Control Preferences Scale Research Articles

Association of Decision-making with Patients' Perceptions of Care and Knowledge during Longitudinal Pulmonary Nodule Surveillance.

Patient participation in medical decision-making is widely advocated, but outcomes are inconsistent. We examined the associations between medical decision-making roles, and patients' perceptions of their care and knowledge while undergoing pulmonary nodule surveillance. The study setting was an academically affiliated Veterans Affairs hospital network in which 121 participants had 319 decision-making encounters. The Control Preferences Scale was used to assess patients' decision-making roles. Associations between decision-making, including role concordance (i.e., agreement between patients' preferred and actual roles), shared decision-making (SDM), and perceptions of care and knowledge, were assessed using logistic regression and generalized estimating equations. Participants had a preferred role in 98% of encounters, and most desired an active role (shared or patient controlled). For some encounters (36%), patients did not report their actual decision-making role, because they did not know what their role was. Role concordance and SDM occurred in 56% and 26% of encounters, respectively. Role concordance was associated with greater satisfaction with medical care (adjusted odds ratio [Adj-OR], 5.39; 95% confidence interval [CI], 1.68-17.26), higher quality of patient-reported care (Adj-OR, 2.86; 95% CI, 1.31-6.27), and more disagreement that care could be better (Adj-OR, 2.16; 95% CI, 1.12-4.16). Role concordance was not associated with improved pulmonary nodule knowledge with respect to lung cancer risk (Adj-OR, 1.12; 95% CI, 0.63-2.00) or nodule information received (Adj-OR, 1.13; 95% CI, 0.31-4.13). SDM was not associated with perceptions of care or knowledge. Among patients undergoing longitudinal nodule surveillance, a majority had a preference for having active roles in decision-making. Interestingly, during some encounters, patients did not know what their role was or that a decision was being made. Role concordance was associated with greater patient-reported satisfaction and quality of medical care, but not with improved knowledge. Patient participation in decision-making may influence perceptions of care; however, clinicians may need to focus on other communication strategies or domains to improve patient knowledge and health outcomes.

Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry.

Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.

Referring Physicians’ Tendency to Collaborate With Radiologists in Managing Contrast Media–Related Risk Factors

PurposeThe aim of this study was to investigate the tendency of referring physicians to collaborate with radiologists in managing contrast media (CM)–related risk factors. MethodsThe study was conducted at a single academic hospital. Among 150 referring physicians from various specialties, 51 referring physicians (34%) responded to the invitation letter asking for an interview with a radiologist. During the interview, a modified form of the Control Preferences Scale was administered, in which there were five preferences (each displayed on a separate card) that ranged from the fully active to fully passive involvement of referring physicians in managing CM-related risk factors. A descriptive analysis was performed through categorization of the results depending on the respondents’ two most preferred roles. ResultsThirty-six referring physicians (70.5%) preferred a collaborative role, and 15 (29.4%) preferred a noncollaborative role (i.e., remained on either the fully active or fully passive side). Among the referring physicians who preferred a collaborative role, the most common response (n = 15 [29.4%]) was collaborative-active. ConclusionsReferring physicians at the authors’ institution have basic cognitive and motivational-affective tone toward collaboration in future teamwork aimed at the management of CM-related risk factors. A modified form of the Control Preferences Scale, as in this study, can be used to investigate the tendency of referring physicians to collaborate with radiologists. The results are discussed from ethical and legal perspectives.

