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1.
Health Technol Assess ; 26(41): 1-118, 2022 10.
Article in English | MEDLINE | ID: covidwho-2099087

ABSTRACT

BACKGROUND: Corticosteroids are a mainstay of the treatment of moderately severe relapses of ulcerative colitis, yet almost 50% of patients do not respond fully to these and risk prolonged steroid use and side effects. There is a lack of clarity about the definitions of steroid resistance, the optimum choice of treatment, and patient and health-care professional treatment preferences. OBJECTIVES: The overall aim of this research was to understand how steroid-resistant ulcerative colitis is managed in adult secondary care and how current practice compares with patient and health-care professional preferences. DESIGN: A mixed-methods study, including an online survey, qualitative interviews and discrete choice experiments. SETTING: NHS inflammatory bowel disease services in the UK. PARTICIPANTS: Adults with ulcerative colitis and health-care professionals treating inflammatory bowel disease. RESULTS: We carried out a survey of health-care professionals (n = 168), qualitative interviews with health-care professionals (n = 20) and patients (n = 33), discrete choice experiments with health-care professionals (n = 116) and patients (n = 115), and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals showed that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that anti-tumour necrosis factor drugs (particularly infliximab) are the most frequently offered drugs across most steroid-resistant (and steroid-dependent) patient scenarios, but they are less frequently offered to thiopurine-naive patients. Patient interviews identified several factors influencing their treatment choices, including effectiveness of treatment, recommendations from health-care professionals, route of administration and side effects. Over time, depending on the severity and duration of symptoms and, crucially, as medical treatment options become exhausted, patients are willing to try alternative treatments and, eventually, to undergo surgery. The discrete choice experiments found that the probability of remission and of side effects strongly influences the treatment choices of both patients and health-care professionals. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. The treatments ranked most positively by patients were infliximab and tofacitinib (each preferred by 38% of patients), and the predicted probability of uptake by health-care professionals was greatest for infliximab (62%). LIMITATIONS: The survey and the discrete choice experiments with patients and health-care professionals are limited by their relatively small sample sizes. The qualitative studies are subject to selection bias. The timing of the different substudies, both before and during the COVID-19 pandemic, is a potential limitation. CONCLUSIONS: We have identified factors influencing treatment decisions for steroid-resistant ulcerative colitis and the characteristics to consider when choosing treatments to evaluate in future randomised controlled trials. The findings may be used to improve discussions between patients and health-care professionals when they review treatment options for steroid-resistant ulcerative colitis. FUTURE WORK: This research highlights the need for consensus work to establish an agreed definition of steroid resistance in ulcerative colitis and a greater understanding of the optimal use of tofacitinib and surgery for this patient group. A randomised controlled trial comparing infliximab with tofacitinib is also recommended. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 41. See the NIHR Journals Library website for further project information.


Steroids are one of the main treatments for ulcerative colitis; however, steroids work well for only about 50% of people who take them. There are many other treatments that can be given when steroids do not work, but evidence is limited about how these treatments are best used. To carry out better research about the best treatment options and to improve clinical practice in the future, this study aimed to find out how adults with steroid-resistant ulcerative colitis are managed in hospital and why patients and health-care professionals prefer different treatments. The study combined various methods of research, including an online survey of health-care professionals (n = 168), interviews with health-care professionals (n = 20) and patients (n = 33), a survey of health-care professionals (n = 116) and patients (n = 115) to ask them about treatment preferences, and a multistakeholder workshop (n = 9). The interviews with and survey of health-care professionals found that most health-care professionals define steroid resistance as an incomplete response to 40 mg per day of prednisolone after 2 weeks. The survey also found that the most frequently offered drugs are anti-tumour necrosis factor drugs (particularly infliximab). Patient interviews found that several factors influenced treatment choices, including effectiveness of treament, guidance from health-care professionals, route of administration and side effects. Patients were willing to try alternative treatments and surgery over time. The survey found that a higher level of remission and a lower chance of side effects strongly influenced treatment choices. Patients are less likely to choose a treatment that takes longer to improve symptoms. Health-care professionals are willing to make difficult compromises by tolerating greater safety risks in exchange for therapeutic benefits. Infliximab and tofacitinib were ranked most positively by patients, and the predicted uptake by health-care professionals was greatest for infliximab. The results of this study help improve understanding of why people choose certain treatments, improve decision-making in partnership and inform the design of future research.


