Increase Patient Understanding Research Articles

Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives.

ObjectiveTo explore patient preferences that influence decision‐making in the management of rheumatoid arthritis (RA) by indigenous patients living in southern Alberta, Canada.MethodsWe conducted a qualitative narrative‐based study within a social constructivist framework. Thirteen in‐depth interviews with indigenous patients with RA who had attended 1 of 3 rheumatology practices in southern Alberta (1 rural and 2 urban) were completed. Codes generated through 2 phases of analysis were condensed into main themes, triangulated, and used to produce theoretical statements.ResultsPatients preferred to use a combination of nonpharmacologic and pharmacologic treatments to manage their RA. Nonpharmacologic treatments included physical, mental, emotional, and spiritual strategies. Patients’ preferences for taking medications varied and were influenced by factors that were clinical (i.e., trust in health providers and understanding drugs’ mechanisms of action, benefits, harms, and administration burden), familial (i.e., support), and societal (i.e., access to medications and stigmatization of drug dependency).ConclusionIndigenous patients apply a holistic approach to the nonpharmacologic management of RA. Increases in preferences for RA medications could be supported through enhanced communication strategies to increase patient understanding of medication effects and health provider recognition of societal and familial influences on patient decisions. A patient–provider relationship based on trust was fundamental to reaching mutual understanding and should be fostered by models of practice that promote cultural safety, empathy, compassion, openness, acknowledgment, and respect of cultural differences.

Communication and understanding of mild cognitive impairment diagnoses.

Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis. To identify how MCI is communicated and to explore the relationship with patient and companion understanding. Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding. Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia. Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.

P004 A PERSPECTIVE ON PORTRAYAL: MEN AND MINORITIES ARE UNDER-REPRESENTED ON BIOLOGIC WEBSITES

Abstract Introduction Biologics are important options for inflammatory bowel disease (IBD) management. It has been reported that people of color (POC) with IBD are less frequently prescribed biologics compared to whites. Drug manufacturers’ websites are often designed to improve patient awareness and understanding of medical conditions and treatment. There is a paucity of information evaluating racial minorities depicted on pharmaceutical websites focused on biologic therapy. This study evaluated minority representation on websites of common biologic therapies used for IBD. Methods Websites for 4 major biologics were evaluated (Humira, Remicade, Stelara, Entyvio) for minority representation. Stock photos and videos were analyzed. Individuals were categorized based upon perceived ethnicity (person of color [POC], racially ambiguous [RA], white), gender, and role (patient, provider). Individuals were categorized independently by 3 investigators. Repeat images, incomplete facial images, inactive background role in videos, or images in which there was disagreement among all investigators were excluded. Statistical analysis was performed using two-sample t-test with significance set at p<0.05. Results In the 4 websites, there were 102 total subjects (49 photos, 53 videos). There were 89 white, 11 POC, and 2 RA subjects with 33 males (32 white, 1 POC, 0 RA) and 69 females (57 white, 10 POC, 2 RA). There were significantly less POC compared to whites in photos (14.2% vs 81.6%; p=0.0003) and videos (7.0% vs 93.0%; p=0.001). Males were less frequently represented than females in photos (33.3% vs 66.7%; p=0.0096) and videos (32.3% vs 67.7%; p=0.0238). There were no males of color in photos. Humira portrayed 10 POC, Entyvio portrayed 1 POC and none were identified on Remicade and Stelara websites. Humira included 1 white, male provider, and Remicade 1 female POC provider. Stelara and Entyvio included no providers in either photos or videos. There were no images or videos about which all 3 reviewing investigators disagreed. All websites included at least 1 image with which a single investigator disagreed. Only Humira and Vedolizumab included a video with single investigator disagreement. Discussion Biologic therapy has a significant role in IBD treatment and should be considered for all IBD patients who have the appropriate indications. Pharmaceutical websites can have a role in increasing patient understanding and acceptance of therapy. Patients may have increased acceptance of treatment based upon portrayed images. While this study revealed that males and POC were significantly less represented on biologic websites, it may reflect gender and minority group IBD prevalence. However, consideration should be given to increase minority representation on biologic websites to enhance male and POC acceptance of therapeutic options and potentially improve clinical outcomes.