Clinicians’ Control Preferences Regarding Prevention of Contrast Agent Reactions

Objectives: To investigate the control preferences of clinicians working in a regional hospital to prevent contrast agent reactions. Materials and Methods: This study investigated through a questionnaire the role preferred by 75 participant specialist physicians working in two local hospitals regarding prevention of contrast agent reactions. The questionnaire form included five different items consisting of modified forms of preferences found in control preferences scale (Degner et al., 1997). These items were as follows: A, I prefer to make a decision as a clinician; B, I prefer to make a decision as a clinician but should get radiologist’s opinion; C, Radiologist and I should make a decision together. The ideas of the two of us are equally important; D, The radiologist should make a decision but after getting my opinion; E, I prefer the radiologist to make a decision. Participants were asked to specify their primary (the most preferred) and secondary (subsequent) preferences. Results: The results of the statistical analysis indicated that females showed more equalitarian approach when compared to males (43.3% versus 15.6%, P < 0.005). Also, the physicians in internal medicine branches showed more equalitarian approach when compared to the physicians in surgical branches (37.8% versus 15.8%, P < 0.01) Conclusion: When we attempt to establish a clinical guideline committee towards preventing reactions to contrast agents, involvement of physicians exhibiting cooperative attitude in the committee will facilitate communication, and thereby improve group performance.

Treatment decision-making among breast cancer patients in Malaysia.

PurposeThis study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making.Participants and methodsA cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease.ResultsThe majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient–physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5) and 2 (IQR =2–3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients’ preferred role in the process of treatment decision-making and the patients’ preference for information seeking (p>0.05). However, only educational qualification (p=0.004) was significantly associated with patients’ preference for information seeking in multivariate analysis.ConclusionPhysicians failed to understand patients’ perspectives and preferences in treatment decision-making. The concordance between physicians’ perception and patients’ perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.

Validation of a scale to measure parental psychological empowerment in the vaccination decision.

Background and aims.Parents’ empowerment is advocated to promote and preserve an informed and autonomous decision regarding their children’ immunization. The scope of this study is to develop and evaluate the psychometric properties of an instrument to measure parents’ psychological empowerment in their children’s vaccination decision and propose a context-specific definition of this construct.Materials and methods.Grounding in previous qualitative data, we generated an initial pool of items which was later content and face validated by a panel of experts. A pretest allowed us to reduce the initial pool to 9 items. Convergent and discriminant validity measures included the General Self-Efficacy Scale, a Psychological Empowerment Scale, and the Control Preference Scale. Vaccination-related outcomes such as attitude and intention were also included.Results.Principal Component Analysis revealed a 2-factor structure, with each factor composed of 2 items. The first factor concerns the perceived influence of one’s personal and family experience with vaccination, while the second factor represents the desire not to ask other parents about their experience with vaccination and their lack of interest in other parents’ vaccination opinion.ConclusionsIn light of its association with positive immunization-related outcomes, public health efforts should be directed to reinforce parents’ empowerment.Significance for public healthSuboptimal vaccination coverage is associated with increased risk of disease outbreak. Increasing parental acceptance of childhood vaccinations will help public health systems to reach the recommended threshold to eliminate a number of preventable diseases. This study contributes to our knowledge of the antecedents of parental immunization decision, showing that parents who excessively rely on their peers and are less self-determined have lower levels of vaccination knowledge and decreased intention to vaccinate their children. The results of this study can be used to design effective public health communication campaigns aimed at increasing vaccination acceptance.

Preferences for dental decisional control and associations with quality of life among third molar patients attending public dental services.

To explore (1) the prevalence of dental decisional control preferences (DDCP) among third molar (TM) patients attending public dental services and associated individual's characteristics, and (2) the association between DDCP and quality of life (QoL). Participants were adult public dental patients with internet access referred for TM consultation. Collected data included patients' socio-demographic variables, the Control Preferences Scale (CPS), the Oral Health Impact Profile (OHIP-14) and the EuroQol EQ-5D-5L. Participants (n=163) were mainly females (73.6%) with a mean age of 26.2 years (SD=8.3). Most participants preferred an active DDCP (n=71, 44.1%) or a collaborative DDCP (n=60, 37.3%) while a minority preferred a passive DDCP (n=30, 18.6%). Gender (P=.05) and education (P=.03) were associated with DDCP. In a multinomial logistic regression model for DDCP, females were more likely to have an active DDCP (OR=2.73, P=.04) as were participants who had tertiary education (OR=2.72, P=.04). In a linear regression model for OHIP-14, active (P=.05) and collaborative DDCP (P=.04) were associated with less impact on oral health-related QoL. Patients attending public dental services preferred to be involved (either actively or collaboratively) in dental treatment decision-making. Being a female and/or having tertiary education were associated with an active DDCP. The positive association between patients' involvement in decision-making and oral health-related QoL might support the benefit for enhancing patients' involvement in decision-making.

