Increase Patient Knowledge Research Articles

Implementation of Patient-Centered Shared Decision Making for LVAD Candidates: Year 1 Results of a Multi-Site Study

A decision aid (DA) prior to left ventricular assist device (LVAD) placement significantly increased patient knowledge and satisfaction with life after LVAD implant in a multi-site RCT (VADDA). Little evidence exists regarding best practices for implementation of a DA in real-world cardiovascular care. This project aims to evaluate DA implementation at nine U.S. hospitals with a focus on optimizing shared decision-making (SDM). Sites received an implementation plan and participated in a training webinar about ways to use the DA during LVAD evaluation to promote SDM. LVAD coordinators completed a 10-item SDM Implementation Fidelity Checklist (score 0-10) describing optimal DA use and integration of SDM as part of the DA deployment for each patient. DA "reach" is calculated by dividing the number of checklists received by the total number of patients receiving pre-LVAD education during evaluation. DA "fidelity" is calculated using LVAD coordinator self-report of the patient encounter on the Fidelity Checklist. Sites received ongoing monitoring and support from a coordinating center to discuss barriers and facilitators of DA use. Physicians and coordinators (n=30) were surveyed about their attitudes towards use of the LVAD decision aid during the first year of implementation. 454 patients received a DA from September 2018-September 2019 with an average Fidelity Checklist score of 8.5 (range 6.2-10.0). Reach ranged from 14.7%-90.2% of patients across sites with an overall reach of 53.2%. At baseline, a majority (60%, SD=1.00) of cardiologist and coordinator stakeholders believed DAs are relevant to clinical practice, and agree they improve patients' knowledge (63%, SD=0.87), satisfaction (57%, SD=0.95) and decrease anxiety (57%, SD=0.97). The most frequently cited barrier to using DAs was "not enough time to use the tool in its entirety" (50%, SD=1.34) and questioning that "the effectiveness of the aid was not well established" (40%, SD=1.42). These findings support the feasibility, high fidelity and usefulness of a LVAD DA into busy real-world cardiovascular care. The majority of clinical providers believe the aid is relevant to clinical practice.

Heart Failure Support Group

Background/Objectives Heart Failure, a leading disease that is responsible for hospitalizing and/or killing millions of Americans every year. Heart Failure is amongst the leading diagnosis that results in frequent admission and readmission rates, resulting in millions of dollars spent by health care facilities every year. Lack of information, comprehension, and communication regarding heart failure and treatment provided by healthcare provider's, results in patients being hospitalized more frequently for longer admissions. To aid the improvement in heart failure management the focus group will concentrate on increasing patient knowledge of heart failure and ways to better manage this disease. The overall goal was to improve the knowledge base of heart failure patients on 5E by 90% after attending the focus group. Methods In efforts to better serve the heart failure population, the Heart Failure Unit at Christiana Care developed a focus group that concentrates on heart failure education and maintenance strategies. The focus group provides biweekly sessions organized by the Facilitator and a RN III who provided education sessions that discuss what heart failure is, how it can be treated and life style change that must occur to control symptoms (examples: daily weights, low sodium diets, family support, follow up with medical professionals, what to eat while at a restaurant). Evaluation of heart failure knowledge prior to attending the focus group was determined by having the patients complete a pretest. The pretest identified patient's knowledge base of heart failure, frequency and cause of heart failure admissions, and an assessment on identifying signs of heart failure and how it can be controlled. With review of the pretest 66.6% of patients identified lack of knowledge as their cause of readmission while 33.4% identified lack of desire to create lifestyle changes. With a large percentage identifying lack of knowledge as a main source of readmission, it was clear that guidance and education was necessary to better provide for these patients. Results/outcomes After attending the heart failure focus group, patients were asked to repeat the test with their new-found knowledge. Comparison of the pre and post test results identified that 100% of patients felt their knowledge base of the discussed heart failure topic had increased after attending the focus group. 66.6% of the patients that attended the focus group were able to identify signs of heart failure that require medical attention and ways to prevent progression of the disease after the educational session. Positive feedback from patients and results of knowledge base were identified after reviewing the results following the focus group. Conclusion Reviewing the results obtained post focus group identified a weakness in the lack of participants and frequency of group sessions. Over the next year the focus group will be increased frequency to three days a week as well as attempt to increase the number of participants. After establishment of the focus group, we hope to encourage other units to implement a similar educational experience or to participate in the focus group improve patient care and education for all heart failure patients.

Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south.

Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty. This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient. Free clinic in the United States rural south. Twenty-four patients with comorbid hypertension and type 2 diabetes. A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention. A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%. The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.

Cognition, Emotion, and the Bladder: Psychosocial Factors in bladder pain syndrome and interstitial cystitis (BPS/IC).

To review findings from empirical studies assessing the role of psychosocial factors in bladder pain syndrome and interstitial cystitis (BPS/IC). There is a high rate of psychosocial comorbidity in BPS/IC, including elevated levels of anxiety and depression. Recent studies assessing the role of illness perceptions in BPS/ICrelate poorer illness perceptions to more unhelpful illness coping patterns. Conversely, positive illness perceptions including self-efficacy in illness management are associated with more adaptive coping behaviors such as exercising and acceptance. New research is investigating the role of trauma in BPS/ICand the impact of suicidality. There is a paucity of psychosocial interventions for BPS/ICover the last 5 years. The three small-scale studies reviewed included a mindfulness-based stress reduction (MBSR) intervention tailored for BPS/IC, a brief self-management intervention designed to increase patient knowledge and symptom management techniques and a 90-minute interview aimed at increasing awareness about physiological-affective relationship in IC.

Factors influencing Australian podiatrists\u2019 behavioural intentions to adopt a smart insole into clinical practice: a mixed methods study

BackgroundDiabetes is the leading cause of lower limb amputation in Australia, costing the Australian health care system an estimated A$1.6 billion annually. Podiatrists are the primary foot health care provider in Australia. Research suggests that health professional attitudes can impact patient utilisation of e-health technologies, such as wearable foot monitoring devices aimed at preventing foot ulceration. The aim of this study was to explore factors that impact the intentions of Australian podiatrists to adopt smart insole foot monitoring technology.MethodsA mixed methods explanatory sequential design was undertaken. One hundred and eleven Australian podiatrists completed an online version of the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the strongest predictive model of podiatrists’ behavioural intention to adopt technology. Additionally, two focus groups were conducted, and thematic analysis was performed to explore podiatrists’ perceived barriers and enablers to smart insole adoption.ResultsOne hundred and eleven Australian podiatrists completed the online UTAUT questionnaire. The majority of respondents practiced in the private sector (58.6%) and were female (50.5%), with Victoria the most common practice location (39.6%). Significant positive correlations existed between behavioural intention and six psychosocial domains including performance expectancy (r = 0.64, p < 0.001), effort expectancy (r = 0.47, p < 0.001), attitude (r = 0.55, p < 0.001), social influence (r = 0.45, p < 0.001), facilitating conditions (r = 0.36, p < 0.001), and self-efficacy (r = 0.30, p < 0.002). Multiple regression analysis determined that performance expectancy alone was most predictive of behavioural intention to adopt a smart insole into clinical practice (adjusted R2 = 42%, p < 0.001). Qualitative analyses revealed that podiatrists believed that the insole would increase patient knowledge, engagement and self-efficacy. However, concerns were raised about cost, footwear issues and the device’s utility with elderly and remote populations.ConclusionsPerformance expectancy was the most important psychosocial factor predicting the intentions of Australian podiatrists to adopt smart insole foot monitoring technologies. While Australian podiatrists are open to adopting smart insoles into clinical practice, evidence of the device’s efficacy is a precursor to adoption. Other perceived barriers to adoption including device cost, compatibility with off-loading, footwear issues and patient age also need to be addressed prior to implementation and clinical adoption.

