Michael Fordis

Passport for care: implementing the survivorship care plan.

Approximately 12,000 children in the United States are diagnosed with cancer each year, and roughly 75% of these patients become long-term survivors. The Passport for Care was developed to support these survivors and their health care providers.

Childhood cancer survivor care: development of the Passport for Care

Survivors of childhood cancer are at risk of long-term adverse effects and late effects of the disease and/or its treatment. In response to national recommendations to improve evidence-based follow-up care, a web-based support system for clinical decision making, the Passport for Care (PFC), was developed for use at the point of care to produce screening recommendations individualized to the survivor. To date, the PFC has been implemented in over half of the nearly 200 clinics affiliated with the Childrens Oncology Group across the USA. Most clinician users report that the PFC has been integrated into clinic workflows, and that it fosters improved conversations with survivors about the potential late effects a survivor might experience and about the screening and/or behavioural interventions recommended to improve health status. Furthermore, clinicians using the PFC have indicated that they adhered more closely to follow-up care guidelines. Perspectives on the challenges encountered and lessons learned during the development and deployment of the PFC are reviewed and contrasted with other nationwide approaches to the provision of guidance on survivor follow-up care; furthermore, the implications for the care of childhood cancer survivors are discussed.

Understanding Age-based Transition Needs: Perspectives from Adolescents and Adults with Congenital Heart Disease.

OBJECTIVE The purpose of this study was to explore the transition process in congenital heart disease (CHD) care through the perceived needs and concerns of adolescents (pretransition) and the experiential insight from adults (post-transition), in order to inform future transition initiatives and information delivery methods. DESIGN In this cross-sectional study, adolescents and adults with moderate or complex CHD participated in semistructured telephone interviews. Interview transcripts were coded using NVivo qualitative data software. SETTING Single large urban tertiary care CHD center PATIENTS Adolescents (between 16 and 20 years of age) and adults (21-40 years of age) with moderate or complex CHD. Patients with global developmental delay or known chromosomal abnormalities were excluded. Twenty adolescents and 20 adults participated in the study; each interview allowed for participants to discuss issues relevant to them. RESULTS Among adolescents, half wanted more CHD information and half were concerned about becoming adults with CHD. All adolescents had access to the Internet via a mobile phone, but only 55% had searched online for CHD information. Adolescents were interested in mentorship with other adolescents (90%) and adults (60%) with CHD either in person or via protected social media. Among adults, 55% were satisfied with the amount of information they had received as adolescents. Areas in which adults would have preferred additional information include longer-term implications of CHD, employment, insurance, family planning, and mental health. CONCLUSIONS There are similarities and differences in the perceived transition needs of a diverse group of adolescents and adults with CHD. Both cohorts desire additional information during the transition process, including interest in use of a transition checklist to learn about managing their CHD. Adolescents are interested in interactions with other teens and adult mentors with CHD and are open to Internet-based interventions. Web-based initiatives could deliver CHD information and provide a platform for social media mentorship.

Differing Levels of Clinical Evidence: Exploring Communication Challenges in Shared Decision Making

The near ubiquitous access to information is transforming the roles and relationships among clinical professionals, patients, and their care givers in nearly all aspects of healthcare. Informed patients engage their physicians in conversations about their conditions, options and the tradeoffs among diagnostic and therapeutic benefits and harms. The processes of care today increasingly and explicitly integrate exploration of patient values and preferences as patients and clinicians jointly engage in reaching decisions about care. The informed patient of today who can understand and use scientific information can participate as an equal partner with her clinician. Others with beliefs or educational, cultural, or literacy backgrounds that pose challenges to comprehending and applying evidence may face disenfranchisement. These barriers are significant enough, even in the face of certainty of evidence, that clinicians and investigators have given much thought to how best to engage all patients in decision making. However, barriers remain, as most decision making must occur in settings where uncertainty, if not considerable uncertainty, accompanies any statement of what we know. In September 2011, health care and health communication experts came together in Rockville, Maryland under the auspices of the Agency for Healthcare Research and Quality (AHRQ) John M. Eisenberg Center for Clinical Decisions and Communications Science Annual Meeting to explore the challenges of differing levels of evidence in promoting shared decisions and to propose strategies for going forward in addressing these challenges. Eight scholarly papers emerged, and with this introductory article, comprise this special issue of Medical Care Research and Review.

