TY - JOUR
T1 - Patients’ and physicians’ beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy
AU - Kostick-Quenet, Kristin M.
AU - Lang, Benjamin
AU - Dorfman, Natalie
AU - Estep, Jerry
AU - Mehra, Mandeep R.
AU - Bhimaraj, Arvind
AU - Civitello, Andrew
AU - Jorde, Ulrich
AU - Trachtenberg, Barry
AU - Uriel, Nir
AU - Kaplan, Holland
AU - Gilmore-Szott, Eleanor
AU - Volk, Robert
AU - Kassi, Mahwash
AU - Blumenthal-Barby, J. S.
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2024/5
Y1 - 2024/5
N2 - Background: Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). Methods and Results: As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a patient's condition and risks, prepare mentally and logistically for likely outcomes, and meaningfully engage in decision making. Physicians felt it can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups also raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance. Conclusion: Stakeholders are optimistic about integrating PR into clinical decision making, but acceptability depends on prospectively demonstrating accuracy, relevance and evidence that benefits of PR outweigh potential negative impacts on decision making quality.
AB - Background: Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). Methods and Results: As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a patient's condition and risks, prepare mentally and logistically for likely outcomes, and meaningfully engage in decision making. Physicians felt it can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups also raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance. Conclusion: Stakeholders are optimistic about integrating PR into clinical decision making, but acceptability depends on prospectively demonstrating accuracy, relevance and evidence that benefits of PR outweigh potential negative impacts on decision making quality.
KW - Clinical decision making
KW - Patient engagement
KW - Personalized risk estimates
KW - Shared decision making
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U2 - 10.1016/j.pec.2024.108157
DO - 10.1016/j.pec.2024.108157
M3 - Article
C2 - 38290171
AN - SCOPUS:85184249386
SN - 0738-3991
VL - 122
JO - Patient Education and Counseling
JF - Patient Education and Counseling
M1 - 108157
ER -