Role In Medical Decision Research Articles

Patient Participation in Multidisciplinary Team Meetings in Residential Mental Health Services: An Explorative Study of Patients' Perception.

The lack of evidence of mental health patients' perception on patient participation in multidisciplinary team meetings (MTMs) is a potential threat to the person-centeredness of care. To explore the perceptions of mental health patients regarding patient participation in MTMs and to identify factors associated with these perceptions. In a cross-sectional study, 127 former and 109 currently admitted mental health patients completed the Patient Participation during Team Meetings Questionnaire (PaPaT-Q). The STROBE-checklist was used for reporting the study. Overall, patients' perceptions were positive. Former patients expressed greater willingness to participate in MTMs, considered participation as more important, and felt more competent. These patients also exhibited a stronger preference for an autonomous role in medical decision making when participating in MTMs. The perception varied across factors such as gender, educational level, nature of psychological complaints and prior experience(s) with participation in MTMs. These findings may help mental healthcare professionals to become more aware to factors associated with mental health patients' perception of patient participation in MTMs. The results can be used by mental healthcare professionals to motivate mental health patients in an even more tailor-made basis to participate in MTMs when admitted in a hospital.

Decision threshold models in medical decision making: a scoping literature review

BackgroundDecision thresholds play important role in medical decision-making. Individual decision-making differences may be attributable to differences in subjective judgments or cognitive processes that are captured through the decision thresholds. This systematic scoping review sought to characterize the literature on non-expected utility decision thresholds in medical decision-making by identifying commonly used theoretical paradigms and contextual and subjective factors that inform decision thresholds.MethodsA structured search designed around three concepts—individual decision-maker, decision threshold, and medical decision—was conducted in MEDLINE (Ovid) and Scopus databases from inception to July 2023. ProQuest (Dissertations and Theses) database was searched to August 2023. The protocol, developed a priori, was registered on Open Science Framework and PRISMA-ScR guidelines were followed for reporting on this study. Titles and abstracts of 1,618 articles and the full texts for the 228 included articles were reviewed by two independent reviewers. 95 articles were included in the analysis. A single reviewer used a pilot-tested data collection tool to extract study and author characteristics, article type, objectives, theoretical paradigm, contextual or subjective factors, decision-maker, and type of medical decision.ResultsOf the 95 included articles, 68 identified a theoretical paradigm in their approach to decision thresholds. The most common paradigms included regret theory, hybrid theory, and dual processing theory. Contextual and subjective factors that influence decision thresholds were identified in 44 articles.ConclusionsOur scoping review is the first to systematically characterizes the available literature on decision thresholds within medical decision-making. This study offers an important characterization of the literature through the identification of the theoretical paradigms for non-expected utility decision thresholds. Moreover, this study provides insight into the various contextual and subjective factors that have been documented within the literature to influence decision thresholds, as well as these factors juxtapose theoretical paradigms.

A comparison of adult-child and spousal cancer caregivers' participation in medical decisions.

Family caregivers often play a key role in medical decision-making for patients with cancer. Adult-children account for nearly half of caregivers, but often have less experience with serious illness care and decision-making and face unique relational challenges as the patient's child. Yet little research explores the potentially distinctive decision-making, involvement in decisions, and support needs of adult-child caregivers. Analysis of survey data of U.S. cancer caregivers conducted by CancerCare® in 2021. Chi-square tests and multivariable regression models assessed whether adult-child and spousal caregivers differed on the type of medical decisions they participated in (e.g., treatment planning, medication management), who made the decision (e.g., caregiver or joint decision), and the resources that informed decisions (e.g., friends and family, education materials). Adult-children (N = 892) were less likely than spouses (N = 314) to participate in treatment planning (beta = -0.41; 95%CI = -0.81,-0.01), but more likely to be involved in decisions about whether to challenge medical authority (e.g., seeking alternative treatment, second opinion) (beta = 0.50; 95%CI = 0.22,0.78). Compared to spouses, adult-children made joint decisions with patients less often (-13.2-percentage points; 95%CI = -19.64,-6.67) and acted as primary decision-maker more frequently (5.60-percentage points; 95%CI = 0.01,10.43). More adult-children than spouses sought help and information regarding decisions from the oncology team (8.42-percentage points; 95%CI = 1.98,14.87) and friends and family (7.91-percentage points; 95%CI = 1.34,14.48). How cancer caregivers and patients are related to each other shapes caregivers' medical decision-making. Adult-children's and spouses' probabilities of participating in and influencing decisions differed for certain types of decisions while adult-children were more likely to seek information and social support regarding decisions. These findings highlight the importance of the patient's and caregiver's relationship type in medical decision-making, suggesting that decision support programs may be more effective if they tailor programs by relationship type.