Subject(s)
COVID-19 , Colitis, Ulcerative , Adult , Humans , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/surgery , Infliximab/therapeutic use , Patient Preference , Pandemics , Neoplasm Recurrence, Local , Prednisolone/therapeutic use , Cost-Benefit Analysis , Randomized Controlled Trials as Topic
2.
J Med Internet Res ; 24(10): e40989, 2022 10 26.
Article in English | MEDLINE | ID: covidwho-2089644

ABSTRACT

BACKGROUND: Virtual health care use has dramatically increased in response to the COVID-19 pandemic, raising the question of its potential role after the pandemic. For transgender (trans) and nonbinary (TNB) people, virtual care is promising because it may expand access to appropriate health care providers. However, emerging research indicates potential disparities in virtual care access related to sociodemographic, health, and social factors. There is a paucity of research on the factors affecting patient preferences for virtual versus in-person care, particularly in TNB communities. OBJECTIVE: This study aimed to identify the sociodemographic, health, and social factors associated with postpandemic virtual care preferences in TNB communities. METHODS: The 2020 Trans PULSE Canada COVID survey examined the health, social, and economic impacts of the COVID-19 pandemic among 820 TNB participants who previously completed the prepandemic 2019 Trans PULSE Canada survey (n=2783). Data were weighted to the demographics of the 2019 sample. Chi-square tests were used to compare postpandemic preferences for virtual versus in-person care across sociodemographic, health, and social characteristics. Participants provided open-text responses explaining their preferences, which were used to contextualize quantitative findings. RESULTS: Among 812 participants who indicated whether they would prefer virtual or in-person care after the pandemic, a weighted 32.7% (n=275) would prefer virtual care and 67.3% (n=537) would prefer in-person care. Preference for in-person over virtual care was associated with being in the 14-19 (49/56, weighted 85.0%), 50-64 (51/62, weighted 80.0%), and ≥65 (9/10, weighted 90.7%) age groups (χ25=19.0; P=.002). Preference for virtual over in-person care was associated with having a chronic health condition (125/317, weighted 37.7% versus 150/495, weighted 29.9%; χ21=4.7; P=.03) and having probable anxiety (229/645, weighted 34.7% versus 46/167, weighted 25.7%; χ21=4.3; P=.04). Among participants with romantic partners, preferences varied based on the partner's level of support for gender identity or expression (χ23=13.3; P=.004). Participants with moderately supportive partners were more likely than participants with very supportive partners to prefer in-person care (36/43, weighted 85.1% versus 275/445, weighted 62.3%). Care preferences did not vary significantly based on the indicators of socioeconomic status. Open-text responses showed that multiple factors often interacted to influence participant preferences, and that some factors, such as having a chronic condition, simultaneously led some participants to prefer virtual care and others to prefer in-person care. CONCLUSIONS: TNB people may have differential interest in virtual care based on factors including age, chronic and mental health conditions, and gender-unsupportive home environments. Future research examining virtual care preferences would benefit from mixed methods intersectional approaches across these factors, to explore complexity in the barriers and facilitators of virtual care access and quality. These observed differences support flexibility with options to choose between in-person and virtual health care to meet TNB patients' specific health needs.


Subject(s)
COVID-19 , Transgender Persons , Humans , Female , Male , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Gender Identity , Patient Preference
3.
Int J Public Health ; 67: 1604958, 2022.
Article in English | MEDLINE | ID: covidwho-2065659

ABSTRACT

Objectives: This study aims to assess the trade-offs between vulnerability and efficiency attributes of contact tracing programmes based on preferences of COVID-19 contact tracing practitioners, researchers and other relevant stakeholders at the global level. Methods: We conducted an online discrete choice experiment (DCE). Respondents were recruited globally to explore preferences according to country income level and the prevailing epidemiology of COVID-19 in the local setting. The DCE attributes represented efficiency (timeliness, completeness, number of contacts), vulnerability (vulnerable population), cooperation and privacy. A mixed-logit model and latent class analysis were used. Results: The number of respondents was 181. Timeliness was the most important attribute regardless of country income level and COVID-19 epidemiological condition. Vulnerability of contacts was the second most important attribute for low-to-lower-middle-income countries and third for upper-middle-to-high income countries. When normalised against conditional relative importance of timeliness, conditional relative importance of vulnerability ranged from 0.38 to 0.42. Conclusion: Vulnerability and efficiency criteria were both considered to be important attributes of contact tracing programmes. However, the relative values placed on these criteria varied significantly between epidemiological and economic context.


