An interactive, online decision aid assessing patient goals and preferences for treatment of aortic stenosis to support physician-led shared decision-making: Early feasibility pilot study.

Background: Guidelines recommend shared decision making when choosing treatment for severe aortic stenosis but implementation has lagged. We assessed the feasibility and impact of a novel decision aid for severe aortic stenosis at point-of-care.

Methods: This prospective multi-site pilot cohort study included adults with severe aortic stenosis and their clinicians.

Implementing Shared Decision-Making for Multiple Sclerosis: The MS-SUPPORT Tool.

Background: Disease modifying therapies (DMTs) offer opportunities to improve the course of multiple sclerosis (MS), but decisions about treatment are difficult. People with multiple sclerosis (pwMS) want more involvement in decisions about DMTs, but new approaches are needed to support shared decision-making (SDM) because of the number of treatment options and the range of outcomes affected by treatment. We designed a patient-centered tool, MS-SUPPORT, to facilitate SDM for pwMS.

What matters most to patients with severe aortic stenosis when choosing treatment? Framing the conversation for shared decision making.

Background: Guidelines recommend including the patient's values and preferences when choosing treatment for severe aortic stenosis (sAS). However, little is known about what matters most to patients as they develop treatment preferences. Our objective was to identify, prioritize, and organize patient-reported goals and features of treatment for sAS.

Shared Decision-Making and Short-Course Radiotherapy for Operable Rectal Adenocarcinoma: A Patient's Right to Choose.

Background: As new treatment options for colorectal cancer (CRC) emerge, physicians and WOC nurses must be prepared to assist patients to choose care that meets their needs and preferences. A patient with T2N0M0 rectal adenocarcinoma was offered the US current standard of practice; he was not offered alternative treatment options. This case study emphasizes the need to ensure patients are offered all reasonable options for treatment.

Evaluation of a Novel Preference Assessment Tool for Patients with Multiple Sclerosis.

Background: We developed a preference assessment tool to help assess patient goals, values, and preferences for multiple sclerosis (MS) management. All preference items in the tool were generated by people with MS. The aim of this study was to evaluate this tool in a national sample of people with MS.

Whose Preferences Matter? A Patient-Centered Approach for Eliciting Treatment Goals.

Background: Patients facing a high-stakes clinical decision are often confronted with an overwhelming array of options. High-quality decisions about treatment should reflect patients' preferences as well as their clinical characteristics. Preference-assessment instruments typically focus on pre-selected clinical outcomes and attributes chosen by the investigator.

Ovarian suppression in combination endocrine adjuvant therapy in premenopausal women with early breast cancer.

Purpose: The benefits of adding ovarian suppression to either tamoxifen or aromatase inhibitors as adjuvant breast cancer therapy in premenopausal women are controversial. Therefore, we performed a systematic literature review and meta-analysis of relevant randomized trials.

Methods: We identified and combined four qualifying trials reporting disease-free survival (DFS) and overall survival (OS) using meta-analysis.

Impact and Feasibility of Personalized Decision Support for Older Patients with Diabetes: A Pilot Randomized Trial.

Background: Diabetes guidelines recommend individualizing glycemic goals (A1C) for older patients. The aim of this study was to assess a personalized Web-based decision support tool.

Methods: We randomized physicians and their patients with type 2 diabetes (≥65 years of age) to a support tool or educational pamphlet (75:25 patients).

Effects of Design Features of Explicit Values Clarification Methods: A Systematic Review.

Background: Diverse values clarification methods exist. It is important to understand which, if any, of their design features help people clarify values relevant to a health decision.

Purpose: To explore the effects of design features of explicit values clarification methods on outcomes including decisional conflict, values congruence, and decisional regret.

Design Features of Explicit Values Clarification Methods: A Systematic Review.

Background: Values clarification is a recommended element of patient decision aids. Many different values clarification methods exist, but there is little evidence synthesis available to guide design decisions.

Purpose: To describe practices in the field of explicit values clarification methods according to a taxonomy of design features.

Decision aids for people facing health treatment or screening decisions.

Background: Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty.

Objectives: To assess the effects of decision aids for people facing treatment or screening decisions.