The Role of Language Concordant Care on Increasing Parental Engagement in Shared Decision Making

BACKGROUND: Shared decision making (SDM) allows patients and physicians to make decisions together by incorporating clinical expertise and patient preference. While SDM can improve patient satisfaction, preferences on the extent of involvement in SDM vary, particularly among different cultures and languages. We sought to describe preferences in decision making and degree of SDM among Spanish-speaking caregivers receiving pediatric Otolaryngology care. We hypothesized that language-concordant encounters would have higher SDM scores. METHODS: A cross-sectional study of Spanish-speaking caregivers undergoing consultation with pediatric otolaryngology was performed (May-August 2022). Care was provided in a language-concordant (LC) setting in which the physician and caregiver communicate in Spanish, or a language–discordant (LD) setting in which the physician communicates with interpreter support. Following their appointment, caregivers were invited to complete the Spanish Control Preferences Scale (CPS, select 2 of 5 options) to determine their two most preferred roles in medical decision making, and the Shared Decision-Making Questionnaire (SDM-Q-9; scored 0-100) to assess perceived SDM. Descriptive statistics, Fisher’s exact and the Mann-Whitney U test were used for analysis. RESULTS: Sixty-one caregivers were enrolled. CPS scores revealed the passive-collaborative medical decision making role was the most favored (59%), followed by an active-collaborative role (26%), and passive role (13%). Median SDM-Q-9 score for all caregivers was 100.00 (mean=93.70). The median SDMQ-9 score was 100 in LC visits, and 97.78 in LD visits (p = 0.428). No differences in SDM-Q-9 scores were detected for CPS categories between LC and LD visits. CONCLUSION: High levels of SDM were observed among Spanish-speaking caregivers using both LC and LD care. Most caregivers preferred a passive-collaborative role in medical decision making. Results may be influenced by positive response bias given the high scores observed. Further studies with larger sample sizes can further our understanding of the impact of LC care in SDM.

Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research.

Health preference research (HPR) is being increasingly conducted to better understand patient preferences for medical decisions. However, patients vary in their desire to play an active role in medical decisions. Until now, few studies have considered patients' preferred roles in decision making. In this opinion paper, we advocate for HPR researchers to assess and account for role preferences in their studies, to increase the relevance of their work for medical and shared decision making. We provide recommendations on how role preferences can be elicited and integrated with health preferences: (1) in formative research prior to a health preference study that aims to inform medical decisions or decision makers, (2a) in the development of health preference instruments, for instance by incorporating a role preference instrument and (2b) by clarifying the respondent's role in the decision prior to the preference elicitation task or by including role preferences as an attribute in the task itself, and (3) in statistical analysis by including random parameters or latent classes to raise awareness of heterogeneity in role preferences and how it relates to health preferences. Finally, we suggest redefining the decision process as a model that integrates the role and health preferences of the different parties that are involved. We believe that the field of HPR would benefit from learning more about the extent to which role preferences relate to health preferences, within the context of medical and shared decision making.