Patient and family co-developed participant information to improve recruitment rates, retention, and patient understanding in the Rehabilitation Strategies Following Oesophago-gastric and Hepatopancreaticobiliary Cancer (ReStOre II) trial: Protocol for a study within a trial (SWAT)

Background: Whilst the potential benefits of exercise rehabilitation in cancer survivorship are plentiful, recruitment to survivorship rehabilitation trials remains suboptimal. There is growing evidence that Public and Patient Involvement (PPI) initiatives can increase the rate of recruitment to research. This study within a trial (SWAT) will examine if participant information co-developed by patients and their families can lead to greater recruitment rates, retention and understanding of the Rehabilitation Strategies in Oesophago-gastric and Hepatopancreaticobiliary Cancer (ReStOre II) trial when compared to standard participant information. Methods: This SWAT will be carried out over two phases. Phase I will utilise qualitative methods to develop (Phase Ia) and refine (Phase Ib) the new participant information. Phase Ia will recruit up to 20 survivors of upper gastrointestinal or hepatopancreaticobiliary cancer, or their family members, to take part in a focus group or interview to develop the new participant information. Focus groups/interviews will be recorded, transcribed verbatim and analysed thematically. In Phase Ib, participants will return for a second focus group/interview to refine the participant information. Once finalised, the participant information will be submitted to ethics for approval. In Phase II, potential participants for the ReStOre II trial will be randomly assigned to receive either the standard or patient and family co-developed participant information. The two forms of participant information will be compared by recruitment and retention rates, and participant understanding of the trial (Decision-Making Questionnaire). Discussion: We anticipate that engaging with patients and their families to develop participant information will help to increase patient understanding of the ReStOre II trial and therefore recruitment and retention rates. The results of this SWAT will indicate the usefulness of this strategy for optimising recruitment to exercise rehabilitation trials in cancer survivorship. Registration: SWAT: Northern Ireland Hub for Trials Methodology Research SWAT Repository Store ( SWAT-100). ReStOre II: ClinicalTrials.gov ( NCT03958019).

Development and Implementation of a Culturally Appropriate Education Program to Increase Cervical Cancer Screening among Maasai Women in Rural Tanzania.

Background:In Tanzania, the incidence of cervical cancer is nearly ten times that found in the US. Tanzanian women of the traditional Maasai tribe are financially and educationally marginalized and face a language barrier that reduces access to health care. While cervical cancer (CACX) screening programs are available locally, in our experience, Maasai women were less likely to use these services compared to local women of other tribal backgrounds.Objectives:A novel patient education program was designed to teach Maasai women about the natural history of cervical cancer and available screening and treatment. The program addressed the importance of preventative health and informed consent. Additionally, we sought to better understand the specific barriers Maasai women face in accessing and utilizing CACX screening services.Methods:The program used simple, scripted language translated into Maa language, the Maasai native language, with accompanying culturally appropriate 3D models. The effectiveness of the program was evaluated through pre and post-intervention surveys administered to Maasai and non-Maasai women as well as local healthcare providers, assessing knowledge of cervical cancer, screening, and treatment. Paired t-test analyses were used to analyze significance. Extensive question and answer sessions followed the education sessions from which additional barriers to screening were identified.Findings:Maasai women had minimal understanding of preventative health services prior to the intervention. While all groups showed an increase in knowledge following the education program, Maasai women demonstrated the greatest statistically significant improvement in knowledge. The proportion of Maasai women in attendance to CACX screening clinics increased by 18% after the intervention.Conclusions:Through a culturally sensitive and accessible patient education program, Maasai women gained knowledge of cervical cancer screening and treatment. This program serves as an adaptable model for other marginalized populations to increase patient understanding and informed consent, and to address issues that pertain to underutilization of health care services.

Informed Consent in the Genomics Era.

