Development and Pilot Testing of Decision Aid for Shared Decision Making in Barrett's Esophagus With Low-Grade Dysplasia.
Autor: | Krishnamoorthi R; Division of Gastroenterology and Hepatology.; Virginia Mason Medical Center, Digestive Disease Institute, Seattle, WA., Hargraves I; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN., Gopalakrishnan N; Division of Gastroenterology and Hepatology., Blevins CH; Division of Gastroenterology and Hepatology., Priyan H; Division of Gastroenterology and Hepatology., Johnson ML; Division of Gastroenterology and Hepatology., Maixner KA; Division of Gastroenterology and Hepatology., Wang KK; Division of Gastroenterology and Hepatology., Katzka DA; Division of Gastroenterology and Hepatology., Talwalkar JA; Division of Gastroenterology and Hepatology., LeBlanc A; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.; Department of Family and Emergency Medicine, Faculty of Medicine University Laval, Quebec City, QC, Canada., Iyer PG; Division of Gastroenterology and Hepatology. |
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Jazyk: | angličtina |
Zdroj: | Journal of clinical gastroenterology [J Clin Gastroenterol] 2021 Jan; Vol. 55 (1), pp. 36-42. |
DOI: | 10.1097/MCG.0000000000001319 |
Abstrakt: | Goals: To develop an encounter decision aid [Barrett's esophagus Choice (BE-Choice)] for patients and clinicians to engage in shared decision making (SDM) for management of BE with low-grade dysplasia (BE-LGD) and assess its impact on patient-important outcomes. Background: Currently, there are 2 strategies for management of BE-LGD-endoscopic surveillance and ablation. SDM can help patients decide on their preferred management option. Study: Phase-I: Patients and clinicians were engaged in a user-centered design approach to develop BE-Choice. Phase-I included review of evidence on BE-LGD management, observation of usual care (UC), creation, field-testing, and iterative development of BE-Choice in clinical settings. Phase-II: Impact of BE-Choice on patient-important outcomes (patient knowledge, decisional conflict, and patient involvement in decision making) was assessed using a controlled before-after study design (UC vs. BE-Choice). Results: Phase-I: Initial prototype was designed with observation of 8 clinical encounters. With field-testing, 3 successive iterations were made before finalizing BE-Choice. BE-Choice was paper based and fulfilled the qualifying criteria of International patient decision aid standards. Phase II: 29 patients were enrolled, 8 to UC and 21 to BE-Choice. Compared with UC, use of BE-Choice improved patient knowledge (90.4% vs. 70.5%; P=0.03), decisional comfort (89.6 vs. 71.9; P=0.01), and patient involvement (OPTION score: 27.1 vs. 19.2; P=0.01). Conclusions: BE-Choice is a feasible and effective decision aid to promote SDM in the management of BE-LGD. On pilot testing, BE-Choice had promising impact on patient-important outcomes. A larger multicenter trial is needed to confirm our results and promote widespread use of BE-Choice. |
Databáze: | MEDLINE |
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