Reducing the Price of Naïveté in return‐to‐play from sports‐related concussion

Patient‐reported outcomes (PROs) play an increasingly important role in medical decision making. Yet, patients whose objectives differ from their physician's may strategically report symptoms to alter treatment decisions. For example, athletes may underreport symptoms to expedite return‐to‐play (RTP) from sports‐related concussion (SRC). Thus, clinicians must implement treatment policies that mitigate the Price of Naïveté, that is, the reduction in health outcomes due to naïvely believing strategically reported symptoms. In this study, we analyze dynamic treatment cessation decisions with strategic patients. Specifically, we formulate the Behavior‐Aware Partially Observable Markov Decision Process (BA‐POMDP), which optimizes the timing of treatment cessation decisions while accounting for known symptom‐reporting behaviors. We then analytically characterize the BA‐POMDP's optimal policy, leading to several practical insights. Next, we formulate the Behavior‐Learning Partially Observable Markov Decision Process (BL‐POMDP), which extends the BA‐POMDP by learning a patient's symptom‐reporting behavior over time. We show that the BL‐POMDP is decomposable into several BA‐POMDPs, allowing us to leverage the BA‐POMDP's structural properties for solving the BL‐POMDP. Then, we apply the BL‐POMDP to RTP from SRC using data from 29 institutions across the United States. We estimate the Price of Naïveté by comparing the BL‐POMDP to naïve benchmark policies. Accordingly, the BL‐POMDP reduces premature RTP by over 44% and provides up to 3.63 additional health‐adjusted athletic exposures per athlete compared to current practice. Overall, changing the interpretation of reported symptoms can better reduce the Price of Naïveté over adjusting treatment cessation thresholds. Therefore, to improve patients' health outcomes, clinicians must understand how strategic behavior manifests in PROs.

Artificial Intelligence in Healthcare

Technology's impact on today's world cannot be overstated. Human work is made easier to manage and more productive by technological advancements. Errors attributable to human error have been reduced because of technological advancements in the healthcare sector. Artificial intelligence (AI) has the potential to impact the medical and healthcare industries significantly. The "quadruple goals" of healthcare include better population health, better care for individual patients, better care for individual caregivers, and lower overall healthcare expenses. To achieve these objectives, healthcare systems across the world face significant challenges. In this paper, we examine the existing use of AI in healthcare, outline a process for creating reliable, safe, and efficient AI systems, and make some educated guesses about their future. It was determined that AI plays a crucial role in medical decision-making, especially predictive analytics when it comes to diagnosing and treating patients and managing health services in general. The current study's findings outline the implications for policymakers and regulatory authorities. In addition to that, the last section outlines the future research directions.

Preferences and Attitudes Towards Life-Sustaining Treatments of Older Chinese Patients and Their Family Caregivers.

The family plays a major role in medical decision-making in China. Little is known about whether family caregivers understand patients' preference for receiving life-sustaining treatments and are able to make decisions consistent with them when patients are incapable of making medical decisions. We aimed to compare preferences and attitudes concerning life-sustaining treatments of community-dwelling patients with chronic conditions and their family caregivers. We conducted a cross-sectional study among 150 dyads of community-dwelling patients with chronic conditions and their family caregivers from four communities in Zhengzhou. We measured preferences for life-sustaining treatments (cardiopulmonary resuscitation, mechanical ventilation, tube feeding, hemodialysis, chemotherapy), who should decide, the timing of making decisions, and their most important consideration. The consistency of preferences for life-sustaining treatments between patients and family caregivers was poor to fair, with kappa values ranging from 0.071 for mechanical ventilation to 0.241 for chemotherapy. Family caregivers more frequently preferred each life-sustaining treatment for the patients than the patients themselves. More family caregivers than patients preferred the patient to make their own decisions about life-sustaining treatments (29% of patients and 44% of family caregivers). The most important considerations when deciding on life-sustaining treatments are family burden and the patient's comfort and state of consciousness. There is a poor to fair consistency between community-dwelling older patients and their family caregivers in their preferences and attitudes towards life-sustaining treatments. A minority of patients and family caregivers preferred that patients make their own medical decisions. We recommend healthcare professionals to encourage discussions between patients and their families on future care to improve the mutual understanding within the family about medical decision-making.

Patient control preferences for medical decision making before and after evaluation for left ventricular assist device

Understanding patients' preferred roles in medical decision making (i.e., passive, collaborative, active) is important to personalized care and patient engagement. Patient control preferences have been described for many treatment decisions, but their stability over time has not been characterized, particularly for major medical events with long-term implications. We prospectively surveyed 233 patients at the initiation of evaluation for a left ventricular assist device, and 1 and 6 months later, including collection of the Control Preferences Scale. Collaborative and active preferences were most common initially, followed by a shift towards more active. Approximately half of patients reported a different control preference in follow up. Patients with higher income and education levels were more likely to prefer an active role. These findings suggest that most patients want to be engaged in shared decision making, but to what degree is varied, can change over time, and is influenced by social determinants of health.