Predicting the preferences for involvement in medical decision making among patients with mental disorders.

BackgroundThe involvement of patients in medical decision making has been investigated widely in somatic diseases. However, little is known about the preferences for involvement and variables that could predict these preferences in patients with mental disorders.ObjectiveThis study aims to determine what roles mentally ill patients actually want to assume when making medical decisions and to identify the variables that could predict this role, including patients’ self-efficacy.MethodDemographic and clinical data of 798 patients with mental disorders from three psychotherapeutic units in Germany were elicited using self-report questionnaires. Control preference was measured using the Control Preferences Scale, and patients’ perceived self-efficacy was assessed using the Self-Efficacy Scale. Bivariate and multivariate regression analyses were conducted to investigate the associations between patient variables and control preference.ResultsMost patients preferred a collaborative role (57.5%), followed by a semi passive (21.2%), a partly autonomous (16.2%), an autonomous (2.8%) and a fully passive (2.3%) role when making medical decisions. Age, sex, diagnosis, employment status, medical pretreatment and perceived self-efficacy were associated with the preference for involvement in the multivariate logistic model.ConclusionOur results confirm the preferences for involvement in medical decisions of mentally ill patients. We reconfirmed previous findings that older patients prefer a shared role over an autonomous role and that subjects with a high qualification prefer a more autonomous role over a shared role. The knowledge about predictors may help strengthen treatment effectiveness because matching the preferred and actual role preferences has been shown to improve clinical outcome.

Internet use, online information seeking and knowledge among third molar patients attending public dental services.

While Australians are searching the internet for third molar (TM) information, the usefulness of online sources may be questioned due to quality variation. This study explored: (i) internet use, online information-seeking behaviour among TM patients attending public dental services; and (ii) whether patients' TM knowledge scores are associated with the level of internet use and eHealth Literacy Scale (eHEALS) scores. Baseline survey data from the 'Engaging Patients in Decision-Making' study were used. Variables included: sociodemographics, internet access status, online information-seeking behaviour, eHEALS, the Control Preferences Scale (CPS) and TM knowledge. Participants (N = 165) were mainly female (73.8%), aged 19-25 years (42.4%) and had 'secondary school or less' education (58.4%). A majority (N = 79, 52.7%) had sought online dental information which was associated with active decisional control preference (odds ratio = 3.1, P = 0.034) and higher educational attainment (odds ratio = 2.7, P = 0.040). TM knowledge scores were not associated with either the level of internet use (F(2,152) = 2.1, P = 0.094, χ2 = 0.0310) or the eHEALS scores (r = 0.147, P = 0.335). 'The internet-prepared patient' phenomena exists among public TM patients and was explained by preference for involvement in decision-making. However, internet use was not associated with better TM knowledge. Providing TM patients with internet guidance may be an opportunity to improve TM knowledge.

Decision-Making Preferences Among Older Hispanics Participating in a Colorectal Cancer (CRC) Screening Program.

Shared decision making has been shown to improve patients experience and satisfaction with care within the health care setting but it is not clear that all patients want to play an active role in health care decisions. The aim of this study is to describe general decision control preferences among a predominantly Spanish speaking Hispanic population. This is a cross-sectional study using the Control Preference Scale to assess decision-making preference. A total of 780 subjects completed the survey (response rate 89.9%). The majority preferred a collaborative role (53.3%) compared to a passive (26.4%) or active role (20.3%). We observed that individuals who were married or living with a partner were more likely to prefer an active or collaborative role than their unmarried counterparts (RRR 1.78 P value 0.017; RRR 1.56 p value 0.012). Less acculturated individuals (i.e. more Spanish speaking at home were less likely to prefer an active vs. passive role) (RRR 0.296, P value 0.029). Our predominantly Spanish speaking Hispanic population showed a preference for collaborative versus active or passive roles. There are several demographic factors that are associated with this preference but it remains important to determine individual's preference for decision making in health care settings.