117 Effectiveness of Physician-Tailored Medical Care on Patient Understanding and Doctor-Patient Trust

With improving technology, patients are more likely to conduct internet-based searches to understand their health problems. Quality educational materials, especially in urology-related fields, are often difficult to find. In urology practice, quality educational DVDs have been noted to increase patient knowledge, satisfaction, and patient-physician communication. This descriptive pilot study aims to gather preliminary data to determine the potential effectiveness of physician-led pre-encounter patient education videos in the field of sexual medicine. In this prospective clinical study, men ≥ 18 years with scheduled clinic visits for testosterone deficiency (TD) and/or erectile dysfunction (ED) were consented and randomized into one of two cohorts: control (n= 33) or video (n=27). Both groups underwent routine clinic visits, with the video cohort additionally watching physician-led educational videos on their specific health condition(s) at the appointment, before meeting with the physician. Pre- and post- knowledge assessments and visit satisfaction surveys were then administered. Clinical characteristics were reported as aggregate counts both overall and by cohort. Differences between groups were evaluated with a two-sample t-test where appropriate.

A cross-sectional study exploring levels of physical activity and motivators and barriers towards physical activity in haemodialysis patients to inform intervention development

Purpose To describe physical activity (PA) levels and motivators and barriers to PA amongst haemodialysis (HD) patients and to identify an appropriate approach to increasing their PA. Methods A cross-sectional mixed methods study conducted in a tertiary and satellite HD unit. One hundred and one participants aged 18 years and over, receiving regular HD for at least four months, were recruited. Patients with recent hospital admission or acute cardiac event were excluded. Participants completed health status (EQ-5D-3L™) and activity (Human Activity Profile (HAP)) questionnaires. A subgroup was invited to wear accelerometers and wearable cameras to measure PA levels and capture PA episodes, to inform subsequent semi-structured interviews on motivators and barriers. Semi-structured interviews were analysed using the framework method informed by constructs of the Health Belief Model. Results 98/101 completed the study (66 males, 32 females). For 68/98 participants, adjusted activity scores from the HAP indicated “impaired” levels of PA; for 67/98 participants, the EQ-5D-3L indicated problems with mobility. Semi-structured interviews identified general (fear of falls, pain) and disease specific barriers (fatigue) to PA. Motivators included tailored exercise programmes and educational support from health care professionals. Conclusions Participants indicated a need for co-development with healthcare professionals of differentiated, targeted exercise interventions. Implications for rehabilitation Healthcare professionals should encourage and motivate haemodialysis patients to participate in physical activity (PA). As part of this approach, there is a need to increase patient knowledge of safe beneficial exercise activities and help individuals identify and overcome barriers. To allow for individualised approaches, clinical interventions should focus on other community activities that patients can do outside the dialysis clinic setting and utilise existing networks such as the British Renal Society Rehabilitation Network. The dialysis clinic provides professionals the opportunity to monitor and motivate patients. Relevant education is needed for staff about the benefits of PA and how to engage patients and their carers in safe and effective approaches.

Making decisions about antipsychotics: a qualitative study of patient experience and the development of a decision aid

BackgroundShared decision making is a widely accepted standard of patient-centred care that leads to improved clinical outcomes, yet it is commonly underutilised in the field of mental health. Furthermore, little is known regarding patient decision making around antipsychotic medication, which is often poorly adhered to. We aim to explore psychiatric patients’ experiences of antipsychotic medication decision making in order to develop a patient decision aid to promote shared decision making.MethodsFocus groups were conducted with patients with chronic psychotic illnesses (n = 20) who had previously made a decision about taking or changing antipsychotic medication. Transcripts were coded and analysed for thematic content and continued until thematic saturation. These themes subsequently informed the development of a decision aid with the help of expert guidance. Further patient input was sought using the think aloud method (n = 3).ResultsTwenty-three patients participated in the study. Thematic analysis revealed that ‘adverse effects’ was the most common theme identified by patients surrounding antipsychotic medication decision-making followed by ‘mode and time of administration’, ‘symptom control’ and ‘autonomy’. The final decision aid is included to provoke further discussion and development of such aids.ConclusionsPatients commonly report negative experiences of antipsychotic medication, in particular side-effects, which remain critical to future decision making around antipsychotic medication. Clinical encounters that increase patient knowledge and maximise autonomy in order to prevent early negative experiences with antipsychotic medication are likely to be beneficial.