Opportunities and challenges for advance care planning in strongly religious family-centric societies: a Focus group study of Indonesian cancer-care professionals

BackgroundMost studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients.MethodsFocus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital.ResultsWe included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and families’ religious beliefs regarding the control and sanctity of life; and 4) the availability of a support system for advance care planning (healthcare professionals’ education and training, public education, resource allocation, and formal regulation). Participants believed that, although family hierarchical structure and certain religious beliefs may complicate patients’ engagement in advance care planning, a considerate approach to involving family and patients’ religious perspectives in advance care planning may actually facilitate their engagement in it.ConclusionIndonesian healthcare professionals believed that, for culturally congruent advance care planning in Indonesia, it was essential to respect the cultural aspects of collectivism, communication norms, and patients’ religious beliefs.

The portion of goods that falleth to me: Parental rights, children's rights, and medical decisions after COVID-19.

The advent and perpetuation of the COVID‐19 pandemic has served to highlight issues in American law that have long gone unaddressed. Prominent among them are the issues involving parents, the government, and the medical decisions of children. This article examines the current state of American law involving parental rights, children's rights, and the government's role in medical decisions of children and proposes a uniform act as a solution to the discrepancy and unpredictability in this area of American law.

How Involved Do Patients Want to Be in the Medical Decision-Making at the Initial Urogynecology Clinic Visit?

The aim of this study was to compare patients' preferred role in medical decision-making before the initial urogynecology visit to their perceived role after the visit. This prospective cohort study enrolled women presenting for their initial urogynecology visit. Before and after the visit, patients completed the Control Preference Scale (CPS), which categorizes the role that patients want to have in medical decision-making: active, collaborative, or passive. Patients also completed the Pelvic Floor Distress Inventory, CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, and Short Test of Functional Health Literacy in Adults questionnaires. Univariable and multivariable generalized estimating equations were used. Women (n = 100) with a mean age of 59.1 years (SD = 15.5) participated in the study. Based on CPS before the visit, 50% of the women preferred active involvement, whereas 45% preferred collaborative and 5% preferred passive involvement. After the visit, these rates change to 40%, 48%, and 11%, respectively. On univariable analysis, women were 1.56 times more likely to report a collaborative or passive CPS response after the visit (P = 0.02). This remained true on multivariable analysis (odds ratio, 1.57; P = 0.04). Patients' CPS responses were not associated with their responses on CollaboRATE, Patient Global Impression of Improvement, patient satisfaction, or Short Test of Functional Health Literacy in Adults. Eighty-eight percent of women reported a fully collaborative visit based on CollaboRATE, and 87% reported being "completely satisfied" with the visit. Despite a change in women's reported involvement in decision-making after their first urogynecology visit compared with their preferences before the visit, most women perceived collaboration during their visit and were completely satisfied.

Parents’ views on medical decisions related to life and death for their ageing child with profound intellectual and multiple disabilities: A qualitative study

BackgroundThe increased life expectancy of persons with profound intellectual and multiple disabilities (PIMD) raises questions regarding the medical decisions related to life and death, made on their behalf during their later lives. However, little is known about how parents make such decisions for their ageing child. AimExplore parents’ views on medical decisions related to life and death for their ageing child with PIMD. MethodsWe interviewed 27 parents of persons with PIMD (≥ 15 years) and analyzed the data thematically. ResultsParents who were convinced that their ageing child’s quality of life (QoL) was good, stated that their child “deserved the same treatment as any other person”. Others rejected life-prolonging treatments for their child because they believed such treatment would diminish their child’s QoL. Some of the parents who thought their child’s QoL was poor, mentioned that withholding treatment is only an option in a crisis situation and contemplated other options to shorten their child’s life. ConclusionsParents feel equipped to take on a central role in medical decisions related to life and death for their ageing child with PIMD, and desire understanding from medical professionals for their views on their child’s interests, which sometimes includes physician-assisted death.