Shared decision making in the management of midshaft clavicular fractures: Nonoperative treatment or plate fixation

IntroductionMost patients with a displaced midshaft clavicular fracture can be treated either operatively or nonoperatively, with similar long-term outcomes. The treatment choice depends on individual preferences, and is therefore suited for a shared decision making (SDM) approach. However, little is known about SDM in fracture treatment. The purpose of this study was to evaluate the current daily practice of shared decisional behaviour in clavicular fracture treatment, in order to assess the need for improvement and set a baseline level for future research. Patients and methodsAll consecutive adult patients treated in two hospitals for a displaced, midshaft clavicular fracture in 2015 filled out a questionnaire shortly after the decision making moment, that consisted of questions concerning their knowledge and preferences regarding the treatment options; the SDM-Q-9-NL to measure the perceived degree of SDM, and the Control Preferences Scale to measure patients’ preferred and actual roles in decision making. ResultsFifty patients were included. Eighteen percent of the patients were unaware of the treatment options before the consultation, 48% had no preference for either treatment option. The mean score for perceived degree of SDM was 74 out of 100 (SD 23, range 12.5–100). In 68% of patients, the preferred role matched the actual role in making the decision. Sixteen patients (32%) would have preferred either a less (n=8) or a more (n=8) active role. ConclusionThe patient-reported level of SDM in treatment decisions for clavicular fractures was high, but not all patients had the role in this process that they preferred. To improve patients’ involvement in the treatment decision making process for clavicular fractures, it is important to create general awareness about SDM, and increase knowledge of orthopaedic trauma surgeons about SDM behaviour.

Individualized patient decision-aid for immunosuppressive drugs in women with lupus nephritis: study protocol of a randomized, controlled trial

BackgroundSystemic Lupus erythematosus (SLE), also commonly referred to as lupus, is a rare, but sometimes, fatal disease, that primarily affects young women. Lupus nephritis, a common manifestation of lupus, is more common and more devastating in patients of minority race/ethnicity. Patients have negative views of immunosuppressive drugs for lupus nephritis due to a concern about side effects and under-appreciation of its benefit. We designed a study to assess the effectiveness of individualized, computerized patient decision-aid for immunosuppressive drugs for lupus nephritis compared to a standard pamphlet for patient decision-making.MethodsAdult women with lupus nephritis, with a current lupus nephritis flare or at risk of a future lupus nephritis flare will be randomized to individualized, computerized patient decision-aid for immunosuppressive drugs vs. standard pamphlet with information about lupus and its treatment including immunosuppressive drugs and outcomes. Patients will complete outcome assessments immediately after the intervention has been administered. Patients will be followed at 3-months with a brief survey, either in person or on the phone, and at 6-months with medical record review for exploratory outcomes. Co-primary outcomes are decisional conflict and informed choice regarding immunosuppressive drugs (combines values, knowledge and choice). Secondary outcomes include: (1) assessment of patient-physician communication by assessing audio-taped physician-patient communication after intervention administration; (2) concordance between patient’s desired and actual role in immunosuppressive drugs decision-making using the control preference scale (CPS); and (3) patient perception of physician interaction using the interpersonal process of care- short form (IPC-SF).DiscussionThis is one of the first studies to evaluate the effectiveness of an educational intervention targeting minorities with lupus nephritis. This patient-centered lupus nephritis decision-aid will be available in the public domain in English and Spanish.Trial registrationClinicalTrials.gov Identifier: NCT02319525; registered on November 5, 2014.

Patients control preferences and results in knee arthroplasty.

