to antidepressant treatment, possibly influenced by various relevant determinants such as sociodemographic factors or those related to the health system and their professionals. The aim of this paper is to review the scientific evidence on sociodemographic and clinical predictors of adherence to pharmacological treatment in patients diagnosed with a depressive disorder.Methods: a systematic review (SR) was conducted. The search for a previous SR was updated and de novo searches were performed in Medline, EMBASE, Web of Science (WoS) and PsycInfo (last 10 years). The risk of bias was assessed using the Cochrane tool for non-randomized studies—of Exposure (ROBINS-E). Meta-analyses were conducted.Results: Thirty-nine studies (n = 2,778,313) were included, 24 of them in the meta-analyses. In the initiation phase, no association of adherence was found with any of the predictors studied. In the implementation and discontinuation phases, middle-aged and older patients had better adherence rates and lower discontinuation rates than younger ones. White patients adhered to treatment better than African-American patients.Discussion: Age and ethnicity are presented as the predictive factors of pharmacological adherence. However, more research is needed in this field to obtain more conclusive results on other possible factors.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023414059], identifier [CRD42023414059

Measuring Explicit Prejudice and Transphobia in Nursing Students and Professionals

Trans* people frequently report attitudes of prejudice/transphobia in health professionals.Conversely, health professionals indicate the lack of adequate training to care for these peopleand its impact on the quality of care provided. Objective: Our objective was to evaluate theexplicit prejudices/transphobia of health students and professionals and compare them with thegeneral population in Tenerife. Methods: A descriptive cross-sectional study was carried out withthe Genderism and Transphobia Scale (GTS) and the Negative Attitude towards Trans* peopleScale (EANT) with a total of 602 participants. Results: We found a low mean level of explicitprejudice/transphobia, with little/no differences between occupation groups. Explicit transphobia wascorrelated with being a man, less educated, and heterosexual, and not personally knowing a trans*person. Men and women were less transphobic about trans* people whose identities coincided withtheir own. Conclusion: All participants showed a low mean level of explicit transphobia. This resultis not incompatible with unconscious prejudice, which may translate to discriminatory behaviors.Interventions to change negative attitudes are still needed, since even a small percentage of transphobichealth professionals could exert a considerable negative impact on health care. In professionalswithout transphobic attitudes, the barriers identified by trans* people might be a problem due to thelack of specific trainin