Assessment of Informed Consent and the Impact of Simulation on Anesthesia Trainees.

IntroductionOver the years, the process of obtaining informed consent has evolved and now places an emphasis on the concept that patients should play a major role in medical decision making. Failure to adequately involve patients in making decisions regarding their health can lead to medicolegal consequences.Therefore, taking informed consent is a fundamental component of anaesthesia training. Simulation, for training, is an excellent tool that is being utilised widely in the training of medical professionals. The use of simulated training for teaching the process of informed consent is an innovative initiative that can provide improved results.Material and methodsAfter approval from the institutional review board, a prospective clinical study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from August 2019 to September 2020. Sixteen anaesthesia trainees were randomly selected for the study. The study was divided into pre-interventional, interventional and post interventional phases. For data collection, a predesigned checklist was used. Data collected was analysed using SPSS version 23 (IBM Inc., Armonk, New York). The McNemar test was deployed to assess the difference between the baseline assessment and post-simulated training assessment; p-value < 0.05 was taken to be significant.ResultsOf the 16 participants, the majority were males (n= 13). A positive impact was observed in terms of improvement of the outcome of the following study components i.e., description of benefits of the procedure (p=0.01), disclosure of associated minor risks (p=0.005), disclosure of major risks (p=0.01), discussion of alternatives (p=0.001), teach back (p=0.001), documentation of patients’ verbal agreement (p=0.01), and communication skills involving utilising the process of connecting, introduction, communication, permission, response, and exit (p = 0.01).ConclusionSimulated training had a positive impact in improving outcomes in the following study components: description of benefits of the procedure, disclosure of associated risks, discussion of alternatives, teach back, documentation of patients’ verbal agreement, and utilisation of the process of connecting, introduction, communication, permission, responding, and exiting.

Abstract 2821: Spectral classifier as a complement to magnetic resonance spectroscopy in the management of patients with brain tumors of the central nervous system

Abstract Introduction: In the last decades molecular imaging, more precisely Magnetic Resonance Spectroscopy (MRS), has taken an important role in medical decision-making. The MRS provides biochemical information on metabolites on tissues, it also provides information regarding tissue metabolism, allowing to characterize some brain metabolites of a certain volume of the brain. With due experience, patterns of relative metabolite levels can be visually interpreted to arrive at radiological guidance, but the most robust result is obtained from quantitative analysis of the spectra using pattern recognition methods. Within these methods we find the Spectral Classifier (SC), it is a Java solution for designing and implementing MRS based classifiers. The main goal of SC is to allow users with minimum background knowledge of multivariate statistics to perform a fully automated pattern recognition analysis, it is able to read low resolution in-vivo MRS (single-voxel and multi-voxel) and high resolution tissue MRS. Objective: To implement the use of the SC as a tool for the processing of Magnetic Resonance Spectroscopy (MRE) studies in patients with brain tumors of the central nervous system treated at the National Cancer Institute, Bogotá, Colombia. Methods: The spectral acquisition parameters in the Siemens 1.5T resonator were homogenized, the spectra acquisition protocol for ERM was modified by including new single and multivoxel voxel sequences (10x10 voxel mesh). 63 studies were carried out using single and multivoxel voxel, which were processed with the jMRUI and jMRUI2xml plugin of the SC program, a pattern recognition program, which takes the information and introduces it into a glial tumor database, allowing it to classify the masses depending on the pattern of their metabolites, and the scVisualizer. The reading was performed by two neuroradiologists, to whom only the spectroscopic data and the reference image in the axial plane and T2-weighted were provided. Results: From the first radiological reading without SC, 36.5% by single voxel and 36.5% by multivoxel corresponded to glial tumor patterns. By using SC, 76.2% per single voxel and 63.5% per multivoxel corresponded to glial tumor patterns. From the follow-up and post-radiological diagnosis, it was confirmed that of the 63 studies, 77.8% corresponded to recurrences. 100% and 87.2% of the lesions with glial tumor patterns corresponded to recurrences according to the post-radiological diagnosis for single-voxel and multi-voxel SC, respectively. Conclusions: Through the implementation of the SC, additional information is obtained that allows to determine and confirm the presence of glial tumor patterns, which could contribute to better decision-making in the management of this type of patients. Citation Format: Milena Acosta, Gina Catalina Malaver, Oscar Gamboa, Cesar Rodriguez, Julian Beltran, Pablo Moreno-Acosta. Spectral classifier as a complement to magnetic resonance spectroscopy in the management of patients with brain tumors of the central nervous system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2821.

