Feasibility and Acceptability of a Palliative Care Intervention Among Older or Adults with Advanced CKD and their Caregivers.

Background: In non-nephrology settings, specialty Palliative Care (PC) improves decision-making, patient's quality of life (QoL), advance care planning (ACP), and certain indicators of the quality of end-of-life (EoL) care. This pilot RCT explored the feasibility and acceptability of a PC intervention, CKD-EDU, for older adults ≥75 years with eGFR ≤25 ml/min and their caregivers.

Methods: Participants randomized to the control group received standard nephrology care and routine kidney therapy (KT) education, while those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss KT decisions and EoL planning.

US trends in social isolation, social engagement, and companionship ⎯ nationally and by age, sex, race/ethnicity, family income, and work hours, 2003-2020.

Social connectedness is essential for health and longevity, while isolation exacts a heavy toll on individuals and society. We present U.S.

Are Increasing Trends in Opioid-Related Hospitalizations Attributable to Increases in Diagnosis Recordability? Evidence from 2 Large States.

Based on calculations using all-listed diagnoses, the Agency for Healthcare Research and Quality (AHRQ) reports increasing national trends in opioid-related hospitalizations. It is unclear whether the reported increases are attributable to increases in available diagnosis fields. We leveraged increases in available diagnosis fields, ie, diagnosis recordability, in 2 states to examine their effects on opioid-related hospitalizations, graphically and with nonlinear least squares.

Did Medicaid expansion matter in states with generous Medicaid?

Objectives: It is unclear whether the Medicaid expansion under the Affordable Care Act had an effect on coverage in states with relatively generous pre-expansion Medicaid eligibility levels. We examined the effect of the Medicaid expansions on Medicaid coverage in 4 generous states: New York, Vermont, Massachusetts, and Delaware.

Study Design: We used the American Community Survey (2011-2016) to estimate effects on coverage among nonelderly adults with incomes up to 138% of the federal poverty level.

Harnessing Expert Judgment to Support Clinical Decisions When the Evidence Base Is Weak.

Purpose: In the process of developing an evidence-based decision dashboard to support treatment decisions for patients with newly diagnosed prostate cancer, we found that the clinical evidence base is insufficient to provide high-quality comparative outcome data. We therefore sought to determine if clinically acceptable outcome estimates could be created using a modified version of the Sheffield Elicitation Framework (SHELF), a formal method for eliciting judgments regarding probability distributions of expected decision outcomes.

Methods: We asked a panel of 3 urologists, 4 radiation oncologists, and 2 medical oncologists to estimate the probabilities of 11 treatment outcomes based on their clinical experience and an annotated evidence summary.

Political orientation, political environment, and health behaviors in the United States.

Political orientation (Republican/Democrat and conservative/liberal) and political environment (geo-spatial political party affiliated voting patterns) are both associated with various health outcomes, including mortality. Modern disease etiology in the U.S.

The Feasibility of Sophisticated Multicriteria Support for Clinical Decisions.

Background: Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision-making processes and outcomes of patient-level analyses done with a range of multicriteria methods that vary in ease of use and intensity of decision support, 2 factors that could affect their ease of implementation into practice.

Decision Aids: The Effect of Labeling Options on Patient Choices and Decision Making.

Background: Conscious and unconscious biases can influence how people interpret new information and make decisions. Current standards for creating decision aids, however, do not address this issue.

Method: Using a 2×2 factorial design, we developed surveys that contained a decision scenario (involving a choice between aspirin or a statin drug to lower risk of heart attack) and a decision aid.

Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria.

Should Health Numeracy Be Assessed Objectively or Subjectively?

Introduction: Because current evidence suggests that numeracy affects how people make decisions, it is an important factor to account for in studies assessing the effectiveness of medical decision support interventions. Subjective and objective numeracy assessment methods are available that vary in theoretical background, skills assessed, known relationship with decision making skills, and ease of implementation. The best way to use these tools to assess numeracy when conducting medical decision-making research is currently unknown.

Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.

Background: Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context.

Regulatory focus affects physician risk tolerance.

Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention-regulatory focus theory suggests such a factor.

How Older Persons Structure Information in the Decision to Seek Medical Care.

Typical models of the decision to seek care consider information as a single conceptual object. This paper presents an alternative that allows multiple objects. For older persons seeking care, results support this alternative.

Who avoids going to the doctor and why? Audience segmentation analysis for application of message development.

This exploratory study examines the prevalent and detrimental health care phenomenon of patient delay in order to inform formative research leading to the design of communication strategies. Delayed medical care diminishes optimal treatment choices, negatively impacts prognosis, and increases medical costs. Various communication strategies have been employed to combat patient delay, with limited success.

Predictors of avoiding medical care and reasons for avoidance behavior.

Background: Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay.

Objective: To identify predictors of care avoidance and reasons for avoiding care.

Methods: Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior.

Is personality associated with health care use by older adults?

Context: The patterns of health care utilization in the United States pose well-established challenges for public policy. Although economic and sociological research has resulted in considerable knowledge about what influences the use of health services, the psychological literature in this area is underdeveloped. Importantly, it is not known whether personality traits are associated with older adults' use of acute and long-term care services.

Development and initial evaluation of a treatment decision dashboard.

Background: For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices.

Cardiac resynchronization and quality of life in patients with minimally symptomatic heart failure.

Objectives: This study compared the quality of life (QOL) of patients with cardiac resynchronization therapy (CRT) and an implantable cardioverter-defibrillator (ICD) to patients with an ICD only.

Background: CRT with ICD is associated with a reduction in heart failure risk among minimally symptomatic patients. It is unknown whether this improves QOL.

Identifying sincerity of effort based on the combined predictive ability of multiple grip strength tests.

Study Design: Retrospective Cohort.

Introduction: Detecting sincerity of effort (SOE) of grip strength remains a frustrating and elusive task for hand therapists because there are no valid, reliable, or widely accepted assessments for identifying feigned effort. Some therapists use various combinations of different SOE tests in an attempt to identify feigned effort, but there is lack of evidence to support this practice.

How well do commonly used data presentation formats support comparative effectiveness evaluations?

Background: Good decisions depend on an accurate understanding of the comparative effectiveness of decision alternatives. The best way to convey data needed to support these comparisons is unknown.

Objective: To determine how well 5 commonly used data presentation formats convey comparative effectiveness information.

Role of the gender-linked norm of toughness in the decision to engage in treatment for depression.

Objective: Given their prevalence and persuasive power in our culture, gender norms--commonly described as socially reinforced, learned expectations of what it means to be a man or a woman--likely contribute to sex differences in service utilization for depression. This study investigated whether sex differences in toughness, a gender-linked norm characterized by a desire to hide pain and maintain independence, were associated with a preference to wait for depression to resolve on its own without active professional treatment ("wait-and-see" approach).

Methods: Participants (N=1,051) in the California Behavioral Risk Factor Surveillance System (BRFSS) survey were contacted in a follow-on survey to assess toughness, the kind of treatment they would prefer were they to receive a diagnosis of depression, and current symptoms of depression.

Coronary stent use in New York State in the drug-eluting stent era.

Objectives: The drug-eluting stent (DES) was perceived as a revolutionary medical technology because of the lower risk of restenosis compared with bare metal stent (BMS). However, the safety of DES use was called into question in 2006 due to increased incidence of catastrophic late stent thrombosis. This study aims to describe coronary stent use in the DES era in New York State.

Attitudes towards drug-eluting stent use and the distribution of motivation type among interventional cardiologists.

Objectives: The safety of drug-eluting stent (DES) use was called into question in 2006. However, the attitudes towards DES use after DES safety concerns were expressed and the distribution of chronic motivation type among interventional cardiologists are unknown. This study aims to examine the current attitudes towards DES use among interventional cardiologists and to investigate the distribution of chronic motivation type among these doctors.

Factors associated with emergency department use among the rural elderly.

Context: Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood.

Purpose: To characterize factors associated with having any versus no ED use among the rural elderly.