Patients' intuitive judgments about surveillance endoscopy in Barrett's esophagus: a review and application to models of decision-making

Hinojosa-Lindsey, Marilyn; Arney, Jennifer; Heberlig, S.; Kramer, Jennifer R.; Street, Richard L.; El–Serag, Hashem B.; Naik, Aanand D.

doi:10.1111/dote.12028

Cited by 16 publications

(19 citation statements)

References 28 publications

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“…Additional details on methodology and the full interview guide are published elsewhere. 12 All interviews were conducted by either JA or MHL (both female) and were recorded, transcribed, and analyzed for content. We used Atlas.ti 6.2 to facilitate data analysis and management.…”

Section: Methodsmentioning

confidence: 99%

“…17 Furthermore, a recent systematic review of studies describing patients’ perceptions of surveillance EGD found that global judgments about surveillance EGD were often shaped by patients’ perceptions of the prior endoscopy experience. 12 These findings underscore the importance of how patients’ experiences shape their overall judgment of EGD—and intention to adhere to surveillance EGD. However, no previous study has described the salient elements that comprise the patient experience of EGD.…”

Section: Introductionmentioning

confidence: 92%

“…10 However, an analysis of national Department of Veterans Affairs (VA) data found relatively low rates (23%) of guideline-concordant surveillance EGD in routine care. 11 Prior work has explored the role of patients’ perceptions of cancer risk 12 and health-related quality of life, 13 and type of insurance on the utilization and psychosocial effects of surveillance EGD. 10 Less attention has been given to how patients frame their experiences with EGD and how these ‘patient experiences’ shape intentions to pursue BE surveillance.…”

Section: Introductionmentioning

confidence: 99%

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Patient Experiences with Surveillance Endoscopy: A Qualitative Study

et al. 2014

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Background Prior studies examining patterns of esophagogastroduodenoscopy (EGD) surveillance in patients with Barrett’s Esophagus (BE) demonstrate variable adherence to practice guidelines. In prior studies, memories of endoscopic experiences shaped patients’ overall perceptions and subsequent adherence behaviors, but the specific elements of that experience are unclear. We therefore sought to identify elements of the EGD experience that frame patients’ memories and overall perceptions of surveillance. Methods We conducted structured in-depth, qualitative interviews with BE patients in a single regional medical center. We recruited patients with a range of severity of BE (non-dysplastic, low-grade and high-grade dysplasia) who recently completed an EGD. Data collection continued until we reached thematic saturation (n=20). We applied principles of framework analysis to identify emerging themes regarding patients’ salient EGD experiences. We validated our coding scheme through multidisciplinary consensus meetings comprised of clinician (gastroenterologist and internist) and non-clinician investigators (sociologist and public health expert). Results Patient experiences can be conceptualized within a temporal model of surveillance EGD: prior to endoscopy, during the endoscopy procedure, and after endoscopy. Within this model, the most memorable aspects of the EGD experience include physician-patient communication prior to EGD, wait time at the endoscopy center, interpersonal interactions at the time of the EGD, level of pain or discomfort with the procedure, level of trust in the physician following EGD, and gaining a sense of control over BE. Conclusions We identified six salient memories before, during, and after the procedure that shape patients’ perceptions of the EGD experience. We offer recommendations for measuring the patient experience of EGD using a composite of validated survey items. Future studies should test the relation of patient experience measures and adherence to surveillance EGD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Patient Experiences with Surveillance Endoscopy: A Qualitative Study

et al. 2014

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“…In addition, the invasive nature of the surveillance can lead to decreased adherence with the associated decrease of screening effectiveness. Perceived risk plays a role in adherence to recommended surveillance [32], so a tool that better defines risk could contribute to improved adherence. The high cost and limited effectiveness of BE surveillance combined with the benefits of early diagnosis and treatment of EAC create a substantial opportunity to improve cost-effectiveness by stratifying the risk of progression to cancer and targeting more intensive surveillance to those at high risk [27].…”

Section: Overview Of Opportunity For Economic Evaluations To Inform Dmentioning

confidence: 99%

Economic Evaluation of Pharmacogenomics: A Value-Based Approach to Pragmatic Decision Making in the Face of Complexity

Snyder¹,

Mitropoulou

Patrinos

et al. 2014

Public Health Genomics

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Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies.

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“…13 These are the memories that come to define a healthcare experience and shape a patient's judgment of the care received; therefore, they influence subsequent health behaviors and are worth measuring despite their flaws. 13,14 The novel study by Ottenberg et al, 15 also in this issue of Circulation Cardiovascular Quality and Outcomes, provides further evidence of the need to systematically measure patient experiences. Their qualitative study describes patient experiences from pre-to postimplantation of left ventricular assist devices (LVAD) as destination therapy in patients with advanced heart failure.…”

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confidence: 98%

Peering Inside the Black Box of Patient-Centered Care

Naik

2014

Circ: Cardiovascular Quality and Outcomes

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P atient centeredness is a distinct dimension of healthcare quality. Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values in ways that guide treatment decisions.1 Translating patient centeredness into routine care is challenging. Citing evidence that patients often do not want a role in treatment decision making, many initially questioned the utility of engaging patients or eliciting their preferences.2,3 It is not surprising that many subjects enrolled in older studies of medical decision making would endorse passive decision making styles, given the paucity of tools to facilitate meaningful patient or caregiver engagement. When such tools were available, they were often overly complex and technical with little appreciation for health literacy, numeracy, or cognitive biases. The purpose of these tools was to facilitate decision making for clinicians rather than explore or uncover patient preferences, values, and goals. In essence, these earlier studies attempted to measure patient participation, experiences, and preferences within the context of clinician-centric medical encounters. Articles see p 353, 360, 368The results described by Dunlay et al 4 in this issue of Circulation Cardiovascular Quality and Outcomes are illustrative of these early attempts in understanding patient centeredness within the context of a clinician-centered healthcare environment. Their study sought to better understand the endof-life preferences of patients with heart failure and how those preferences changed during the disease course and, in particular, during hospitalizations for acute exacerbation. 5 The focus on do-not-resuscitate (DNR) orders as a surrogate is indicative of our limited capacity to clearly understand, elicit, and document end-of-life preferences. DNR orders are rudimentary measures of patient values and preferences for end-of-life care; orders are often placed with little or no previous discussions and are largely for the purpose of clinician decision making. 5,6 Dunlay et al 4 found that changes in DNR status in patients with heart failure are associated with acute heart failure exacerbations and with predictors of mortality (eg, age, functional impairment, malignancy, and comorbid chronic obstructive pulmonary disease). The disconnect between DNR orders and advance care planning is evident by the finding that patients with class 3 or 4 heart failure symptoms were less likely to have DNR orders in place on study enrollment. 4 The results of this study highlight the lack of standardized, patient-centered measures of advanced care planning. In contrast, the presence of DNR orders has surprisingly powerful effects on clinicians' decision making that go far beyond the simple intent of documenting the patient's preferences for resuscitation. In a previous study, Beach and Morrison 7 found that the presence of a DNR order was associated with significantly lower willingness to draw blood cultures, place central lines, or provide blood transfusions among physicians. T...

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Patients' intuitive judgments about surveillance endoscopy in Barrett's esophagus: a review and application to models of decision-making

Cited by 16 publications

References 28 publications

Patient Experiences with Surveillance Endoscopy: A Qualitative Study

Patient Experiences with Surveillance Endoscopy: A Qualitative Study

Economic Evaluation of Pharmacogenomics: A Value-Based Approach to Pragmatic Decision Making in the Face of Complexity

Peering Inside the Black Box of Patient-Centered Care

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