Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling

Aschmann, Hélène E; Puhan, Milo A.; Robbins, Craig; Bayliss, Elizabeth A.; Chan, Wiley; Mularski, Richard A.; Wilson, Renée F; Bennett, Wendy L; Sheehan, Orla C.; Yu, Tsung; Yebyo, Henock; Leff, Bruce; Tabano, Heather; Armacost, Karen; Glover, Carol; Maslow, Katie; Mintz, Suzanne; Boyd, Cynthia M.

doi:10.1186/s12955-019-1250-6

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…2,56 Best interest should also imply giving attention to holistic well-being, although it has been shown that patients' preferences and subjective illness experiences are often not a consideration in clinical judgement or decision-making. 19,57,58,59 It seems sexual history taking in practice is not core to the decision-making process in the management of patients with chronic disease despite being a theoretical and health priority.…”

Section: Discussionmentioning

confidence: 99%

Sexual history taking: Doctors’ clinical decision-making in primary care in the North West province, South Africa

Pretorius

Couper

Mlambo

2021

African Journal of Primary Health Care & Family Medicine

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Background: Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire.Aim: The aim of this research study was to assess doctors’ clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios.Setting: This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district.Methods: This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors’ clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group.Results: One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group.Conclusion: Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.

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Section: Discussionmentioning

confidence: 99%

Sexual history taking: Doctors’ clinical decision-making in primary care in the North West province, South Africa

Pretorius

Couper

Mlambo

2021

African Journal of Primary Health Care & Family Medicine

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“…SUCRA has a natural scale from zero to one and can therefore be readily used as a weight. 35 If an attribute is always ranked as the ‘worst’ option, it will receive a SUCRA score of zero. However, if it is always ranked as the ‘best’ option, it will receive a score of 1.…”

Section: Methodsmentioning

confidence: 99%

Assessing patient information needs for new antidiabetic medications to inform shared decision‐making: A best–worst scaling experiment in China

Xie,

Meng,

Feng

et al. 2024

Health Expectations

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BackgroundShared decision‐making (SDM) is a patient‐centred approach to improve the quality of care. An essential requirement for the SDM process is to be fully aware of patient information needs.ObjectivesOur study aimed to assess patient information needs for new antidiabetic medications using the best–worst scaling (BWS) experiment.MethodsBWS tasks were developed according to a literature review and the focus group discussion. We used a balanced incomplete block design and blocking techniques to generate choice sets. The final BWS contains 11 attributes, with 6‐choice scenarios in each block. The one‐to‐one, face‐to‐face BWS survey was conducted among type 2 diabetic patients in Jiangsu Province. Results were analyzed using count‐based analysis and modelling approaches. We also conducted a subgroup analysis to observe preference heterogeneity.ResultsData from 539 patients were available for analysis. The most desired information domain was the comparative effectiveness of new antidiabetic medications. It consists of the incidence of macrovascular complications, the length of extended life years, changes in health‐related quality of life, the incidence of microvascular complications, and the control of glycated haemoglobin. Of all the attributes, the incidence of macrovascular complications was the primary concern. Patients' glycemic control and whether they had diabetes complications exerted a significant influence on their information needs.ConclusionsInformation on health benefits is of critical significance for diabetic patients. Patients have different information needs as their disease progresses. Personalized patient decision aids that integrate patient information needs and provide evidence of new antidiabetic medications are worthy of being established.Patient or Public ContributionBefore data collection, a pilot survey was carried out among diabetic patients to provide feedback on the acceptability and intelligibility of the attributes.

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“…We used the best-worst scaling (BWS) method to assess respondents' rankings of perceived barriers to deprescribing a medication in this population. [27][28][29] The BWS method presents respondents with multiple sets of factors (choice sets) in varied combinations to compare choices.…”

Section: Survey Developmentmentioning

confidence: 99%

Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia

Norton,

Zeng,

Bayliss

et al. 2023

JAMA Netw Open

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ImportancePhysicians endorse deprescribing of risky or unnecessary medications for older adults (aged ≥65 years) with dementia, but there is a lack of information on what influences decisions to deprescribe in this population.ObjectiveTo understand how physicians make decisions to deprescribe for older adults with moderate dementia and ethical and pragmatic concerns influencing those decisions.Design, Setting, and ParticipantsA cross-sectional national mailed survey study of a random sample of 3000 primary care physicians from the American Medical Association Physician Masterfile who care for older adults was conducted from January 15 to December 31, 2021.Main Outcomes and MeasuresThe study randomized participants to consider 2 clinical scenarios in which a physician may decide to deprescribe a medication for older adults with moderate dementia: 1 in which the medication could cause an adverse drug event if continued and the other in which there is no evidence of benefit. Participants ranked 9 factors related to possible ethical and pragmatic concerns through best-worst scaling methods (from greatest barrier to smallest barrier to deprescribing). Conditional logit regression quantified the relative importance for each factor as a barrier to deprescribing.ResultsA total of 890 physicians (35.0%) returned surveys; 511 (57.4%) were male, and the mean (SD) years since graduation was 26.0 (11.7). Most physicians had a primary specialty in family practice (50.4% [449 of 890]) and internal medicine (43.5% [387 of 890]). A total of 689 surveys were sufficiently complete to analyze. In both clinical scenarios, the 2 greatest barriers to deprescribing were (1) the patient or family reporting symptomatic benefit from the medication (beneficence and autonomy) and (2) the medication having been prescribed by another physician (autonomy and nonmaleficence). The least influential factor was ease of paying for the medication (justice).Conclusions and RelevanceFindings from this national survey study of primary care physicians suggests that understanding ethical aspects of physician decision-making can inform clinician education about medication management and deprescribing decisions for older adults with moderate dementia.

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Outcome preferences of older people with multiple chronic conditions and hypertension: a cross-sectional survey using best-worst scaling

Cited by 10 publications

References 24 publications

Sexual history taking: Doctors’ clinical decision-making in primary care in the North West province, South Africa

Sexual history taking: Doctors’ clinical decision-making in primary care in the North West province, South Africa

Assessing patient information needs for new antidiabetic medications to inform shared decision‐making: A best–worst scaling experiment in China

Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia

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