Biomedical subjects

Karen R Sepucha

Publications and source records attributed to Karen R Sepucha.

5 recordsLinked to original sources

PubMed2006

Decision aids in routine practice: lessons from the breast cancer initiative.

BACKGROUND: Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. OBJECTIVE: To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. CONCLUSIONS: It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals.

Academic Medical Centers↗

PubMed2004

Policy support for patient-centered care: the need for measurable improvements in decision quality.

The phenomenon of practice variation draws attention to the need for better management of clinical decision making as a means of ensuring quality. Different policies to address variations, including guidelines and measures of appropriateness, have had little demonstrable impact on variation itself or on the underlying quality problems. Variations in rates of interventions raise questions about the patient-centeredness of decisions that determine what care is provided to whom. Policies that support the development and routine use of measures of decision quality will provide opportunities to measurably improve the quality of decisions, thereby leading to more patient-centered and efficient health care.

Decision Making↗

PubMed2003

Extending decision support: preparation and implementation.

The shift towards patient-centered care requires innovative, flexible decision-making models. Current decision aids provide information and help patients clarify values. By focusing almost exclusively on these two components, the aids miss some necessary elements that can improve decision quality. We discuss two such elements in this paper. First is avoiding the tendency to move into providing information about options and outcomes before adequate preparation. The second is the tendency to neglect to provide adequate implementation support.

Cooperative Behavior↗

PubMed2002

Consultation planning to help breast cancer patients prepare for medical consultations: effect on communication and satisfaction for patients and physicians.

PURPOSE: To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. PATIENTS AND METHODS: We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients' and physicians' satisfaction with the consultation. RESULTS: Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. CONCLUSION: Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient's agenda, were more satisfying to patients and physicians than the Productive Listening sessions.

Adaptation, Psychological↗

PubMedDate not supplied

Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template.

PURPOSE/OBJECTIVES: To describe two templates that can be used to improve the quality of breast cancer treatment decisions. DATA SOURCES: Case study, survey of current users, three clinical trials. FINDINGS: Clinical applications of the Consultation Planning Template and Consultation Recording Template vary across organizations. Clinical trials have demonstrated that the templates can improve the quality of decisions, the quality of communication between patients and providers, and satisfaction. CONCLUSIONS: The templates can be adapted to different clinical settings and can improve the quality of treatment decisions. IMPLICATIONS FOR NURSING: Nurses often provide the majority of education and coaching for patients making decisions. As patients' demands for involvement in decision making increase, nurses need practical tools to help patients participate. The templates are practical tools that nurses can use to help patients make better decisions.

Adult↗