The impact of decision aids in patients with colorectal cancer: a systematic review

ObjectivesOur aim was to conduct a systematic review of the literature to determine the impact of patient decision aids (PDA) on patients facing treatment decisions for colorectal cancer.DesignSystematic review.Data sourcesSources...

Standardization of Education of Patients With Cancer in a Low- and Middle-Income Country: A Quality Improvement Project Using the Cancer and You Booklet.

PURPOSEThe Butaro Cancer Centre of Excellence is the first comprehensive referral cancer center in Rwanda and at its inception did not have a standardized patient education program. Partners in Health/Inshuti Mu Buzima and the Rwandan Ministry of Health conducted a quality improvement project to increase patient knowledge by implementing a standardized oncology education program using picture-based and culturally appropriate materials designed for patients with cancer in low- and middle-income countries.METHODSFour Rwandan nurses were trained to provide patient education using the Cancer and You education booklet created by Global Oncology. A pre- and post-test design was used to evaluate patients’ knowledge of cancer, treatment, and management of adverse effects. Nurses administered a posteducation questionnaire in Kinyarwanda to determine patients’ level of satisfaction with the education session and booklet. The four nurses were interviewed at the completion of the project for their feedback. A total of 40 oncology patients were included in the pilot project, of which 85% reported completing primary school or less.RESULTSOn average, participants improved 19% (95% CI, 13.9% to 24.1%; standard deviation, 16%) from pre- to postevaluation, demonstrating a significant increase in knowledge (P ≤ .001). Nearly all patients (97.5%) reported that they were either satisfied or very satisfied with the education program. Oncology nurses gave positive feedback, highlighting that it was helpful to have a standard tool for education with descriptive illustrations for those patients with low literacy.CONCLUSIONImplementation of a standardized patient education program demonstrated a statistically significant increase in patient knowledge and a high level of satisfaction among patients and nurses. The project serves as an example for other low- and middle-income countries looking to standardize oncology patient education.

DOZ047.63: Closing the gap: transitioning adolescents with esophageal atresia to adult care

Abstract Introduction Evidence supports engaging adolescents and carers in an individualized transition process to improve health outcomes through increased patient knowledge, skills, adherence, quality of life and ultimately, engagement with adult services. Further, a comprehensive transition process promotes confidence in navigating adult health services. While transition for chronic medical cohorts has received considerable attention over decades, there is increasing recognition of the importance of transition for adolescents with surgical conditions. Background It is widely held that the transition of adolescents born with esophageal atresia (OA) from pediatric to adult services is important, and if not managed well, may compromise outcomes. We designed and implemented a transition process for adolescent OA patients at our hospital (with establishment of a transfer pathway in partnership with adult health services) in 2017. Methods Following implementation of a transition process a retrospective review was undertaken in 2019 to identify themes from the dedicated Transition Support Service (TSS) Clinics (October, 2017–December, 2018) for OA patients aged 15–19 years. Patients were identified from an institutional database (Nate Myers Oesophageal Atresia Database, Royal Children's Hospital, Melbourne). These patients had previously been invited to: Attend TSS Clinics as part of routine clinical care.Re-engage in multidisciplinary follow-up (if necessary) including with a consultant surgeon, OA nurse and respiratory physician. Institutional ethics approval was obtained prior to commencement of the study (HREC #QA/51265/RCHM-2019). Results A total of 18 adolescent OA patients and their parents attended RCH TSS and associated follow-up clinics. We observed three key themes in attendees reports and experiences: Poor health knowledge: 56% of adolescents had poor knowledge about their OA, including previous surgery, possible complications and their symptoms;Poor compliance: 54% of adolescents reported poor compliance with prescribed regular medications (e.g. anti-reflux therapy);Mental health issues: 39% of adolescents identified as having mental health concerns, e.g. low mood or clinical depression, anxiety, anger or had engaged in self-harm. Anxiety about transfer to adult services was moderate to high in the majority (61%) of adolescents and their parents. Conclusions The themes identified in this study support the need for, and importance of, a structured process to transition adolescents born with OA to adult services.

Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCT

Colorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with "usual care," but whether interactivity further increases CRCS rate remains unknown. A two-armed RCT compared the effect of a web-based DA that interactively assessed patient CRC risk and clarified patient preference for specific CRCS test to a web-based DA with the same content but without the interactive tools. The study sites were 12 community- and three university-based primary care practices (56 physicians) in southeastern Michigan. Participants were men and women aged 50-75 years not current on CRCS. Random allocation to interactive DA (interactive arm) or non-interactive DA (non-interactive arm). Primary outcome was medical record documentation of CRCS 6 months after the intervention. Secondary outcome was patient decision quality (i.e., knowledge, preference clarification, and intent) measured immediately before and after DA use, and immediately after the office visit. To determine that either DA had a positive effect on CRCS adherence, usual care CRCS rates were determined from the three university-based practices among patients eligible for but not participating in the study. Data were collected between 2012 and 2014; analysis began in 2015. At 6 months, CRCS rate was 36.1% (95% CI=30.5%, 42.2%) in the interactive arm (n=284) and 40.5% (95% CI=34.7%, 46.6%) in the non-interactive arm (n=286, p=0.29). Usual care CRCS rate (n=440) was 18.6% (95% CI=15.2%, 22.7%), significantly lower than both arms (p<0.001). Knowledge, attitude, self-efficacy, test preference, and intent increased significantly within each arm versus baseline, but the rate was not significantly different between the two arms. The interactive DA did not improve the outcome compared to the non-interactive DA. This suggests that the resources needed to create and maintain the interactive components are not justifiable. This study is registered at www.clinicaltrials.gov NCT01514786.

Tablet-Based Patient Education Regarding Human Papillomavirus Vaccination in Colposcopy Clinic

The aim of this study was to use an electronic tablet-based education module to increase patient knowledge about human papillomavirus (HPV). Patients presenting to an academic colposcopy clinic were first queried as to whether they had been infected with HPV. A quality improvement project was then conducted using a 4-question pretest assessing baseline knowledge about HPV and cancer, followed by a tablet-based education module and a 5-question posttest. Between June 2017 and January 2018, 119 patients participated in the tablet education. At their initial visit, only 50 (42.0%) of patients were aware that they had an HPV infection; however, medical records revealed that 74 women (62.2%) were presenting with a documented HPV infection. After the tablet education, 95% of women identified cervical cancer as a problem that can be caused by HPV, as compared with 88.2% in the pretest (p = .046). Knowledge of head and neck cancer as a disease that can be caused by HPV increased from 10.9% to 80.7% (p < .001). More patients answered that they "definitely" or "probably" would consider the vaccine for a child in their family: 108 (95.6%) pretest vs. 112 (99.1%) posttest (p = .046). The activities were ranked as "extremely" or "very" helpful by 93.3% of patients. Patients presenting to colposcopy clinic are not well educated regarding the connection between an abnormal Pap test, HPV infection, and certain cancers. Tablet-based education improves patient knowledge of HPV-associated cancers in an outpatient clinic setting.

Visualizing Prenatal Twin Anatomy: A Parent Education Resource for Twin‐Twin Transfusion Syndrome