Healthcare professionals’ perspectives on unique communication and care needs for Chinese American cancer patients.

e24122 Background: Effective clinician-patient discussions of cancer diagnoses and prognoses are essential to enhance health outcomes in diverse oncology populations. To provide guidance on communication preferences and needs among Chinese Americans, one of the fastest growing yet understudied ethnic groups in the United States, we explored considerations and observations from healthcare providers experienced in caring for this oncologic population. Methods: In this inductive, emergent qualitative study, we completed 20 semi-structured virtual interviews with providers from assorted healthcare disciplines with experience caring for Chinese American cancer patients in Boston’s Chinatown. Responses were systematically collected and analyzed using open and focused coding, constant comparative methods, and thematic analysis. Results: Twenty healthcare professionals with experience working with the Chinese American patients were interviewed including medical oncologists, radiation oncologists, primary care physicians, nurses, nurse practitioners, social workers, case managers, patient navigators and dietitians. Fifteen were female, 5 were male, and 11 participants self-identified as Asian. Six key themes were identified: (1) Discussing cancer diagnoses and prognoses is taboo and often avoided by Chinese Americans in family, community, and healthcare settings. (2) A cancer diagnosis may be considered a death sentence by Chinese Americans, regardless of cancer location or stage. This could be related to the meaning implied by direct translation of the word “cancer.” (3) In settings where cancer diagnoses and prognoses are discussed, Chinese American patients often prefer indirect communication approaches including use of expressions such as “tumor,” “mass,” or “illness” to avoid the use of the word “cancer.” (4) The family centered role in medical decision making for Chinese American cancer patients and the preference of some family units to protect the patient from their diagnoses present unique challenges in the context of standard care. (5) Obtaining a detailed psychosocial history is important to guide communication approaches, as patient characteristics like age, generation since immigration, and education play a foundational role in communication preferences. (6) Karma and nutritional beliefs should be considered and addressed in oncologic care, as they play a critical role in health and disease management for Chinese American cancer patients. Conclusions: Further exploration of these insights and confirmation of their accuracy by discussing directly with Chinese American patients is imperative. If these findings are corroborated through further investigation, this knowledge can be used develop educational tools and implement clinical practice changes to enhance care outcomes and communication with Chinese American cancer patients.

Whole genome sequencing in the Middle Eastern Qatari population identifies genetic associations with 45 clinically relevant traits

Clinical laboratory tests play a pivotal role in medical decision making, but little is known about their genetic variability between populations. We report a genome-wide association study with 45 clinically relevant traits from the population of Qatar using a whole genome sequencing approach in a discovery set of 6218 individuals and replication in 7768 subjects. Trait heritability is more similar between Qatari and European populations (r = 0.81) than with Africans (r = 0.44). We identify 281 distinct variant-trait-associations at genome wide significance that replicate known associations. Allele frequencies for replicated loci show higher correlations with European (r = 0.94) than with African (r = 0.85) or Japanese (r = 0.80) populations. We find differences in linkage disequilibrium patterns and in effect sizes of the replicated loci compared to previous reports. We also report 17 novel and Qatari-predominate signals providing insights into the biological pathways regulating these traits. We observe that European-derived polygenic scores (PGS) have reduced predictive performance in the Qatari population which could have implications for the translation of PGS between populations and their future application in precision medicine.