Informed consent, the process of gathering autonomous authorization for a medical intervention or medical research participation, is a fundamental component of medical practice. Medical informed consent assumes decision-making capacity, voluntariness, comprehension, and adequate information. The increasing use of genetic testing, particularly genomic sequencing, in clinical and research settings has presented many new challenges for clinicians and researchers when obtaining informed consent. Many of these challenges revolve around the need for patient comprehension of sufficient information. Genomic sequencing is complex-all of the possible results are too numerous to explain, and many of the risks and benefits remain unknown. Thus, historical standards of consent are difficult to apply. Alternative models of consent have been proposed to increase patient understanding, and several have empirically demonstrated effectiveness. However, there is still a striking lack of consensus in the genetics community about what constitutes informed consent in the context of genomic sequencing. Multiple approaches are needed to address this challenge, including consensus building around standards, targeted use of genetic counselors in nongenetics clinics in which genomic testing is ordered, and the development and testing of alternative models for obtaining informed consent.

Primary Care Providers' Preferences and Concerns Regarding Specific Visual Displays for Returning Hemoglobin A1c Test Results to Patients.

Purpose. Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. We sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation. Methods. In an online survey, 327 primary care physicians (>50% patient care time) recruited through the online e-community/survey research firm SERMO compared hemoglobin A1c (HbA1c) test results presented in table format to various visual displays (number line formats) previously tested in public samples. Half of participants also compared additional visual formats displaying target goal ranges. Outcome measures included preferred display format and whether any displays were unacceptable, would change physician workload, or would induce liability concerns. Results. Most (85%-89%) respondents preferred visual displays over tables for result communications both to patients tested for diagnosis purposes and to diagnosed patients, with a design with color-coded categories most preferred. However, for each format (including tables), 11% to 23% rated them as unacceptable. Most respondents also preferred adding goal range information (in addition to standard ranges) for diagnosed patients. While most physicians anticipated no workload changes, 19% to 32% anticipated increased physician workload while 9% to 28% anticipated decreased workload. Between 32% and 40% had at least some liability concerns. Conclusions. Most primary care physicians prefer visual displays of HbA1c test results over table formats when communicating results to patients. However, workload and liability concerns from a minority of physicians represent a barrier for adoption of such designs in clinical settings.

Impact of multidisciplinary patient education sessions on expectations and understanding of new calcitonin gene-related peptide treatments

Background: The new calcitonin gene-related peptide (CGRP) medications offer an exciting alternative to daily preventative migraine treatments. Finding effective and efficient ways to educate patients can be challenging for providers and pharmacists alike given the treatments are subcutaneous injections with extended half-lives and data is limited on long-term efficacy and adverse effects. Aims: We aimed to develop and evaluate a patient-oriented, multidisciplinary presentation to inform patients about the new CGRP drug class to decrease provider and pharmacist education burden while increasing patient understanding. Methods: Three live, one-hour CGRP informational sessions were conducted jointly by a headache medicine neurologist and clinical pharmacist from the institution’s specialty pharmacy. Prior to medication initiation, patients were educated about CGRP pathophysiology, benefits, risks, injection technique, and logistics of cost and medication access. The third presentation was video recorded and transitioned to an online platform. Participants completed surveys before and after watching the in-person or online session. Patients had the ability to fill these self-injectable therapies at the institution’s specialty pharmacy, who assisted with benefits investigation and prior authorization. If within payor network, the patient was offered specialty pharmacy services. Results: A total of 84 patients participated in the session (41 in-person; 43 online). Patients had frequent headaches (mean = 18/month; SD = 9.2) with severe (MIDAS >21) headache-related disability (mean MIDAS score = 63.1). Participants reporting confidence in understanding CGRP significantly increased from 68% to 97% following the informational session (p < .001) for those completing both the pre- and post-survey question (n = 69). There was also a significant increase from 84% to 97% in participants reporting comfort with injection technique (p = .008, n = 70). For both measures, there was no statistically significant difference between the in-person and online sessions. Nearly all participants (97%) would recommend the session to family or friends with migraine. Conclusions: The multidisciplinary informational session was an effective and efficient method of educating patients about these new treatments while concurrently decreasing provider and pharmacist education burden. The online video was as effective as the in-person session in educating patients, but improved access and availability.

