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Publications (188)
This cross-sectional study examines the content and quality of information about urinary tract infections and asymptomatic bacteriuria on publicly available websites.
Objective
To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States.
Methods
We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM...
Background
Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counsel...
Background/Aims
Congenital melanocytic nevi (CMN) are often unexpected discoveries at time of childbirth or adoption. Understanding how parents/guardians cope with these visible birthmarks can help clinicians better care for children and their families. Using qualitative methods, we sought to categorize early family responses to CMN and identify ap...
Objective
To elicit clinicians’ perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria.
Design
Semi-structured qualitative interviews.
Setting
Infectious disease clinics, community senior living f...
Introduction
To implement effective conversation aids for early-stage breast cancer surgery, we introduced an online learning collaborative, SHAIR Collaborative, targeting clinical teams who treat these patients. In this qualitative study, we explored factors impacting conversation aid implementation and participation in SHAIR.
Methods
Using an in...
Introduction
Shared decision-making (SDM) in breast cancer care lacks routine implementation. We initiated the SHared decision-making Adoption and Implementation Resource (SHAIR) online coproduction learning collaborative to promote early-stage breast cancer surgery SDM by implementing effective text and picture-enhanced conversation aids in preope...
Objective
To implement the BREASTChoice decision tool into the electronic health record and evaluate its effectiveness.
Background
BREASTChoice , is a multilevel decision tool that: 1) educates patients about breast reconstruction; 2) estimates personalized risk of complications; 3) clarifies patient preferences; and 4) informs clinicians about pa...
Background: Novel applications of telemedicine can improve care quality and patient outcomes. Telemedicine for intraoperative decision support has not been rigorously studied.
Methods: This single centre randomised clinical trial (clinicaltrials.gov NCT03923699) of unselected adult surgical patients was conducted between July 1, 2019 and January 31...
Background
Patients often desire involvement in anesthesia decisions, yet clinicians rarely explain anesthesia options or elicit preferences. We developed My Anesthesia Choice-Hip Fracture, a conversation aid about anesthesia options for hip fracture surgery and tested its preliminary efficacy and acceptability.
Methods
We developed a 1-page, tabu...
Introduction:
Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncologica...
Introduction
Evidence-based policies are a powerful tool for impacting health and addressing obesity. Effectively communicating evidence to policymakers is critical to ensure evidence is incorporated into policies. While all public health is local, limited knowledge exists regarding effective approaches for improving local policymakers' uptake of e...
As treatment options for patients with rectal cancer evolve, patients with early-stage rectal cancer may have a treatment choice between surgery and a trial of nonoperative management. Patients must consider the treatments’ clinical tradeoffs alongside their personal goals and preferences. Shared decision-making (SDM) between patients and clinician...
Objective
To explore older adults’ and caregivers’ knowledge and perceptions of guidelines for appropriate antibiotics use for bacteria in the urine.
Design
Semi-structured qualitative interviews.
Setting
Infectious disease clinics, community senior living facilities, memory care clinics, and general public.
Participants
Patients 65 years or old...
Background
More than 300 million patients undergo surgical procedures requiring anesthesia worldwide annually. There are 2 standard-of-care general anesthesia administration options: inhaled volatile anesthesia (INVA) and total intravenous anesthesia (TIVA). There is limited evidence comparing these methods and their impact on patient experiences a...
Background
Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients’ unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral a...
Background. While nerve and tendon transfer surgery can restore upper extremity function and independence after midcervical spinal cord injury, few individuals (∼14%) undergo surgery. There is limited information regarding these complex and time-sensitive treatment options. Patient decision aids (PtDAs) convey complex health information and help in...
Objective
Identify stakeholders’ tracheostomy decision-making information priorities in the Neonatal Intensive Care Unit (NICU).
Study design
English-speaking caregivers and clinicians who participated in NICU tracheostomy discussions between January 2017 and December 2021 were eligible. They reviewed a pediatric tracheostomy communication guide p...
Importance
Telemedicine for clinical decision support has been adopted in many health care settings, but its utility in improving intraoperative care has not been assessed.