Twin‐twin transfusion syndrome (TTTS) is a complication occurring in 10–20% of monochorionic diamniotic multiple pregnancies characterized by unequal circulation due to placental anastomoses. Left untreated, chronic TTTS has an 80–100% mortality rate, with sequelae including cardiovascular, neurodevelopmental and renal anomalies in surviving infants. Prognosis is improved by timely diagnosis and intervention, with selective fetoscopic laser photocoagulation emerging as the front‐line treatment. Considering poor prognosis and the urgent need for invasive treatment, TTTS announcement is a traumatic event for expectant parents regardless of survival outcome, thus adequate support from their providers is essential. Parent perception of their care relies on receiving ample information, and while antenatal multidisciplinary consultations at fetal centers provide space for parent education, parents often have difficulty understanding the fetal and placental anatomy. Currently, at the Colorado Fetal Care Center, supplemental educational resources include 2D images and literature intended for a scientific audience. The objective of this project was to develop and implement an interactive 3D virtual model of TTTS during antenatal consultations to facilitate parent education. The model was developed from deidentified fetal MRI Digital Imaging and Communications in Medicine (DICOM) data demonstrating TTTS (COMIRB # 18‐1955). A total of 10 MRI datasets (6 with selective intrauterine growth restriction (SIUGR), 4 without SIUGR) were identified as possible candidates. One dataset was selected for model construction based on representation of the pathology. The DICOM data was segmented on 3D Slicer. The segmentations were imported into Blender for 3D rendering and to smooth artifacts, then published onto Sketchfab for user interaction. The tool was assessed by obstetric and surgical specialists for accuracy. By providing an anatomically accurate fetal, placental, and pathologic anastomosis visualization, this model can assist providers in demonstrating the diagnosis, explaining prognosis, and discussing potential treatment options. The new 3D, interactive virtual TTTS model has the potential to improve parents' experience by increasing patient knowledge and engaging them in the intervention planning required to optimize fetal outcomes. Further investigation is required to determine the efficacy and educational value of the model.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Study aims to improve colorectal cancer screening rates.

Study aims to improve colorectal cancer screening rates.

A 3-Dimensional Anatomical Education Model in Postpartum Perineal Laceration Care: A Pre-Post Intervention Study.

The aim of this study was to investigate the effects of postpartum patients introduction to and interaction with a virtual 3-dimensional (3D) pelvic model on the self-care, knowledge, and anxiety parameters. The model was designed from computed tomography data displaying the involvement of the levator ani in a fourth-degree perineal laceration. This 3D model was used to educate postpartum day 1 patients at the bedside. Patient data were collected using a pre and post questionnaire assessing knowledge, anxiety, and confidence in perineal wound self-care. Thirty-six patients were enrolled with a median age of 28.5 years (interquartile range, 31, 21.75 years) and a median parity of 1 (interquartile range, 2, 1). Patient use of the tool significantly decreased patient anxiety regarding perineal lacerations (P < 0.01) and significantly increased patient knowledge on what part of their vagina was lacerated during vaginal delivery (P < 0.01). Reviewing a 3D model of perineal lacerations with patients on postpartum day 1 is associated with less anxiety and increased knowledge of pelvic floor anatomy. These pilot data represent a preliminary investigation into the relations between 3D model of perineal lacerations and a range of patient outcomes.

The Influence of Self Management Dietary Counseling on The Value of Sodium and Edema in Hemodialysis Patients

Background: Reducing salt care &amp; reducing fluid intake is one of the efforts to prevent fluid imbalance in patients. The increase in the prevalence of events that occur in hemodialysis patients is caused by various factors, one of which is inaccuracy in doing therapy. Self Management Dietary Counseling (SMDC) aims to increase patient knowledge and participate in health decision making to improve patient compliance and clinic outcome.Purposes : Knowing the effect of Self Management Dietary Counseling (SMDC) on the value of sodium in hemodialysis patients.Methode : Quasy Experiment, prestest - post test design, 60 samples consisted of 3 groups. Sampling using random sampling technique.Result : the group treated with SMDC has a p value &lt;0.050, while the non-treated group has a p value&gt; 0, 050.Conclusion : Self Management Dietary Counseling has an effect on the value of sodium in hemodialysis patients. This study recommends that nurses apply SMDC to each hemodialysis patient to improve the value of sodium.Keywords : SMDC, hemodialisa, sodium, edema

Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy.