Patient Education of Osteopathic Manipulative Medicine as a Gateway to Treatment: A Pilot Study

Abstract Context The use of osteopathic manipulative medicine (OMM) continues to decline in medical practice, despite an increasing number of osteopathic physicians. Objective This pilot study was designed to determine if a brochure created to increase knowledge about osteopathic medicine and OMM was read by patients, reviewed as being helpful, needed modifications and increased patient understanding of and willingness to receive OMM in preparation for a large scale trial that will assess this in both the hospital and ambulatory settings. Methods The study was performed using an educational brochure and 2 closed questionnaires. Twenty-seven patients of either inpatient or observation status aged 18 and above with English literacy were enrolled. Participants first completed a pre-questionnaire with questions regarding understanding of OMM and willingness to receive treatment. They then read the provided educational brochure, which contained a checkbox to verify the material was read in its entirety. Participants completed a post-questionnaire with similar questions. The results were analyzed with Wilcoxon signed rank test with 95% confidence to observe any changes in pre- and post-questionnaire responses. Results Of the participants, 48.1% provided verification that they read the brochure. A significant increase in patient willingness to receive OMM as part of their treatment regimen was observed for those who read the brochure (P=.008 ). No significant change was seen for those who didn’t read the brochure (P=.26). Additionally, 100% of participants indicated that the brochure was helpful, and 100% of participants indicated a better understanding of OMM. Cost remained a significant barrier to accepting or pursuing OMM treatment. Conclusion This pilot study demonstrated a statistically significant improvement in willingness to receive treatment after reviewing the designed brochure. It also identified a need to convey information regarding cost of OMM treatment to patients and a need to better emphasize the checkbox located within the brochure for verification purposes. The brochure and study design proved feasible and will provide the foundation for a larger scale trial looking to assess if a patient educational handout improves understanding of OMM and willingness to receive treatment in the hospital and ambulatory settings.

Videos improve patient understanding of misunderstood chemotherapy terminology.

Chemotherapy is the backbone of many cancer therapies; however, the terminology used to describe chemotherapy may be difficult for patients to understand, particularly in underserved populations. Studies have shown that educational videos can improve patient understanding of cancer-related terms. The goal of this study was to identify chemotherapy terms that were difficult for an underserved population to understand and then develop and test educational videos describing these terms. A word bank of 50 difficult-to-understand chemotherapy terms was developed by querying 15 providers and 50 patients at an underserved hospital. Twenty of these terms were then tested with 50 additional patients to determine rates of misunderstanding. Six pilot educational videos describing 6 important terms were created using VideoScribe and then assessed with 50 patients to see if they improved understanding. Fifteen of the 20 terms tested to establish rates of misunderstanding were misunderstood by more than one third of patients, with 98% unable to define maintenance, 74% unable to define cancer, and 58% unable to define chemotherapy. Patient understanding of all 6 terms improved by at least 20% after watching the videos. Notable improvement was reported for palliative chemotherapy, where before-and-after video understanding increased from 0% to 72%. Chemotherapy, a backbone of cancer treatment, is described with terms that are difficult to understand. Short, animated educational videos can significantly increase patient understanding of chemotherapy terminology.

Effectiveness of personalized 3D printed models for patient education in degenerative lumbar disease

ObjectiveThree-dimensional printing may play an important role in patients’ education. The objective of this study was to assess the effectiveness of personalized 3D printed models for increasing patient understanding of their medical condition and surgical plan. MethodsForty-five patients with degenerative lumbar diseases were randomized by block design into three groups: educational program presented by CT & MRI imaging (care-as-usual), 3D reconstructions, or personalized 3D printed models. Patients’ level of understanding and satisfaction were evaluated by two questionnaires one day after education. ResultsPatients educated with personalized 3D printed models demonstrated an expanded level of understanding than patients educated with CT & MRI imaging (care-as-usual) (P ＜ 0.05) and 3D reconstructions (P ＜ 0.05). Personalized 3D printed models also resulted in a higher degree of patient satisfaction (P ＜ 0.05). ConclusionsPersonalized 3D printed models and 3D reconstructions can simplify and enhance understanding of lumbar anatomy, physiology, and patients’ disease and surgical plan. Personalized 3D printed models also enhance patients’ subjective satisfaction. Practice implicationsPersonalized 3D printed models for patient education are feasible and could be generalized for degenerative lumbar diseases.

The Impact of Genetic Counseling Educational Tools on Patients' Knowledge of Molecular Testing Terminology.