Patient engagement in a patient-physician decision-making process has been correlated with satisfaction and clinical outcomes. Aim of this study is to evaluate if patient control preference may also influence TKA results. One hundred and seventy-six patients (120w-56m, age 66±9years, BMI 28±4) underwent TKA and were prospectively evaluated, before surgery and at 6 and 12months. The preoperative assessment included the Control Preference Scale (CPS) and other scales measuring psychological aspects (STAI, BDI, TSK), as well as SF12 (physical and mental subscales) and the assessment of pain and function. Pain, function, and SF12 subscales were then used to evaluate the improvement at 6- and 12-month follow-up. Pain, function, and SF12 scores improved at 6 and 12months. CPS correlated with the outcome: pain and functional improvement at 6months (p=0.014; p=0.003, respectively), patient function at 6months (p=0.022), improvement of SF12 physical subscale at 6 and 12months (p=0.027; p=0.037, respectively), and satisfaction at 6months (p=0.033). Moreover, the multivariate analysis confirmed the importance of CPS regardless of other demographic, physical or psychological characteristics. In contrast with previous literature findings, this study shows that patients with more propensity for control presented lower improvements of pain and function than those more prone to rely on the physician making the decision. Physicians should be aware that the patient control preference may influence the treatment outcome and undertake measurements to optimize patient participation in the shared process to optimize the chances of TKA success. IV.

The Role of Illness Perceptions on Health-Related Decision-Making—A Focus Group Study of Patients with Long-Term Conditions

Facing long-term conditions, patients often find themselves in situations where they need to make health-related decisions. The aim of this study was to gain a better understanding of patient preferences for involvement in decision-making as well as the process of decision-making both inside and outside the hospital setting. Seventeen participants with various long-term somatic conditions and different types of treatment regimens participated in this focus group study. Preference for involvement in decision-making was quantitatively measured prior to the interviews using the Control Preference Scale. To obtain the qualitative data, an interpretive description strategy was used. The Self-Regulation Model of illness perceptions was applied as a conceptual framework for discussing the findings. A number of discrepancies between questionnaire- and interview data were discovered, indicating that cognitive beliefs about personal involvement in decision-making are influenced and changed by emotions as well as a number of contextual actors, including personal values concerning everyday quality of life. This study provides insight into understanding how context influences self-regulation of health related decisions amongst patients with a number of long-term conditions. Moreover, decisions are not isolated events, they evolve over time. Thus, data on patients' desired level of involvement in decisions based on questionnaire responses alone should be interpreted with caution. Healthcare providers may benefit from exploring the patients’ illness representation in the decision process and thus reduce the risk of talking at cross-purposes.

Abstract: 15.10 Shared Decision-Making In The Management Of Congenital Vascular Malformations

INTRODUCTION: In shared decision-making (SDM) clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients’ personal values and preferences. Little is known about the role of SDM in (paediatric) plastic surgery. For patients with congenital vascular malformations, many therapeutic options exist, ranging from surgery to compression stockings, each with different benefits and harms. Preference-sensitive treatment decision-making seems obvious, however, it has never been explored whether patients desire SDM and to what extent SDM is already practiced. Therefore, we investigated preferences regarding decision-making and current SDM behaviour during physician-patient encounters in this patient cohort. MATERIALS AND METHODS: In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale; CPS). Afterwards, participants completed SDM-specific questionnaires (SDM-Q-9, CollaboRATE and satisfaction), physicians completed the SDM-Q-Doc questionnaire. Consultations were audiotaped and patient involvement was scored by 2 independent researchers, using the Observing Patient Involvement (OPTION-5) instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum SDM). RESULTS: Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the SDM-approach (CPS). Objective OPTION-5 scores were low (mean 31 SD 15), whereas patient and physician SDM-Q scores were moderately high; means 68 (SD 18) and 68 (SD 19), respectively. The median CollaboRATE score was 93. There was no clear relationship between SDM and satisfaction scores. CONCLUSIONS: Although adults and parents of children with vascular malformations express a strong desire for SDM, objective SDM-behaviour is still lacking, most likely due to poor awareness of the SDM-concept among parents, patients and physicians. To improve SDM-practice in (paediatric) plastic surgery, targeted interventions (like decision aids, staff training) are essential.

Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

Objective:This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined.Methods:We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed.Result:About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future.Conclusion:Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process.

Improving shared decision-making in adolescents through antibiotic education.

