Head to head randomized trial of two decision aids for prostate cancer.

Background: While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient-provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer.

Methods: 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy.

Quality Improvement Summit 2016: Shared Decision Making and Prostate Cancer Screening.

Introduction: The American Urological Association Quality Improvement Summit occurs regularly to provide education and promote dialogue around the issues of quality improvement and patient safety. Nearly all prostate cancer screening guidelines recommend shared decision making strategies when determining whether prostate specific antigen testing is right for a specific patient. This summit, held in partnership with the Society for Medical Decision Making, focused on techniques to identify and understand patient values in relation to prostate cancer screening and treatment, and to promote incorporation of shared decision making into prostate cancer screening discussions.

Decision aid use during post-biopsy consultations for localized prostate cancer.

Background: Decision Aids (DAs) effectively translate medical evidence for patients but are not routinely used in clinical practice. Little is known about how DAs are used during patient-clinician encounters.

Objective: To characterize the content and communicative function of high-quality DAs during diagnostic clinic visits for prostate cancer.

Periodontal Management of a Patient Undergoing Liver Transplantation.

This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios.

Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment.

Introduction: Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters.

Methods: We analyzed audio-recorded office visits of 252 men with presumed localized prostate cancer (Gleason 6 and Gleason 7 scores) who were seeing 45 physicians at 4 Veterans Affairs Medical Centers.

Refining a brief decision aid in stable CAD: cognitive interviews.

Background: We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD).

Methods: We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA.

Patient-physician communication about early stage prostate cancer: analysis of overall visit structure.

Background: We know little about patient-physician communication during visits to discuss diagnosis and treatment of prostate cancer.

Objective: To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.

Participants: Forty veterans and 18 urologists at one VA medical centre.

Evaluating long-term patient-centered outcomes following prostate cancer treatment: findings from the Michigan Prostate Cancer Survivor study.

Context: Advances in screening and treatment of prostate cancer have dramatically increased the number of survivors in the US population. Yet the effect of screening is controversial, and in some instances may not be beneficial. Previous studies have typically only reported outcomes of treatment and symptoms within a short time frame following treatment.

Addressing health literacy in patient decision aids.

Background: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:

Methods: We reviewed literature for evidence relevant to these two aims.

Nurse-led group visits support shared decision making in stable coronary artery disease.

Objective: The aim of this study was to develop and evaluate a nurse-led educational group visit (GV) as part of a multifaceted intervention, shared decision making (SDM) guidance reminders in practice, to prompt SDM in primary care about angiography in stable coronary artery disease.

Methods: A process evaluation designed to test the feasibility of a nurse-led educational GV was conducted. The evaluation used retrospective pre-post surveys.

Primary care perspectives on prostate cancer survivorship: implications for improving quality of care.

Objectives: Primary care providers often care for men with prostate cancer due to its prolonged clinical course and an increasing number of survivors. However, their attitudes and care patterns are inadequately studied. In this context, we surveyed primary care providers regarding the scope of their prostate cancer survivorship care.

Primary care perspectives on prostate cancer screening.

Although the effectiveness of prostate cancer screening is controversial, screening rates have risen dramatically among primary care providers in the United States. The authors' findings suggest more collaboration among primary care and specialty organizations, especially with respect to decision aid endorsement, is needed to achieve more discriminatory and patient-centered prostate cancer screening.

Shared Decision Making Guidance Reminders in Practice (SDM-GRIP).

Objective: Develop a system of practice tools and procedures to prompt shared decision making in primary care. SDM-GRIP (Shared Decision Making Guidance Reminders in Practice) was developed for suspected stable coronary artery disease (CAD), prior to the percutaneous coronary intervention (PCI) decision.

Methods: Program evaluation of SDM-GRIP components: Grand Rounds, provider training (communication skills and clinical evidence), decision aid (DA), patient group visit, encounter decision guide (EDG), SDM provider visit.

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).

Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation.

Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis.

Objective: To describe the extent to which patient decision aids (PtDAs) meet effectiveness standards of the International Patient Decision Aids Collaboration (IPDAS).

Data Sources: Five electronic databases (to July 2006) and personal contacts (to December 2006).