Molecular testing is increasingly being integrated into cancer management. Despite rapid advancements, little work has been done to explore strategies for communicating with patients undergoing molecular tumor testing. This study evaluated the impact of genetic counseling educational tools on improving patients' understanding of key terms related to molecular testing. A genetic counseling intern designed a picture book to explain six words found in prior research to be difficult to understand (mutation, germline mutation, somatic mutation, biomarker, molecular testing, and targeted therapy). Participants who had previously discussed molecular testing with their oncologist were asked to define the terms. The same participants then received an explanation of each term either from the intern using the picture book in person or from a video presentation of the picture book. They were then asked to redefine each term afterward. The difference between the number of terms defined correctly pre- and post-intervention was compared between presentations. Sixty-three patients with melanoma, colon, lung, or breast cancer were recruited. After both interventions, correct understanding rates improved for all six terms, with significant improvement for germline mutation (p < 0.001), somatic mutation (p < 0.001), biomarker (p < 0.001), and molecular testing (p < 0.001). Understanding of targeted therapy improved significantly (p = 0.011) for the video presentation only. Mean change in knowledge scores did not differ between the two interventions (intern presentation 3.2 vs. video2.9, p = 0.428). Our data suggest that genetic counseling educational tools can increase patient understanding of terms used to describe molecular testing.

How do consent forms for diagnostic high-throughput sequencing address unsolicited and secondary findings? A content analysis.

Whole exome and whole genome sequencing are increasingly being offered to patients in the clinical setting. Yet, the question of whether, and to what extent, unsolicited findings (UF) and/or secondary findings (SF) should be returned to patients remains open and little is known about how diagnostic consent forms address this issue. We systematically identified consent forms for diagnostic genomic sequencing online and used inductive content analysis to determine if and how they discuss reporting of UF and SF, and whether patients are given options regarding the return of these results. Fifty-four forms representing 38 laboratories/clinics were analyzed. A quarter of the forms did not mention UF or SF. Forms used a variety of terms to discuss UF and SF, sometimes using these interchangeably or incorrectly. Reporting policies for UF varied: 5 forms stated that UF will not be returned, 15 indicated UF may be returned, and 28 did not specify their policy. One-third indicated their laboratory returns SF. Addressing inconsistent terminology and providing sufficient information about UF/SF in consent forms will increase patient understanding and help ensure adequate informed consent.

3:45 PM Abstract No. 146 The use of preprocedural educational videos to augment the consenting process and increase patient understanding and satisfaction in interventional radiology

3:45 PM Abstract No. 146 The use of preprocedural educational videos to augment the consenting process and increase patient understanding and satisfaction in interventional radiology

Student Heart Failure Intervention Pilot (SHIP): A Study of Risk Factor Analytics and Population Outreach

Background: Heart failure (HF), the leading cause of hospitalization in adults over the age of 65, is a difficult-to-treat syndrome associated with high morbidity and mortality. Home-monitoring programs may help reduce HF-associated morbidity, but can be difficult to establish in smaller clinical settings. In this quality improvement project, we identified local patients at high risk of HF-related morbidity and hospitalizations, then implemented a medical student-based constant-contact program to encourage their follow-through on self-care.&#x0D; &#x0D; Methods: Between June 2012 and September 2014, our clinic treated 197 patients for systolic or diastolic HF. These patients’ baseline characteristics were evaluated for trends that increased their risk for hospitalization. Of the high-risk patients identified (n=80), 12 (15%) were enrolled in the project. An 8-week constant-contact intervention was initiated through weekly calls. Patients’ health statuses were recorded and the importance of self-care was reiterated.&#x0D; &#x0D; Results: High-risk HF patients were identified based on &gt;10 clinic visits during the study period; 3 were lost to follow-up. Each patient completed two questionnaires at the study’s beginning and conclusion, with response rates of 67% (6/9) and 56% (5/9). Most participants reported symptom improvement and increased knowledge about their conditions.&#x0D; &#x0D; Conclusion: Our preliminary population-guided, medical-student initiated intervention in a small clinical setting was designed to increase patient understanding and compliance and to improve HF symptoms. Although the study was limited by its low participation rate, drastic improvements in self-reported outcomes were noted among participants. A larger study with similar positive outcomes could ultimately influence follow-up methods.

