RESUMEN
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. RESULTS: Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. CONCLUSIONS: Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Prueba de Esfuerzo/normas , Folletos , Anciano , Femenino , Humanos , Entrevista Psicológica/métodos , Masculino , Persona de Mediana Edad , Participación del Paciente/métodosRESUMEN
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. RESULTS: Nurse-led GV was well received and logistically feasible. Patients gained knowledge of options and confidence in doing SDM with providers. However, recruitment at the point of the educational GV was below the threshold of 12 patients per group that would support sustaining this approach in fee-for-service clinical practice. CONCLUSIONS: Nurse-led GV can produce gains in knowledge and confidence required for patients to participate in SDM. However, the constraints of time and personnel required to bring groups of patients together require new approaches. Future development will focus on adapting the content of the GV for SDM as an electronic teaching module associated with integrated personal health records.
Asunto(s)
Enfermedad Coronaria/enfermería , Evaluación de Procesos y Resultados en Atención de Salud , Educación del Paciente como Asunto/métodos , Pautas de la Práctica en Enfermería , Grupos de Autoayuda , Anciano , Estudios de Factibilidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Enfermeras Practicantes , Satisfacción del Paciente , Proyectos Piloto , Atención Primaria de Salud , Estudios RetrospectivosRESUMEN
BACKGROUND: Persons with chronic illness commonly report fatigue. Measurement of perceived self-efficacy for fatigue self-management (PSEFSM) is essential if fatigue is to be monitored and enhanced to improve physical functional status. OBJECTIVE: The objective of the study was to describe the development and testing of the PSEFSM instrument. METHODS: The PSEFSM instrument was incorporated into 2 randomized controlled trials for secondary analysis (N=298): 63 persons with lung cancer and 235 persons with other cancer diagnoses undergoing a course of chemotherapy. RESULT: : Evidence for construct validity and generalizability was supported through hypotheses testing of the mediation pathway from fatigue to physical functional status through PSEFSM, with results indicating support for partial mediation. Structural modeling indicated a good model fit that further supported the construct validity of the PSEFSM instrument. CONCLUSIONS: The instrument provides a reliable and valid measure of PSEFSM that could be used in research to facilitate the development of interventions to increase perceived self-efficacy to achieve optimal symptom self-management. IMPLICATIONS FOR PRACTICE: The PSEFSM instrument is brief and easy to complete, which results in a low response burden for persons who are already fatigued, providing for regular use in transdisciplinary research and practice settings. This is important because the use of this instrument can impact how we partner with our patients to better understand how to manage this troublesome symptom, fatigue.
Asunto(s)
Actividades Cotidianas , Fatiga/psicología , Psicometría/instrumentación , Autocuidado/psicología , Autoeficacia , Perfil de Impacto de Enfermedad , Adaptación Psicológica , Enfermedad Crónica , Fatiga/prevención & control , Femenino , Estado de Salud , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Modelos Estadísticos , Proyectos Piloto , Teoría Psicológica , Autocuidado/métodos , Estrés Psicológico , Encuestas y CuestionariosRESUMEN
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. RESULTS: Participation-Physician training=73% (21/29); patient group visits=25% of patients with diagnosis of CAD contacted (43/168). SDM visits=16% (27/168). Among SDM visit pairs, 82% of responding providers reported using the EDG in SDM encounters. Patients valued the SDM-GRIP program, and wanted to discuss comparative effectiveness information with a cardiologist. SDM visits were routinely reimbursed. CONCLUSION: Program elements were well received and logistically feasible. However, recruitment to an extra educational group visit was low. Future implementation will move SDM-GRIP to the point of routine ordering of non-emergent stress tests to retain pre-decision timing of PCI and to improve coordination of care, with SDM tools available across primary care and cardiology. PRACTICE IMPLICATIONS: Guidance prompts and provider training appear feasible. Implementation at stress testing requires further investigation.
Asunto(s)
Enfermedad Coronaria/terapia , Toma de Decisiones , Técnicas de Apoyo para la Decisión , Relaciones Médico-Paciente , Atención Primaria de Salud , Comunicación , Medicina Basada en la Evidencia , Humanos , Capacitación en Servicio , Participación del Paciente , Evaluación de Programas y Proyectos de Salud , Encuestas y CuestionariosRESUMEN
BACKGROUND: Critical gaps exist in the understanding of cancer symptoms, particularly for cancer-related fatigue (CRF). Existing theories and models do not examine the key role perceived self-efficacy (PSE) plays in a person's ability to manage symptoms. OBJECTIVES: The objective of this study was to test the hypothesis that physical functional status (PFS) is predicted through patient characteristics, CRF, other symptoms, and PSE for fatigue self-management in persons with cancer. METHODS: This study is a secondary data analysis from the baseline observation of two randomized control trials. The combined data set includes 298 participants who were undergoing a course of chemotherapy. Key variables included physiological and contextual patient characteristics, the severity from CRF and other symptoms, PSE, and PFS. Path analysis examined the relationships among the variables in the proposed theoretical model. RESULTS: Persons with cancer reported CRF as the most prevalent symptom among a mean of 7.4 other concurrent symptoms. The severity from CRF had a direct and indirect effect on PFS, with CRF having a direct adverse impact on PFS (t = -7.02) and an indirect adverse effect as part of the severity from the other symptoms (t = 9.69), which also adversely impacted PFS (t = -2.71). Consistent with the proposed theoretical model, PSE had a positive effect on the PFS (t = 2.87) of persons with cancer while serving as a mediator between CRF severity and PFS. DISCUSSION: Cancer-related fatigue is prevalent and related to the presence of other symptoms, and PSE for fatigue self-management is an important factor influencing CRF and PFS. A foundation is provided for future intervention studies to increase PSE to achieve optimal PFS in persons with cancer.