Background Shared decision-making is vital in achieving desired drug therapy goals, especially with antibiotics, in view of the potential long-term reduction in drug resistance. However, shared decision-making is rarely practiced with adolescent patients. Objectives The aim of the study was to identify the effect antibiotic education has on willingness to engage in shared decision-making among adolescents in Malaysia. Setting Participants from secondary schools in Malaysia were enrolled with ethical approval. Method The adolescents answered a validated questionnaire, which included demographics, antibiotic knowledge, attitude towards antibiotic use, and the Control Preference Scale, which measures willingness to engage in shared decision-making. Afterwards, antibiotic education was delivered to participating students. Main outcome measure Knowledge about and attitude toward antibiotics were investigated. Results A total of 510 adolescents participated in the study. Knowledge of antibiotics significantly increased post education (pre 3.2±1.8 vs. post 6.8±2.1, p<0.001), as did attitude score (pre 3.3±1.7 vs. post 5.4±1.9, p=0.003). Interestingly, adolescents were less likely to be passively involved in shared decision-making post education (χ=36.9, df=2, p<0.001). Adolescents who were more collaborative in shared decision-making had a significantly higher total antibiotics knowledge and attitude scores compared to those who were not collaborative (p=0.003). Conclusion The present work demonstrates that antibiotic education improves knowledge, attitude, and willingness to engage in shared decision-making among adolescents. Antibiotic education can therefore be introduced as a strategy to reduce inappropriate antibiotic use.

Web-based medical and health information in multiple sclerosis: for patients and physicians.

Neurodegenerative Disease ManagementVol. 6, No. 6s Symposium PaperWeb-based medical and health information in multiple sclerosis: for patients and physiciansAlessandra SolariAlessandra Solari*Author for correspondence: E-mail Address: Alessandra.Solari@istituto-besta.it Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, ItalySearch for more papers by this authorPublished Online:22 Nov 2016https://doi.org/10.2217/nmt-2016-0050AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleKeywords: decision aidsmultiple sclerosispatientsself-managementshared decision makingweb resourcesReferences1 Lejbkowicz I, Paperna T, Stein N, Dishon S, Miller A. Internet usage by patients with multiple sclerosis: implications to participatory medicine and personalized healthcare. Mult. Scler. Int. 2010, 640749 (2010).Medline, Google Scholar2 Solari A, Giordano A, Kasper J et al. Role preferences of people with multiple sclerosis: image-revised, computerized self-administered version of the Control Preference Scale. PLoS ONE 8, e66127 (2013).Crossref, Medline, CAS, Google Scholar3 Pietrolongo E, Giordano A, Kleinefeld M et al. Decision-making in multiple sclerosis consultations in Italy: third observer and patient assessments. PLoS ONE 8, e60721 (2013).Crossref, Medline, CAS, Google Scholar4 Holmes-Rovner M. International Patient Decision Aid Standards (IPDAS): beyond decision aids to usual design of patient education materials. Health Expect. 10, 103–107 (2007).Crossref, Medline, Google Scholar5 International patient decision aid standards (IPDAS). www.ipdas.ohri.ca.Google Scholar6 Stacey D, Bennett CL, Barry MJ et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. 10, CD001431 (2011).Google Scholar7 Köpke S, Solari A, Khan F, Heesen C, Giordano A. Information provision for people with multiple sclerosis. Cochrane Database Syst. Rev. 4, CD008757 (2014).Google Scholar8 Solari A, Martinelli V, Trojano M et al. An information aid for newly diagnosed multiple sclerosis patients improves disease knowledge and satisfaction with care. Mult. Scler. 16, 1393–1405 (2010).Crossref, Medline, CAS, Google Scholar9 Giordano A, Lugaresi A, Confalonieri P et al. Implementation of the ‘Sapere Migliora’ information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial. Mult. Scler. 20, 1234–1243 (2014).Crossref, Medline, CAS, Google Scholar10 Galea I, Lederer C, Neuhaus A et al. A web-based tool for personalized prediction of long-term disease course in patients with multiple sclerosis. Eur. J. Neurol. 20, 1107–1109 (2013).Crossref, Medline, CAS, Google Scholar11 Colombo C, Filippini G, Synnot A et al. Development and assessment of a website presenting evidence-based information for people with multiple sclerosis: the IN-DEEP project. BMC Neurol. 16, 30 (2016).Crossref, Medline, Google Scholar12 MS Decisions. www.msdecisions.org.uk.Google Scholar13 Healthwise: Health Content and Patient Education Solutions. www.healthwise.org.Google Scholar14 PatientsLikeMe: Live better, together! www.patientslikeme.com.Google Scholar15 Khan F, Amatya B, Kesselring J, Galea M. Telerehabilitation for persons with multiple sclerosis. Cochrane Database Syst. Rev. (4), CD010508 (2015).Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByAdvance Care Planning in Neurodegenerative Disorders: A Scoping Review12 January 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 2RebiQoL: A randomized trial of telemedicine patient support program for health-related quality of life and adherence in people with MS treated with Rebif5 July 2019 | PLOS ONE, Vol. 14, No. 7 Vol. 6, No. 6s Follow us on social media for the latest updates Metrics Downloaded 69 times History Published online 22 November 2016 Published in print December 2016 Information© Future Medicine LtdKeywordsdecision aidsmultiple sclerosispatientsself-managementshared decision makingweb resourcesFinancial & competing interests disclosureA Solari is an advisory board member for Genzyme, Merck Serono and Novartis; and has received honoraria for lecturing from Almirall, Biogen, Excemed, Genzyme, Novartis and Teva. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Writing assistance was utilized in the production of this manuscript. Writing assistance was provided by Content Ed Net (Madrid, Spain), with funding from Almirall SA (Barcelona, Spain).PDF download