Objective
To pilot the implementation of a real-time intraoperative telemedicine decision support program and evaluate whether it reduces postoperative hypothermia and hypergly...
Background
The decision about which type of general anesthetic to administer is typically made by the clinical team without patient engagement. This study examined patients’ preferences, experiences, attitudes, beliefs, perceptions, and perceived social norms about anesthesia and about engaging in the decision regarding general anesthetic choice wi...
Introduction
BREASTChoice is a web-based breast reconstruction decision aid. The previous clinical trial—prior to the adaptation of this refined tool in which we explored usability—measured decision quality, quality of life, patient activation, shared decision making, and treatment choice. The current usability study was designed to elicit patients...
Background
Shared decision making (SDM) in breast cancer care improves outcomes, but it is not routinely implemented. Results from the What Matters Most trial demonstrated that early-stage breast cancer surgery conversation aids, when used by surgeons after brief training, improved SDM and patient-reported outcomes. Trial surgeons and patients both...
Background
Many individuals undergoing cancer treatment experience substantial financial hardship, often referred to as financial toxicity (FT). Those undergoing prostate cancer treatment may experience FT and its impact can exacerbate disparate health outcomes. Localized prostate cancer treatment options include: radiation, surgery, and/or active...
Background
Decision aids help patients consider the benefits and drawbacks of care options but rarely include cost information. We assessed the impact of a conversation‐based decision aid containing information about low‐risk prostate cancer management options and their relative costs.
Methods
We conducted a stepped‐wedge cluster randomised trial...
Objective Identify stakeholders’ tracheostomy decision-making information priorities in the Neonatal Intensive Care Unit (NICU).
Study Design English-speaking caregivers and clinicians who participated in NICU tracheostomy discussions between January 2017 and December 2021 were eligible. They reviewed a pediatric tracheostomy communication guide p...
Background
Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces.
Aims and objectives
This study investigated key factors affecting municipal officials’ policymaking for obesity and related health disparities.
Methods
Se...
Introduction
Millions of patients receive general anaesthesia for surgery annually. Crucial gaps in evidence exist regarding which technique, propofol total intravenous anaesthesia (TIVA) or inhaled volatile anaesthesia (INVA), yields superior patient experience, safety and outcomes. The aim of this pilot study is to assess the feasibility of condu...
BACKGROUND
More than 300 million patients undergo surgical procedures requiring anesthesia worldwide annually. There are 2 standard-of-care general anesthesia administration options: inhaled volatile anesthesia (INVA) and total intravenous anesthesia (TIVA). There is limited evidence comparing these methods and their impact on patient experiences a...
Direct and indirect costs of care influence patients’ health choices and the ability to implement those choices. Despite the significant impact of care costs on patients’ health and daily lives, patient decision aid (PtDA) and shared decision-making (SDM) guidelines almost never mention a discussion of costs of treatment options as part of minimum...
Background
Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients’ unique needs. We developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication opti...
PURPOSE
To elicit end-user and stakeholder perceptions regarding design and implementation of an inpatient clinical deterioration early warning system (EWS) for oncology patients to better fit routine clinical practices and enhance clinical impact.
METHODS
In an explanatory-sequential mixed-methods study, we evaluated a stakeholder-informed oncolo...
Uncertainty is prevalent in various health contexts. It is imperative to understand how health-related uncertainty can impact individuals’ healthcare experiences and health decision making. The purpose of the present paper is to provide five overarching recommendations from an interdisciplinary team of experts to address gaps in the literature on h...
The Covid-19 pandemic required rapid changes to research protocols, including immediate transitions to recruiting research participants and conducting the informed consent process virtually. This case study details the challenges our research team faced adapting an in-person, behavioral-intervention and survey study to virtual recruitment. We refle...
Patient decision aids can support shared decision making and improve decision quality. However, decision aids are not widely used in clinical practice due to multiple barriers. Integrating patient decision aids into the electronic health record (EHR) can increase their use by making them more clinically relevant, personalized, and actionable. In th...
Background: BREASTChoice is a web-based decision tool about breast reconstruction after mastectomy. The current focused usability assessment was designed to elicit patients’ and clinicians’ perspectives on barriers and facilitators for implementing BREASTChoice into the clinical workflow.