Search Methods: For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature.

Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline.

Purpose: To update the 2009 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction.

Methods: A systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 was completed using MEDLINE and Cochrane Collaboration Library. Primary outcome of interest was BC incidence (invasive and noninvasive).

Metformin and breast cancer risk: a meta-analysis and critical literature review.

Observational studies have suggested that metformin decreases the incidence of several common cancers. However, findings regarding breast cancer have been mixed. In order to explore this issue, a systematic literature review and meta-analysis were performed with a focus on potential biases.

National Institutes of Health State-of-the-Science Conference: role of active surveillance in the management of men with localized prostate cancer.

National Institutes of Health (NIH) Consensus and State-of-the-Science Statements are prepared by independent panels of health professionals and public representatives on the basis of 1) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality, 2) presentations by investigators working in areas relevant to the conference questions during a 2-day public session, 3) questions and statements from conference attendees during open discussion periods that are part of the public session, and 4) closed deliberations by the panel during the remainder of the second day and morning of the third. This statement is an independent report of the panel and is not a policy statement of NIH or the U.S.

Factors associated with treatment of women with osteoporosis or osteopenia from a national survey.

Background: Health outcomes could be improved if women at high risk for osteoporotic fracture were matched to effective treatment. This study determined the extent to which treatment for osteoporosis/osteopenia corresponded to the presence of specific risk factors for osteoporotic fracture.

Methods: This retrospective analysis of the United States 2007 National Health and Wellness Survey included women age ≥ 40 years who reported having a diagnosis of osteoporosis (69% of 3276) or osteopenia (31% of 3276).

NIH State-of-the-Science Conference Statement: Role of active surveillance in the management of men with localized prostate cancer.

Objective: To provide healthcare providers, patients, and the general public with a responsible assessment of currently available data on the use of active surveillance and other observational management strategies for low-grade, localized prostate cancer.

Participants: A non-U.S.

Decision aids for people facing health treatment or screening decisions.

Background: Decision aids prepare people to participate in decisions that involve weighing benefits, harms, and scientific uncertainty.

Objectives: To evaluate the effectiveness of decision aids for people facing treatment or screening decisions.

Search Strategy: For this update, we searched from January 2006 to December 2009 in MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 4 2009); CINAHL (Ovid) (to September 2008 only); EMBASE (Ovid); PsycINFO (Ovid); and grey literature.

Decision aids for people facing health treatment or screening decisions.

Background: Decision aids prepare people to participate in 'close call' decisions that involve weighing benefits, harms, and scientific uncertainty.

Objectives: To conduct a systematic review of randomised controlled trials (RCTs) evaluating the efficacy of decision aids for people facing difficult treatment or screening decisions.

Search Strategy: We searched MEDLINE (Ovid) (1966 to July 2006); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library; 2006, Issue 2); CINAHL (Ovid) (1982 to July 2006); EMBASE (Ovid) (1980 to July 2006); and PsycINFO (Ovid) (1806 to July 2006).

American society of clinical oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction.

PURPOSE To update the 2002 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction. METHODS A literature search identified relevant randomized trials published since 2002. Primary outcome of interest was BC incidence (invasive and noninvasive).

Duration of vasomotor symptoms in middle-aged women: a longitudinal study.

Objective: Vasomotor symptoms adversely affect the quality of life and functional status of most women during the menopausal transition, but little is known about how long these symptoms last. The most effective treatment, hormone therapy (HT), carries risks and benefits that depend on the timing and duration of use. In this study we sought to estimate the duration of vasomotor symptoms in a longitudinal study.

Risks and benefits of therapy with menopausal hormones versus selective estrogen-receptor modulators in peri- and postmenopausal women at increased breast cancer risk.

Decision making about menopausal therapies is complex because of the number of clinical factors that must be considered. Menopausal hormone therapy can relieve the vasomotor symptoms of menopause, but the most common preparation, combination estrogen and progesterone, increases the risk of breast cancer. Both tamoxifen and raloxifene can reduce the risk of developing invasive breast cancer, but the adverse effects of these drugs differ substantially.