Results: Among 55 randomized controlled trials, 38 (69%) used at least 1 measure that mapped onto an IPDAS effectiveness criterion.

Shared decision-making in the US--research & development outpaces delivery.

Researchers interested in shared decision-making in the US have developed a set of tools including decision aids and instruction in counseling, to help patients and physicians fully discuss treatment decisions. Although fundamental research and development continues, these tools are disseminated largely through for-profit and not-for-profit companies to group practices and insurance providers. Data on the number of patients and physicians who have access to decision aids and who have ever used a decision aid are not available, but the number may be small.

Men's interpretations of graphical information in a videotape decision aid.

Objective: To examine men's interpretations of graphical information types viewed in a high-quality, previously tested videotape decision aid (DA). SETTING, PARTICIPANTS, DESIGN: A community-dwelling sample of men >50 years of age (N = 188) balanced by education (college/non-college) and race (Black/White) were interviewed just following their viewing of a videotape DA. A descriptive study design was used to examine men's interpretations of a representative sample of the types of graphs that were shown in the benign prostatic hyperplasia videotape DA.

Outpatient medication use and health outcomes in post-acute coronary syndrome patients.

Objective: To investigate the pattern of postdischarge evidence-based outpatient medication use and its impact on subsequent hospital readmissions in post-acute coronary syndrome (ACS) patients.

Study Design: Prospective observational study.

Methods: A telephone survey was conducted to collect information from discharge to 8 months after discharge for 433 patients hospitalized with a primary diagnosis of ACS in 5 mid-Michigan hospitals.

Treatment preference patterns during a videotape decision aid for benign prostatic hyperplasia (BPH).

Objective: As part of a study of men's responses to a videotape decision aid [Rovner DR, Wills CE, Bonham V, Williams G, Lillie J, Kelly-Blake K, Williams MV, Holmes-Rovner M. Decision aids for benign prostatic hyperplasia: applicability across race and education. Med Decis Making 2004;24:359-66], preferences for BPH treatment options were assessed.

Men's theories about benign prostatic hyperplasia and prostate cancer following a benign prostatic hyperplasia decision aid.

Objective: To use qualitative methods to explore audiotape evidence of unanticipated confusion between benign prostatic hyperplasia (BPH) and prostate cancer in using a videotape BPH treatment decision aid (DA).

Design: Qualitative analysis of semi-structured interviews and surveys originally collected to study men's interpretation of a DA.

Setting And Participants: Community sample of college and noncollege educated African American and white men (age> or =50; n=188).

A randomized trial of pegylated interferon alpha-2b plus ribavirin in the retreatment of chronic hepatitis C.

Objectives: The efficacy of combination therapy with pegylated interferon (PEG IFN) alpha plus ribavirin (RBV) in the retreatment of chronic hepatitis C (CHC) in patients who previously failed combination standard IFN plus RBV or IFN monotherapy has not been well established.

Methods: Three hundred and twenty-one CHC patients including virologic nonresponders to combination IFN plus RBV (n = 219) or IFN monotherapy (n = 47), and relapsers to combination therapy (n = 55) were randomized to receive PEG IFN alpha-2b 1.5 microg/kg per wk plus RBV 800 mg per day (Regimen A, n = 160) or PEG IFN alpha-2b 1.

Evidence-based patient choice: a prostate cancer decision aid in plain language.

Background: Decision aids (DA) to assist patients in evaluating treatment options and sharing in decision making have proliferated in recent years. Most require high literacy and do not use plain language principles. We describe one of the first attempts to design a decision aid using principles from reading research and document design.

Decision aids for benign prostatic hyperplasia: applicability across race and education.

Background/method: Decision aids have not been widely tested in diverse audiences. The authors conducted interviews in a 2 x 2 race by education design with participants who were 50 years old (n = 188). The decision aid was a benign prostatic hyperplasia videotape.

Patient education materials about the treatment of early-stage prostate cancer: a critical review.

Background: To ensure that patients make informed medical decisions, patient education materials must communicate treatment risks and benefits.

Objective: To survey publicly available patient education materials and assess their suitability to support informed decision making in early-stage prostate cancer.

Design: Cross-sectional review of Internet, print, and multimedia sources.