Methods: We conducted think-aloud protocols and qualitative...
To describe the process of developing a craniosynostosis decision aid.
We conducted a mixed-methods exploratory study between August 2019 and March 2020 to develop a decision aid about surgical treatment for single suture craniosynostosis.
A single tertiary care academic children’s hospital.
The decision aid development team consisted of surgeon...
Objective
This study adapted Improving Cancer Patients’ Insurance Choices ( I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions , however, users felt limited by choices provided in insurance markets. Using decis...
Objective
The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)—risk-inducing or risk-mitigating workflow deviations—...
BACKGROUND
Guidelines recommend shared decision making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities.
METHODS
The purpose of this...
Introduction
The perioperative period is high risk for older adults. Depression and anxiety are common perioperative problems, frequently coexisting with cognitive impairment. Older patients with these conditions are more likely than younger patients to experience postoperative delirium, long hospital stays, poor quality of life and rehospitalisati...
BACKGROUND
Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations like urban and rural areas.
OBJECTIVE
To identify opportunities to improve COVID-19 messages for community distribution in ru...
Background:
Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations like urban and rural areas.
Objective:
To identify opportunities to improve COVID-19 messages for community distribution i...
Objectives
To explore young women’s preferences for contraceptive education to inform development of an educational resource and to pilot test the resource with patients and clinicians.
Methods
We performed a mixed-methods study to elicit preferences for contraceptive educational resources among patients, develop an online resource, and pilot test...
Objectives:
Our objective was to elicit clinicians' and parents' perspectives about decision-making related to hospitalization for children with bronchiolitis and the use of shared decision-making (SDM) to guide these decisions.
Methods:
We conducted individual, semistructured interviews with purposively sampled clinicians (pediatric emergency m...
Decision support techniques and online algorithms aim to help individuals predict costs and facilitate their choice of health insurance coverage. Self-reported health status (SHS), whereby patients rate their own health, could improve cost-prediction estimates without requiring individuals to share personal health information or know about undiagno...
Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 su...
Background
Clinical decision support systems and telemedicine for remote monitoring can together support surgical patients' intraoperative decision-making and care management. However, there has been limited investigation on patient perspectives about advanced health information technology use in intraoperative settings, particularly within an intr...
Shared decision making can help patients feel supported and empowered when deciding between healthcare options. Decision regret can be a meaningful measure of the quality of that encounter. However, in a patient-engaged research study examining shared decision making for breast cancer surgery, decision regret was a difficult construct to assess, an...
Objective. To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. Materials and Methods. A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer...
Background
Costs of care are important to patients making cancer treatment decisions, but clinicians often do not feel prepared to discuss treatment costs. We aim to (1) assess the impact of a conversation-based decision aid (Option Grid) containing cost information about slow-growing prostate cancer management options, combined with urologic surge...
Purpose of review:
Shared decision making (SDM) is an important part of patient-centered care. However, it is neither widely practiced nor researched in pediatric dermatology. In this article, we provide practical examples of how to engage in SDM in pediatric dermatology, and identify future areas of research.
Recent findings:
Children and paren...
Objective
We explored women's preferences for contraceptive education and assess the role of the clinician in delivering this education.
Study Design
We recruited women ages 16-29 presenting for gynecologic care at three clinical sites. Respondents completed a survey about preferences for receipt of contraceptive information and trustworthiness of...
BACKGROUND
Congenital Diaphragmatic Hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the Internet to supplement their knowledge and decision-making.
OBJECTIVE
We aimed to examine the content and quality of publicly-available, internet-b...
Background
Congenital diaphragmatic hernia (CDH) diagnosis in an infant is distressing for parents. Parents often feel unable to absorb the complexities of CDH during prenatal consultations and use the internet to supplement their knowledge and decision making.
Objective
We aimed to examine the content and quality of publicly available, internet-b...
Background
Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversat...
Objective:
We aimed to develop a parent-reported outcome measure for febrile infants 60 days or younger evaluated in the emergency department.
Methods:
We conducted a 3-part study: (1) individual, semistructured interviews with parents of febrile infants 60 days or younger to generate potential items for the measure; (2) expert review with pedia...