Predictors of BRCA1/2 genetic testing among Black women with breast cancer: a population-based study.

Evidence shows that Black women diagnosed with breast cancer are substantially less likely to undergo BRCA testing and other multipanel genetic testing compared to White women, despite having a higher incidence of early‐age onset breast cancer and triple‐negative breast cancer (TNBC). Our study identifies predictors of BRCA testing among Black women treated for breast cancer and examines differences between BRCA testers and nontesters. We conducted an analysis of 945 Black women ages 18–64 diagnosed with localized or regional‐stage invasive breast cancer in Pennsylvania and Florida between 2007 and 2009. Logistic regression was used to identify predictors of BRCA 1/2 testing. Few (27%) (n = 252) of the participants reported having BRCA testing. In the multivariate analysis, we found that perceived benefits of BRCA testing (predisposing factor) ([OR], 1.16; 95% CI: 1.11–1.21; P < 0.001), income (enabling factor) ([OR], 2.10; 95% CI: 1.16–3.80; p = 0.014), and BRCA mutation risk category (need factor) ([OR], 3.78; 95% CI: 2.31–6.19; P < 0.001) predicted BRCA testing. These results suggest that interventions to reduce disparities in BRCA testing should focus on identifying patients with high risk of mutation, increasing patient understanding of the benefits of BRCA testing, and removing financial and other administrative barriers to genetic testing.

Influential factors on treatment decision making among patients with colorectal cancer: A scoping review.

In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. Findings (n=13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.

Knowledge is Power. A quality improvement project to increase patient understanding of their hospital stay

Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management...

A Push for Progress With Shared Decision-making in Pediatrics.

* Abbreviation: SDM — : shared decision-making Shared decision-making (SDM) is a decision-making model in which “both parties share information…take steps to build consensus about the preferred treatment, and [reach an agreement] on the treatment to implement.”1 It exists on a continuum between 2 extremes (decision-making driven solely by the patient or by the physician) and represents a balance between patient and physician decisional responsibility that is guided by the patient and calibrated to the clinical context.2 At its inception, SDM was proposed to be the “ideal for the physician–patient relationship” as medicine pivoted from paternalism.3 It is now the standard decision-making model in medicine. Despite SDM’s prominence, however, problems linger. The evidence to support the purported benefits of SDM (increased patient understanding and satisfaction, improved adherence, and better health outcomes) is equivocal.4 Physicians are also struggling with how to practice SDM.5 In addition, little is known about how SDM should be applied in the pediatric setting. The gap in our understanding of SDM in pediatrics exists in part because initial frameworks used to develop the concept of SDM were based on the clinical context of a competent adult patient facing an acute, one-time intervention for the treatment of disease. This single, simplistic dyadic scenario has also served as the basis for subsequent analyses of SDM, its features, and tools to facilitate it. Analyses of SDM for scenarios common in pediatrics, such … Address correspondence to Douglas J. Opel, MD, MPH, Seattle Children’s Research Institute, 1900 Ninth Ave, Mail Stop JMB-6, Seattle, WA 98101. E-mail: douglas.opel{at}seattlechildrens.org

A literacy-sensitive approach to improving antibiotic understanding in a community-based setting.

Antibiotic misuse contributes to antibiotic-resistant bacterial infections. Patient and prescriber knowledge and behaviors influence antibiotic use. Past research has focused on describing and influencing prescriber behavior with less attention to the patient role in antibiotic use. This study seeks to: (1) develop and deploy a program to enhance patient knowledge about antibiotic use; (2) evaluate whether providing patient education is associated with improvements in antibiotic knowledge in a community-based sample; and (3) explore whether health literacy may be associated with knowledge of appropriate antibiotic use. This study developed, deployed, and evaluated whether community-based educational seminars enhance patient knowledge about antibiotic use. Twenty-eight participants from five locations completed the seminar. The antibiotic knowledge index score significantly increased by 2.0 points on the 14 point knowledge index from 10.95 (±2.88) to 12.95 (±1.72) (P = 0.0011) for the 19 participants completing both the pre and post-test. A community-based educational seminar on appropriate antibiotic use can effectively increase patient understanding of their role in antibiotic stewardship and combat the inappropriate use of antibiotics.