Evaluation of analytical performance of Alinity i system on 31 measurands

IntroductionAccurate, precise and reliable laboratory test results play a critical role in medical decision making. To satisfy the increasing needs in clinical laboratory tests, the analyzers have been advanced. In this study, authors aimed to evaluate the analytical performance of the Alinity i system (Abbott Laboratories, IL, USA) for diverse analytes measured by using immunoassay principle. Materials and methodsAnalytical performance of recently launched Alinity i system has been evaluated for 31 assays in aspects of precision, linearity and analytical measurement range, correlation with the Architect i2000sr system (Abbott Laboratories), carry-over, and reference interval validation in accordance with CLSI guidelines. ResultsThe within-laboratory CVs of the analytes tested in the study ranged between 1.00 and 7.84%, which met vendor claimed value in precision. In linearity test, most assays satisfied acceptable linearity criteria, best-fit first order regression or polynomial regression with nonlinearity smaller than ±10%, compared with linear regression. The recovery of each analyte distributed from 90.1 to 109.7%. The coefficient of determination (R2) for each test was larger than 0.95 except for folate when compared to the results obtained from existing routine analyzer and statistically or clinically equivalent. The carry-over rates were acceptable, and reference intervals were validated. ConclusionThrough this study, acceptable analytical performance of novel Alinity i system has been verified. It is expected to readily replace existing instrument and to be an option for laboratories considering introduction of automated immunoassay analyzer.

PNS72 Patients Are Playing an Increasing Role in Medical Decisions Due to the Digital Transformation of Healthcare in China

Investigate the impact of the digital transformation of healthcare in China on patient healthcare decision-making and understand the its indicators. A large scale self-administered online survey was conducted with both patients and physicians between 2017-2019. Generalized linear models (GLM) using logit distribution and link functions were used to estimate odds ratios (OR) of “medication use decisions” and “asking for prescription”. The time(year) variables were considered in the models, and the healthcare-related online activities were adjusted as covariates. Patients having online activity in “medical/disease education articles” (top 1 activity, 70%, and with the 2nd highest growth rate 14%, 2019) showed a significantly lower proportion of “medication decisions made only by physicians”, compared with patients without online activity (adjusted OR=0.51; 95%CI 0.39-0.66; P-value<0.01). Compared with patient not having online health-care activities, patient having activities in “medical/disease education articles”, “Medication instructions/references”, “online consultation”, “looking for free online medical consultations” and “doctor-patient interaction (for free)” (top 3 activities or top 3 growth activities in 2018 and 2019) all showed significant increase in “asked for prescriptions when visiting physicians” (adjusted ORs are 1.49, 1.32, 1,29, 1.43, and 1.29 respectively; P-values<0.01). The data are well aligned with logical inference that patients will be more capable and confident to make the medical relevant decisions with more and better exposure to medical knowledge and physicians’ interactions online. Medical decisions could include prescription decisions, treatment strategy, hospital and physician selections. More studies are worthwhile validate the inference and guiding patients’ decisions appropriately.

Did You Get What You Wanted? Patient Satisfaction and Congruence Between Preferred and Perceived Roles in Medical Decision Making in a Hungarian National Survey

ObjectivesIn a growing number of countries, patient involvement in medical decisions is considered a cornerstone of broader health policy agendas. This study seeks to explore public preferences for and experiences with participation in treatment decisions in Hungary. MethodsA nationally representative online panel survey was conducted in 2019. Outcome measures included the Control Preferences Scale for the preferred and actual role in the decision, the 9-item Shared Decision Making Questionnaire, and a Satisfaction With Decision numeric rating scale. ResultsA total of 1000 respondents participated in the study, 424 of whom reported having had a treatment decision in the preceding 6 months. Overall, 8%, 18%, 51%, 19%, and 4% of the population preferred an active, semiactive, shared, semipassive, and passive role in decision making, respectively. Corresponding rates for perceived role were as follows: 9%, 15%, 35%, 26%, and 15%. Preferred and perceived roles matched for 52% of the population, whereas 32% preferred more and 16% less participation. Better health status, attaining role congruence, and higher 9-item Shared Decision Making Questionnaire scores were positively associated with satisfaction, accounting for 32% of the variation in Satisfaction With Decision scores (P < .05). ConclusionsThis study represents the first national survey on decisional roles in healthcare in Hungary and, more broadly, in Central and Eastern Europe. Shared decision making is the most preferred decisional role in Hungary; nevertheless, there is still room to improve patient involvement in decision making. It seems that patient satisfaction may be improved through tailoring the decisional role to reflect patients’ preferences and through practices that encourage shared decision making.