Preliminary Identification of Coping Profiles Relevant to Surrogate Decision Making in the ICU

ObjectiveThe Intensive Care Unit (ICU) is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience.MethodsParticipants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual’s ICU experience. Quality of life was measured by the EQ-5D, personality dimensions were examined with the abbreviated Big Five inventory, coping with stress was assessed with Brief COPE. Shared decision making preferences were assessed by the Degner Control Preferences Scale (CPS) and information seeking style was assessed with the Miller Behavioral Style Scale (MBSS). Social support was examined using an abbreviated version of the Social Relationship Index. Participants also completed a vignette-based simulated ICU experience, in which they made a surrogate decision on behalf of a loved one in the ICU.ResultsThree hundred forty-three participants completed the study. Three distinct coping profiles were identified: adaptive copers, maladaptive copers, and disengaged copers. Profiles differed primarily on coping styles, personality, quality of their closest social relationship, and history of anxiety and depression. Responses to the simulated ICU decision making experience differed across profiles. Disengaged copers (15%) were more likely to elect to refuse dialysis on behalf of an adult sibling compared to adaptive copers (7%) or maladaptive copers (5%) (p = 0.03). Notably, the MBSS and the CPS did not differ by coping profile.ConclusionDistinct coping profiles are associated with differences in responses to a simulated ICU experience. Tailoring communication and support to specific coping profiles may represent an important pathway to improving ICU experience for patients and families.

Validity of the Control Preferences Scale in patients with emotional disorders.

BackgroundThe Control Preferences Scale (CPS) is the most frequently used measure of patients’ preferred roles in treatment decisions. The aim of this study was to provide data about the validity of CPS in psychiatric care of patients with emotional disorders.MethodsThe original CPS was translated to Spanish using the process of cross-cultural adaptation of self-reported measures as the methodological model for Spanish translation. The final version was tested in a convenience sample of 621 consecutive psychiatric outpatients (461 depressive and 160 anxiety disorders) that also completed the Shared Decision-Making Questionnaire, the Multidimensional Health Locus of Control Scale, the Drug Attitude Inventory, and a questionnaire including sociodemographic and clinical variables.ResultsCPS showed a moderate internal consistency and a good convergent validity. Patients with collaborative and passive preferences expressed a greater reliance on psychotropics. Patients preferring a collaborative role self-reported greater perception of involvement in decision-making about their treatment. Patients preferring a passive role showed a greater external health locus of control. The most common preferred role was the collaborative–passive. Older patients and those under longer treatments preferred a passive role, while patients with higher levels of education preferred a collaborative role.ConclusionThe CPS is a valid measure of the amount of control that psychiatric outpatients with emotional disorders want to assume in the process of making decisions about their treatment.