Sandra Feibelmann

Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

BackgroundA high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis.MethodsThe performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined.ResultsIn study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not.ConclusionsThe HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.

Institutional Academic Industry Relationship: Results of Interviews with University Leaders

The purpose of this study was to explore qualitatively the nature, consequences and management of institutional academic industry relationships (IAIRs) in the life and health sciences. The results of our interviews suggest that in the institutions we visited IAIRs are common and deeply embedded in the academic enterprise both among institutional officials and the organization itself. Many believe these relationships have potential benefits for the research and education mission while creating the potential for conflicts of interest. Further tracking and study of IAIRs is required to understand and anticipate the full effects of these relationships on the scientific enterprise in the United States.

What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative.

Background  The Breast Cancer Initiative (BCI) was started in 2002 to disseminate breast cancer decision aids (PtDAs) to providers.

Psychometric Evaluation of a Decision Quality Instrument for Treatment of Lumbar Herniated Disc

Study Design. Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file. Objective. To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc. Summary of Background Data. There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality. Methods. The herniated disc–decision quality instrument (HD-DQI) was developed with input from clinical experts, survey research experts, and patients. The HD-DQI produces 2 scores each scaled to 0% to 100%, with higher scores indicating better quality: (1) a total knowledge score and (2) a concordance score (indicating the percentage of patients who received treatments that matched their goals). We examined hypotheses relating to the acceptability, feasibility, validity, and reliability of the instrument, using data from 3 samples. Results. The HD-DQI survey was feasible to implement and acceptable to patients, with good response rates and low missing data. The knowledge score discriminated between patients who had seen a decision aid or no decision aid (55% vs. 38%, P < 0.001) and between providers and patients (73% vs. 46%, P < 0.001). The knowledge score also had good retest reliability (intraclass correlation coefficient = 0.85). Most patients (78%) received treatments that matched their goals. Patients who received treatments that matched their goals were less likely to regret the decision than those who did not (13% vs. 39%, P = 0.004). Conclusion. The HD-DQI met several criteria for high-quality patient-reported survey instruments. It can be used to determine the quality of decisions for treatment of herniated disc. More work is needed to examine acceptability for use as part of routine patient care.

Factors Associated with the Quality of Patients' Surgical Decisions for Treatment of Hip and Knee Osteoarthritis

BACKGROUND Shared decision making requires informing patients and ensuring that treatment decisions reflect their goals. It is not clear to what extent this happens for patients considering total joint replacement (TJR) for hip or knee osteoarthritis. STUDY DESIGN We conducted a cross-sectional mail survey of osteoarthritis patients at 4 sites, who made a decision about TJR. The survey measured knowledge and goals, the decision making process, decision confidence, and decision regret. Decision quality was defined as the percentage of patients who had high knowledge scores and received treatments that matched their goals. Multivariable regression models examined factors associated with knowledge and decision quality. RESULTS There were 382 patients who participated (78.6% response rate). Mean knowledge score was 61% (SD 20.7%). In multivariate linear regression, higher education, having TJR, and site were associated with higher knowledge. Many patients (73%) received treatments that matched their goals. Thirty-one percent of patients met our definition for high decision quality. Higher decision making process scores, higher quality of life scores, and site were associated with higher decision quality. Patients who had high decision quality had less regret (73.1% vs 58.5%, p = 0.007) and greater confidence (9.0 [SD 1.6] vs 8.2 [SD 2.3] out of 10, p < 0.001). CONCLUSIONS A third of patients who recently made a decision about osteoarthritis treatment met both criteria for a high quality decision. Controlling for treatment, patients reporting more involvement in the decision making process, higher quality of life, and being seen at a site that uses decision aids were associated with higher decision quality.

Decision aid reduces misperceptions about hormone therapy: a randomized controlled trial.

ObjectiveThis study aims to evaluate the role of a decision aid intervention in knowledge of menopausal symptom management. MethodsFive hundred fifteen US women who had menopausal symptoms and had discussed symptom management with providers within the past 12 months were assigned to either receive a decision aid or not. Participants completed a telephone survey 2 weeks after enrollment to assess knowledge. Overall knowledge scores and knowledge scores for general symptoms, benefits of hormone therapy, and risks of HT were compared between the decision aid arm and the control arm. ResultsFour hundred one women completed the survey. Participants in the decision aid arm had a significantly higher mean (SD) knowledge score (63.3% [18.4%]) compared with the control arm (57.5% [16.4%]; P = 0.001). Specifically, participants in the decision aid arm had significantly higher scores for general symptoms (mean difference, 11.0; 95% CI, 5.3 to 16.6; P < 0.001) and knowledge about benefits of HT (mean difference, 4.2; 95% CI, 0.03 to 8.5; P = 0.048) compared with the control arm. However, scores on knowledge about HT risks were not different between the arms (mean difference, 2.1; 95% CI, −3.0 to 7.2; P = 0.422). ConclusionsThe decision aid arm has greater knowledge of menopausal symptom management compared with the control arm, although the difference is small. In general, there is a considerable lack of knowledge about menopausal symptoms and HT risks.

Measuring the quality of surgical decisions for Latina breast cancer patients

A high‐quality decision for breast cancer surgery requires that patients are well informed, meaningfully involved in decision making, and receive treatments that match their goals. There is little in the existing literature that examines a comprehensive measure of decision quality for Latina breast cancer patients.

The Quality of Decisions about Adjuvant Chemotherapy for Early Stage Breast Cancer.

Background: Decisions about adjuvant chemotherapy are highly challenging for many women with early stage breast cancer. We sought to assess the quality of breast cancer patients9 decisions about chemotherapy by measuring their knowledge and the degree to which their treatment decisions reflect their goals and preferences.Methods: We mailed a survey to early stage (I, II) breast cancer survivors who were treated at one of four sites, as part of a larger study to validate decision quality instruments. A subset of women completed the chemotherapy module, which included questions about the patient-provider interaction, about facts, about treatment goals, and about the patient9s preferred treatment. Characteristics associated with knowledge were identified with linear regression. Characteristics associated with chemotherapy were identified with logistic regression.The percentage of patients who received their preferred treatment was calculated.Results: 358 patients completed the survey (response rate 59%). 64% of patients had Stage I disease, and 57% had chemotherapy. Average age was 56.9 years, 82.6% were white, and 63.7% had a college degree.Decision making: 70% of patients reported that their provider mentioned chemotherapy as an option. 43% reported that their provider asked for their preference about chemotherapy. 23% said the doctor mainly made the decision, 29% said they mainly made the decision, and 46% said both made the decision.Most women (92%) felt their level of involvement was about right.Knowledge: The mean knowledge score was 39.6% (SD 20.3). 29.9% knew that less than half of women with early stage breast cancer eventually die from breast cancer without chemotherapy or hormone therapy.21.8% knew that more than half are free from recurrence in 10 years without chemotherapy or hormone therapy. Chemotherapy treatment and the doctor having discussed chemotherapy were significantly associated (p Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2083.