Biomedical subjects

D H Hickam

Publications and source records attributed to D H Hickam.

59 records · Page 4Linked to original sources

PubMedDate not supplied

The effect of physician's explanations on patients' treatment preferences: five-year survival data.

OBJECTIVE: To evaluate the influence of physicians' explanations on patients' choices. SETTING: A university-based Department of Veterans Affairs Medical Center. PARTICIPANTS: 136 patients seen in a continuity-care general medicine clinic. MEASUREMENTS AND RESULTS: Patients were randomized to two groups [Limited Explanation (LE) and Extensive Explanation (EE)] and asked to choose between two alternative treatments (differing in short-term vs long-term survival benefits) for an unidentified medical condition, based on the information given in the explanations. LE consisted of a brief orientation to graphs summarizing the treatment results, while EE consisted of a detailed verbal description of the graphs. Significantly (p < 0.001) more patients receiving EE changed their preferences across the three pairs of five-year survival curves, compared with patients receiving LE. Of the patients receiving EE, 57% reported either medium-term (year 0-to-intercept or intercept-to-year 5) data or the average life expectancy for the five-year period contained in the curves (ALE-5) as most influencing their decision making; whereas 78% of patients receiving LE reported only endpoint (year 0 or year 5) data as most influencing their preferences. CONCLUSIONS: The patients' treatment preferences for long-term vs short-term survival benefits were influenced by the amounts of verbal explanation provided to them about five-year survival graphs summarizing treatment results. The patients appeared to minimize the importance of medium-range data when those data were not specifically pointed out to them.

Female↗

PubMedDate not supplied

The influence of physician explanations on patient preferences about future health-care states.

OBJECTIVE: To determine the influence of alternative explanations by physicians of the purpose of a medical intervention (intubation and ventilatory support, IVS) on three types of patient preferences: desire for IVS, the length of time patients would find IVS acceptable, and the minimum probability of a good medical outcome patients would require before assenting to continued support with IVS. METHODS: Structured interviews were conducted with patients followed in a continuity care general medicine clinic at the Department of Veterans Affairs Medical Center, Portland, Oregon. Patients were asked to consider whether they would accept IVS at a future time. Patients were randomly assigned to one of two explanation conditions that differed in terms of their future medical contexts, that is, the degrees of specification of the nature of the medical condition patients were asked to consider. The general-explanation group was asked to consider the future medical context of " an unspecified medical condition"; the specific-explanation group was asked to consider the future medical context of "a severe pneumonia." Patients were asked three questions: 1) Would you accept IVS (yes or no)? 2) How long would you allow your physician to continue IVS?; and 3) After being on IVS for 2-3 days, what would be the minimum chance of recovery from the condition you would require before agreeing to continued IVS? "Chance of recovery" was defined for both groups as the probability that the patient would be able to leave the hospital and be able to take care of activities of daily living unassisted with minimal change in his or her mental state from the pre-hospitalization status. RESULTS: Of 186 patients (mean age = 66.5 years; mean education = 12.7 years), 97 received the general explanation and 89 received the specific explanation about a severe pneumonia. Significantly fewer (p = 0.03) patients receiving the general explanation wanted physicians to intervene with IVS (general 94% vs specific 100%). Patients receiving the general explanation were willing to accept significantly fewer (p = 0.009) days of intubation (general 65 days vs specific 96 days). Significantly fewer (p < 0.0001) patients receiving the general explanation wanted physicians to continue IVS when the probability of a successful outcome was less than 50% (general 30% vs specific 64%). CONCLUSION: Physician explanations--based on general (unspecified medical condition) vs specific (severe pneumonia) explanations--have a marked influence on the duration of IVS patients would permit and the probability of a good outcome required to continue IVS.

Activities of Daily Living↗

PubMedDate not supplied

How patients' preferences for risk information influence treatment choice in a case of high risk and high therapeutic uncertainty: asymptomatic localized prostate cancer.

To assess how patients' preferences for non-numerical risk information are related to their tendency to choose early surgical treatment for asymptomatic gland-confined prostate cancer (a choice with high risk and high therapeutic uncertainty), the authors conducted a cross-sectional study of 228 patients receiving continuing care in a general medicine clinic. After being provided with three data disclosures related to the treatment decision, subjects were given a choice between surgery-now and watchful waiting. Data about surgical complications were presented in numerical format. The subjects were also asked whether they preferred communication with their physician about the chance (probability) of adverse outcomes-related to management strategies-in terms of words (such as possible or probable) or numbers (such as percentages). Of the 226 patients who chose either surgery-now or watchful waiting, 71.2% preferred risk information in terms of words only or numbers only: 44% words only, and 56% numbers only. Younger patients (OR = 1.06 per year; CI = 1.02-1.10, p = 0.0008) and those wanting risk communication in terms of words only (OR = 2.41; CI = 1.24-4.70, p = 0.01) tended to prefer surgery-now over watchful waiting as the management strategy for asymptomatic gland-confined prostate carcinoma. The authors conclude that there is a significant association between patients' preferences for risk communication with their physicians in terms of words only and a tendency to prefer early surgical intervention for prostate cancer when surgical risk data are provided numerically.

Adult↗

PubMedDate not supplied

Patients' desires and satisfaction in general medicine clinics.

Most patients have explicit desires or requests when they visit their physicians. Identification of patients' requests and needs is the starting point of a patient-centered approach to care. The frequency with which physicians met their patients' desires for services and that frequency's association with patient satisfaction were examined for 243 patients with chronic disease in general medicine clinics of a Department of Veterans Affairs hospital. Patients desired a mean of 11.9 services, of which an average of 67 percent were met. However, many patients' desires for information and most of their desires for help with emotional and family problems were not met. Patients with the most unmet desires for services, especially services related to information, were significantly less satisfied with their physicians than were those with fewer unmet desires. Factor analysis was used to develop a short, 16-item Requests for Services Questionnaire that appeared to cover the range of services that patients with chronic conditions desire. Enhancing physicians' ability to recognize and respond to patients' desires for services by using short patient request questionnaires may have the potential to improve patient satisfaction and other health care outcomes.

Aged↗

PubMedDate not supplied

Patient preferences for management of localized prostate cancer.

We designed this study to determine whether patients with early localized prostate cancer prefer surgical intervention over watchful waiting, which aspects of the 2 management strategies influence patient preferences, and whether there are patient characteristics that predict their preferences for 1 strategy over the other. Structured interviews were used with 140 male patients seen consecutively at a university-based Department of Veterans Affairs Medical Center outpatient clinic. The mean age of the patients was 66.3 years. Of the 140 patients, 53% preferred surgical treatment, 42% preferred observation, 4% preferred that their physician make the decision, and 1% preferred radiotherapy. Of 74 patients selecting surgical intervention, 92% (68) reported that the possibility of complete tumor removal was the strongest factor influencing their decision. Of those selecting observation, 80% (47/59) reported being most influenced by the complications of an operation. Older patients were significantly (P < .002) more likely to prefer expectant management. We conclude that tumor excision is an important factor influencing patient preferences for treatment, irrespective of survival benefits. This factor should be considered when designing approaches to providing information to patients about alternative treatments.

Adult↗