Stroke prevention therapy decisions for patients with atrial fibrillation (AF) are complex and require trade-offs, but few validated patient decision aids (PDAs) are available to facilitate shared decision making. To evaluate the effects of a novel PDA on decision-making parameters for AF patients choosing stroke prevention therapy. We developed an evidence-based individualized online AF PDA for stroke prevention therapy and evaluated it in a prospective observational pilot study. The primary outcome was decisional conflict. Secondary outcomes were knowledge, usability/acceptability, patient preferences, effects on therapy choices, and participant feedback. 37 participants completed the PDA. The PDA could be completed independently and was well accepted. It significantly decreased the mean decisional conflict score ( P < 0.001) and all its subscales and increased participant AF knowledge ( P = 0.02). 76% of participants indicated that their individualized therapy attribute ranking was congruent with their values. The PDA-generated best-match therapy was chosen by 70% of participants in decision 1 (no therapy, aspirin, or oral anticoagulant), and 17% for decision 2 (choice of anticoagulant). Among AF patients, 60% chose a different drug than that currently prescribed to them. Conclusion and Relevance: Our PDA was effective for reducing decisional conflict, increasing patient knowledge, eliciting patients' values, and presenting therapy options that aligned with patients' values and preferences. Using the PDA revealed that many patients have therapy preferences different from their currently prescribed treatment. The PDA is a practical and potentially valuable tool to facilitate decision making about stroke prevention therapy for AF.

Effect of the public disclosure of industry payments information on patients: results from a population-based natural experiment.

ObjectiveTo determine the effect of the public disclosure of industry payments to physicians on patients’ awareness of industry payments and knowledge about whether their physicians had accepted industry payments.DesignInterrupted time series with comparison group (difference-in-difference analyses of longitudinal survey).SettingNationally representative US population-based surveys. Surveys were conducted in September 2014, shortly prior to the public release of Open Payments information, and again in September 2016.ParticipantsAdults aged 18 and older (n=2180).Main outcome measuresAwareness of industry payments as an issue; awareness that industry payments information was publicly available; knowledge of whether own physician had received industry payments.ResultsPublic disclosure of industry payments information through Open Payments did not significantly increase the proportion of respondents who knew whether their physician had received industry payments (p=0.918). It also did not change the proportion of respondents who became aware of the issue of industry payments (p=0.470) but did increase the proportion who knew that payments information was publicly available (9.6% points, p=0.011).ConclusionsTwo years after the public disclosure of industry payments information, Open Payments does not appear to have achieved its goal of increasing patient knowledge of whether their physicians have received money from pharmaceutical and medical device firms. Additional efforts will be required to improve the use and effectiveness of Open Payments for consumers.

Examination of Current Treatments and Symptom Management Strategies Used by Patients With Mal De Debarquement Syndrome.

Introduction: Mal de Debarquement Syndrome (MdDS) is a neurological disorder which affects the vestibular system pathways, manifesting as a constant sensation of movement in the form of rocking, bobbing, or swaying. The mechanism of MdDS is poorly understood and there is a lack of awareness amongst medical professionals about the condition. This study aimed to examine treatments and symptom management strategies used by MdDS patients and evaluate their self-reported effectiveness.Method: Motion-Triggered and Spontaneous/Other onset MdDS patients responded to a set of comprehensive questions as a retrospective survey regarding epidemiological details, diagnostic procedures, onset, and symptom triggers, hormonal influences as well as treatments and symptom management strategies used to reduce symptoms. The Motion-Triggered questionnaire was made available through Survey Monkey and the Spontaneous/Other Onset questionnaire through Qualtrics. The link for each questionnaire was made available on online MdDS support groups and on various research websites. Descriptive statistics were used for epidemiological data and Pearson's Chi Square tests were used for comparisons between and within both subtype groups.Results: A total of 370 patients participated in the surveys, with 287 valid responses collected for the section regarding treatment and symptom management strategies. The success of the treatments and symptom management strategies did not vary between subtypes Benzodiazepines/Antidepressants were reported as being most beneficial in reducing symptoms in both groups.Conclusion: This was the first attempt to evaluate the reported success of treatments and symptom management strategies in MdDS patients by assessing the patients' perceived helpfulness. The treatments and symptom management strategies reported to be the most helpful in managing and/or reducing symptoms are proposed to be effective due to their stress-reducing capacities. We hope this study will broaden MdDS awareness and that this study will increase patient knowledge regarding treatments and symptom management strategies that other patients found helpful.