Healthcare Options for People Experiencing Depression (HOPE∗D): The development and pilot testing of an encounter-based decision aid for use in primary care
mental health care
Attitude of Health Personnel
Decision Making, Shared
Decision Support Techniques
Patient Acceptance of Health Care
Primary Health Care
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/4561
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Abstract© © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care. Design We developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-Test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment rates and semistructured interviews with patients, medical assistants and clinicians. Treatment choice and shared decision-making (SDM) were also assessed. Setting Interviews with adult patients and the public were conducted in a mall and library in Grafton County, New Hampshire, while clinician interviews took place by phone or at the clinician's office. Pilot testing occurred in a New Hampshire primary care practice. Participants Cognitive interviews were conducted with adults, ≥18 years, who could read English from the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting. Results Three stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-Therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59 patients who reviewed study information, 56 were eligible and agreed to participate in pilot testing; however, only 29 could be reached for follow-up. The eDA was widely accepted, though clinicians did not always use it as intended. We found no impact of eDA use on SDM, though patients chose a wider range of treatment options. Conclusions We demonstrated the feasibility of the use of an eDA for depression in primary care that was widely accepted. Further research is needed to improve the fidelity with which the eDA is used and to assess its impact on SDM and related health outcomes.
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Teacher education and its association with decision-making: An investigation of the classroom management decisions of incoming education majors, graduating education majors, and expert teachersByrnes, James P.; Woyshner, Christine A.; Farley, Frank; DuCette, Joseph P.; Smith, Michael W. (Michael William) (Temple University. Libraries, 2009)This study investigates the value of a teacher education program by comparing freshman education majors and senior education majors in their ability to make decisions about classroom management issues. Participants (N = 137) responded to a vignette style interview schedule and responses were coded and analyzed. Senior education majors were found to make significantly better decisions than freshman education majors and two groups of non-education students. Implications for improving and evaluating teacher education are discussed.
Decision aids that facilitate elements of shared decision making in chronic illnesses: A systematic reviewWieringa, TH; Rodriguez-Gutierrez, R; Spencer-Bonilla, G; De Wit, M; Ponce, OJ; Sanchez-Herrera, MF; Espinoza, NR; Zisman-Ilani, Y; Kunneman, M; Schoonmade, LJ; Montori, VM; Snoek, FJ (2019-05-20)© 2019 The Author(s). Background: Shared decision making (SDM) is a patient-centered approach in which clinicians and patients work together to find and choose the best course of action for each patient's particular situation. Six SDM key elements can be identified: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences, and making the decision. The International Patient Decision Aid Standards (IPDAS) require that a decision aid (DA) support these key elements. Yet, the extent to which DAs support these six key SDM elements and how this relates to their impact remain unknown. Methods: We searched bibliographic databases (from inception until November 2017), reference lists of included studies, trial registries, and experts for randomized controlled trials of DAs in patients with cardiovascular, or chronic respiratory conditions or diabetes. Reviewers worked in duplicate and independently selected studies for inclusion, extracted trial, and DA characteristics, and evaluated the quality of each trial. Results: DAs most commonly clarified options (20 of 20; 100%) and discussed their harms and benefits (18 of 20; 90%; unclear in two DAs); all six elements were clearly supported in 4 DAs (20%). We found no association between the presence of these elements and SDM outcomes. Conclusions: DAs for selected chronic conditions are mostly designed to transfer information about options and their harms and benefits. The extent to which their support of SDM key elements relates to their impact on SDM outcomes could not be ascertained. Systematic review registration: PROSPERO registration number: CRD42016050320.
PRE-DOCTORAL ORTHODONTIC ONLINE LEARNING EFFECTS ON CLINICAL DECISION MAKINGGodel, Jeffrey H.; Sciote, James J.; Moore, John V., III; Bhan, Amrita (Temple University. Libraries, 2020)Objectives: A pilot study evaluated the effect of an online assessment on orthodontic diagnostic decisions of dental students subsequently attending an orthodontic diagnostic examination. Case-based assessment improved clinical performance scores when screening patients. This study continues exploration of student performance by changing the time of assessment completion. Methods: Third year dental students are required to complete an orthodontic diagnostic examination as a graded clinical course requirement. Before the clinical examination, students review an online module subsequent to a didactic lecture course. The control group (n=66) completed a graded pre-assessment before viewing the online module and a graded post assessment after reviewing the online module. Both pre and post assessments were completed prior to the rotation. The experimental group (n=66) completed the pre-assessment prior to viewing the online module and completed the post-assessment after the screening rotation. Control and experimental groups completed a self-efficacy survey before and after the screening rotation to evaluate their self-confidence in diagnosing and treating malocclusions. The control and experimental groups were compared based on their online diagnostic assessment scores and self-efficacy surveys. Results: We found a substantial increase in total online pre and post-test assessment performance for the experimental group (p=0.000), but no difference between the pre-self-efficacy scores from the control group and experimental group (p=.631). Finally, a substantial increase in the students’ self-efficacy confidence occurred by changing the timing (p=0.002). Conclusion: This study shows that screening patients in a clinical scenario can improve student’s performance in case based assessments. Student confidence also increased after taking the post-assessment module and screening patients. Evaluating patients helped students solidify their learned diagnostic information and better apply it to a case based scenario.