The Prospects for Web 2.0 Technologies for Engagement, Communication, and Dissemination in the Era of Patient-Centered Outcomes Research: Selected Articles Developed From the Eisenberg Conference Series 2010 Meeting

The Eisenberg Conference Series 2010 Meeting on The Prospects for Web 2.0 Technologies for Engagement, Communication and Dissemination in the Era of Patient-Centered Outcome Research was conducted by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, Texas under contract to the Agency for Healthcare Research and Quality Contract No. HHSA290200810015C, Rockville, MD. The authors of this article are responsible for its content. No statement may be construed as the official position of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. Address correspondence to Michael Fordis, Baylor College of Medicine, One Baylor Plaza, MS BCM 155, Houston, TX 77030, USA. E-mail: fordis@bcm.edu Journal of Health Communication, 16:3–9, 2011 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print=1087-0415 online DOI: 10.1080/10810730.2011.598398

onlineDeCISion.org: a web-based decision aid for DCIS treatment

Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions.

The MERG suite: Tools for discovering competencies and associated learning resources

BackgroundAs the demands for competency-based education grow, the need for standards-based tools to allow for publishing and discovery of competency-based learning content is more pressing. This project focused on developing federated discovery services for competency-based medical e-learning content.MethodsWe built a tool suite for authoring and discovery of medical e-learning metadata. The end-user usability of the tool suite was evaluated through a web-based survey.ResultsThe suite, implemented as an open-source system, was evaluated to identify areas for improvement.ConclusionThe MERG suite is a starting point for organizations implementing competency-based e-learning resources.

Dissemination of Evidence From Systematic Reviews Through Academic Cme Providers: A Feasibility Study

Introduction: Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. Methods: A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. Results: Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. Discussion: This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.

Supporting informed decision making when clinical evidence and conventional wisdom collide: papers developed from the Eisenberg Center Conference Series 2012

AHRQ involvement in exploring issues that impact clinical decision making The AHRQ Effective Health Care (EHC) Program was created in 2003 under the legislative provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The EHC Program supports individual researchers, research centers, and academic organizations working together with AHRQ to produce effectiveness and comparative effectiveness research for various audiences (http://www.effectivehealthcare.ahrq.gov). The EHC Program does this through: 1) reviewing and synthesizing published and unpublished scientific evidence; 2) generating new scientific evidence and analytic tools; and 3) compiling research findings that are synthesized and/or generated and translating these materials into useful formats for clinicians, consumers, and policymakers. Much of the work focusing on translation and dissemination of research findings is done through the John M. Eisenberg Center for Clinical Decisions and Communications Science (the Eisenberg Center), a specialized Center within the EHC Program charged with working in concert with other EHC Program components to organize research results into summaries and other tools that are useful to clinicians, healthcare policy makers, and patients. An important function of the Eisenberg Center involves planning and implementing the Eisenberg Conference Series. This series brings together experts in health communication, health literacy, shared decisionmaking, and related fields to produce white papers (and stakeholder commentaries) that explore developments and advances in the fields of clinical decisionmaking and health communication. The papers from the 2012 Conference Series are assembled here as a supplement in BMC Medical Informatics and Decision Making.

AM Last Page: continuing medical education--the 2008 survey of U.S. and Canadian medical schools.

By the numbers: 34 units involved in CME research 20 the maximum number of grants claimed by a single unit 4 the maximum number of U.S. dollars in millions claimed by a single unit 20 the minimum number of U.S. dollars in thousands claimed by a single unit 18 the percentage of CME research funded by external, peer-reviewed, granting agencies 46 the percentage of CME research funded internally 36 the percentage of CME research funded by other agencies 170 audio, video, or online courses 1 147 courses and conferences 83 regularly scheduled series (rounds) 44 visiting speakers programs