In this issue of JAMA Dermatology, Morrison and colleagues¹ present a scoping literature review of shared decision-making (SDM) in dermatology. The authors analyze 29 articles about SDM and/or patient decision aids for dermatologic conditions. Their analysis suggests that SDM is useful and desired by almost all patients and many clinicians, but mor...
PURPOSE
Physicians treating hematologic malignancies increasingly order targeted sequencing panels to interrogate recurrently mutated genes. The precise impact of these panels on clinical decision making is not well understood.
METHODS
Here, we report our institutional experience with a targeted 40-gene panel (MyeloSeq) that is used to generate a...
Background Conversation aids can facilitate shared decision making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversat...
Background
Women of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women ac...
Purpose:
We examined self-reported financial toxicity and out-of-pocket expenses among adult women with breast cancer.
Methods:
Patients spoke English, Spanish, or Mandarin Chinese, were aged 18+ years, had stage I-IIIA breast cancer, and were eligible for breast-conserving and mastectomy surgery. Participants completed surveys about out-of-pock...
Background
Conversation aids can facilitate shared decision making and improve patient-centered outcomes. However, there are few examples of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored strategies that will promote the sustained use of two early-stage breast cancer co...
180
Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health l...
Background
Although obtaining preoperative procedural consent is required to meet legal and ethical obligations, consent is often relegated to a unidirectional conversation between surgeons and patients. In contrast, shared decision-making (SDM) is a collaborative dialog that elicits patient preferences. Despite emerging interest in SDM, there is a...
Objective
To evaluate the effectiveness of a contraceptive decision aid in reducing decisional conflict among women seeking reversible contraception.
Study Design
We conducted a randomized trial of a computer-based decision aid compared to a control group for women presenting for reversible contraception at two clinics affiliated with an academic...
Objectives
We aimed to develop and test a tool to engage parents of febrile infants ≤60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision‐making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age.
Methods
We condu...
Purpose. There is no gold-standard health literacy measure. The Single Item Literacy Screener (SILS) and Subjective Literacy Screener (SLS) ask people to self-report ability to understand health information. They were developed in older adults, before common use of electronic health information. This study explored whether the SILS and SLS related...
Objective
To explore pediatric clinicians’ attitudes, beliefs, and perceived social norms about the impact of delayed vaccine schedules on the clinical management of their patients.
Methods
We conducted 30 semi-structured qualitative interviews with academic (Infectious Diseases, Emergency Medicine) and community pediatric clinicians (General Pedi...
Illness and injury often entail lasting health and social consequences beyond the acute event. During the immediate and long-term recovery period, consequences of illness or injury can often be mitigated and addressed. As patients and their clinicians discuss care decisions, whether for initial or ongoing management of illness or injury, they must...
Background: Bisphosphonates (BPs) can reduce fracture risk for adults with osteoporosis (OP), but they have rare risks, complicating decision making. Guided by an established health decision and communication framework, we explored older women's feelings and positions toward taking BPs.
Materials and Methods: Using a mixed-methods design, we interv...
Neonatal intensive care unit (NICU) admissions are common and rising. Parents with infants in the NICU face difficult decisions about their infants’ care. Few studies have investigated parents’ engagement in NICU decisions and its effects on decision regret.
We surveyed parents of children who had a NICU stay in the past 3 years. We explored whethe...
Objectives
We had three aims: (1) understand barriers to perioperative management of anxiety and depression in older surgical patients; (2) identify preferences and requirements for interventions to manage their anxiety and depression; and (3) explore the feasibility of implementing such interventions in perioperative care.
Design
A qualitative st...
Background:
Many cancer survivors struggle to choose a health insurance plan that meets their needs because of high costs, limited health insurance literacy, and lack of decision support. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial.
Materials and methods:...
Rationale, aims, and objectives:
Approximately 45% of pregnancies in the United States are unintended. The use of contraception reduces the risk of unintended pregnancy. The initiation of several contraceptive methods requires seeing a clinician. This study explored how clinicians' expressed preferences against particular contraceptive methods imp...
