Including practical issues and patient perspectives in Rapid Recommendations

Heen, Anja Fog; Vandvik, Per Olav; Agoritsas, Thomas

doi:10.1136/bmj.k4871

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…The inclusion of practical issues in indicator care recommendations, as well as consumer perspectives using methods to ensure an equitable voice, should be prioritized to maximize their clinical relevance and person-centredness. 74…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the use of quantitative scoring and ranking approaches during review rounds could assist to refine the indicators to a core set. The inclusion of practical issues in indicator care recommendations, as well as consumer perspectives using methods to ensure an equi table voice, should be prioritized to maximize their clinical relevance and person-centredness 74 …”

Section: Discussionmentioning

confidence: 99%

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What Constitutes “Appropriate Care” for Low Back Pain?

Wiles

Hibbert

Stephens

et al. 2021

Spine

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Study Design. Multiround wiki-based Delphi expert panel survey. Objective. To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on ''appropriate care'' for the assessment, diagnosis, and acute, and ongoing care of people with low back pain (LBP). Summary of Background Data. The provision of inappropriate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recommendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to ''appropriate care.'' Methods. Draft ''appropriate care'' clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators.Results. From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 ''appropriateness'' indicators. In total, 17 experts reviewed these indicators over 18 months. The final set of 27 indicators comprised screening and diagnostic processes (n ¼ 8), assessment (n ¼ 3), acute (n ¼ 5), and ongoing care (n ¼ 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n ¼ 21, 78%), with the remainder focused on care to be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What Constitutes “Appropriate Care” for Low Back Pain?

Wiles

Hibbert

Stephens

et al. 2021

Spine

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“…After the DECIDE project ended in 2014, our team continued user-testing and developing the decision aids. A major consequent refinement was the addition of a display of practical issues to complement evidence on benefits and harms [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Decision aids linked to evidence summaries and clinical practice guidelines: results from user-testing in clinical encounters

Heen

Vandvik

Brandt

et al. 2021

BMC Med Inform Decis Mak

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Background Tools for shared decision-making (e.g. decision aids) are intended to support health care professionals and patients engaged in clinical encounters involving shared decision-making. However, decision aids are hard to produce, and onerous to update. Consequently, they often do not reflect best current evidence, and show limited uptake in practice. In response, we initiated the Sharing Evidence to Inform Treatment decisions (SHARE-IT) project. Our goal was to develop and refine a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries. Methods Applying principles of human-centred design and following the International Patient Decision Aid Standards (IPDAS) and GRADE methods for trustworthy evidence summaries we developed a decision aid prototype in collaboration with the Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence project (DECIDE). We iteratively user-tested the prototype in clinical consultations between clinicians and patients. Semi-structured interviews of participating clinicians and patients were conducted. Qualitative content analysis of both user-testing sessions and interviews was performed and results categorized according to a revised Morville’s framework of user-experience. We made it possible to produce, publish and use these decision aids in an electronic guideline authoring and publication platform (MAGICapp). Results Direct observations and analysis of user-testing of 28 clinical consultations between physicians and patients informed four major iterations that addressed readability, understandability, usability and ways to cope with information overload. Participants reported that the tool supported natural flow of the conversation and induced a positive shift in consultation habits towards shared decision-making. We integrated the functionality of SHARE-IT decision aids in MAGICapp, which has since generated numerous decision aids. Conclusion Our study provides a proof of concept that encounter decision aids can be generically produced from GRADE evidence summaries and clinical guidelines. Online authoring and publication platforms can help scale up production including continuous updating of electronic encounter decision aids, fully integrated with evidence summaries and clinical practice guidelines.

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“…Still, evidence has a fundamental role here, to support treatment decisions by uncovering the relative merits of available options not only in terms of risks and benefits but also in terms of the necessary effects these options will have on most people who use them. The evidence about the effect of care on practical issues, such as how a treatment affects travel, recreation, diet, work, or relationships, remains woefully underdeveloped, demonstrating another limitation of research based on knowledge gaps, which keeps a blind spot on care [21,22].…”

Section: Promoting Research Addressing Care Gapsmentioning

confidence: 99%

Achieving care: promoting alternatives to industrial healthcare

Heen

Montori

2019

Swiss Med Wkly

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We march toward industrial healthcare. With different intensities and speeds depending on the nature of each healthcare system, most countries exhibit features of industrialisation. Perhaps this is the case because industrial healthcare may represent the final common pathway for any system that becomes underfunded as a result of austerity or profit extraction. Industrial healthcare is cruel to those at the frontline. It displaces the language of care, which in turn affects how we think and decide. It is time to reframe the conversation, change the language and draw from the traditions of the caring sciences. By focusing on care, developing models for caring and learning based on the actions of people rather than on data, and developing data based on the problems of care rather than on the advancement of decontextualised knowledge, we can advance toward careful and kind care for all.

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Including practical issues and patient perspectives in Rapid Recommendations

Cited by 5 publications

References 4 publications

What Constitutes “Appropriate Care” for Low Back Pain?

What Constitutes “Appropriate Care” for Low Back Pain?

Decision aids linked to evidence summaries and clinical practice guidelines: results from user-testing in clinical encounters

Achieving care: promoting alternatives to industrial healthcare

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