Subject(s)
COVID-19 , Contact Tracing , COVID-19/epidemiology , COVID-19/prevention & control , Choice Behavior , Humans , Logistic Models , Patient Preference , Surveys and Questionnaires
4.
J Surg Res ; 280: 288-295, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2004290

ABSTRACT

INTRODUCTION: COVID-19 spurred an unprecedented transition from in-person to telemedicine visits in March 2020 at our institution for all prenatal counseling sessions. This study aims to explore differences in demographics of expectant mothers evaluated pre- and post-telemedicine implementation and to explore the patient experience with telemedicine. METHODS: A mixed methods study was completed for mothers with a pregnancy complicated by a fetal surgical anomaly who visited a large tertiary fetal center. Using medical records as quantitative data, patient information was collected for all prenatal visits from 3/2019 to 3/2021. The sample was grouped into pre- and post-telemedicine implementation (based on transition date of 3/2020). Univariate analysis was used to compare demographics between the study groups. Statistical significance was defined as P < 0.05. Eighteen semi-structured interviews were conducted from 8/2021 to 12/2021 to explore patients' experiences. Line-by-line coding and thematic analysis was performed to develop emerging themes. RESULTS: 292 pregnancies were evaluated from 3/2019 to 3/2021 (pre-telemedicine 123, post-telemedicine 169). There was no significant difference in self-reported race (P = 0.28), ethnicity (P = 0.46), or primary language (P = 0.98). In qualitative interviews, patients reported advantages to telemedicine, including the convenience of the modality with the option to conduct their session in familiar settings (e.g., home) and avoid stressors (e.g., travel to the medical center and finding childcare). Some women reported difficulties establishing a physician-patient connection and a preference for in-person consultations. CONCLUSIONS: There was no difference in patient demographics at our fetal center in the year leading up to, and the time following, a significant transition to telemedicine. However, patients had unique perspectives on the advantages and disadvantages of the telemedicine experience. To ensure patient centered care, these findings suggest patient preference should be considered when scheduling outpatient surgical counseling and visits.


Subject(s)
COVID-19 , Telemedicine , Humans , Female , Pregnancy , Telemedicine/methods , Patient Preference , Counseling , Referral and Consultation
5.
BMC Infect Dis ; 21(1): 879, 2021 Aug 28.
Article in English | MEDLINE | ID: covidwho-1383608

ABSTRACT

BACKGROUND: Choice-based experiments have been increasingly used to elicit preferences for vaccines and vaccination programs. This study aims to systematically identify and examine choice-based experiments assessing (differences in) vaccine preferences of vaccinees, representatives and health advisors. METHODS: Five electronic databases were searched on choice-based conjoint analysis studies or discrete choice experiments capturing vaccine preferences of children, adolescents, parents, adults and healthcare professionals for attributes of vaccines or vaccine settings up to September 2020. Data was extracted using a standardized form covering all important aspects of choice experiments. A quality assessment was used to assess the validity of studies. Attributes were categorized into outcome, process, cost and other. The importance of attributes was assessed by the frequency of reporting and statistical significance. Results were compared between high-quality studies and lower-quality studies. RESULTS: A total of 42 studies were included, with the majority conducted in high-income countries after 2010 (resp. n = 34 and n = 37). Preferences of representatives were studied in nearly half of the studies (47.6%), followed by vaccinees (35.7%) and health advisors (9.5%). Sixteen high-quality studies passed the quality assessment. Outcome- and cost- related attributes such as vaccine effectiveness, vaccine risk, cost and protection duration were most often statistically significant across both target groups, with vaccine effectiveness being the most important. Risks associated with vaccination, such as side effects, were more often statistically significant in studies targeting vaccinees, while cost-related attributes were more often statistically significant in studies of representatives. Process-related attributes such as vaccine accessibility and time were least important across both target groups. CONCLUSION: To our knowledge, this is the first systematic review in which vaccine preferences of different target groups were assessed and compared. The same attributes were most important for vaccine decisions of vaccinees and representatives, with only minor differences in level of evidence for vaccine risk and cost. Future research on vaccine preferences of health advisors and/or among target groups in low-resource settings would give insight into the generalizability of current findings.


Subject(s)
Patient Preference , Vaccines , Adolescent , Adult , Child , Choice Behavior , Decision Making , Humans , Parents , Vaccination
6.
Int J Environ Res Public Health ; 19(13)2022 06 22.
Article in English | MEDLINE | ID: covidwho-1934029

ABSTRACT

Background: Person-centered care (PCC) requires knowledge about patient preferences. This formative qualitative study aimed to identify (sub)criteria of PCC for the design of a quantitative, choice-based instrument to elicit patient preferences for person-centered dementia care. Method: Interviews were conducted with n = 2 dementia care managers, n = 10 People living with Dementia (PlwD), and n = 3 caregivers (CGs), which followed a semi-structured interview guide including a card game with PCC criteria identified from the literature. Criteria cards were shown to explore the PlwD's conception. PlwD were asked to rank the cards to identify patient-relevant criteria of PCC. Audios were verbatim-transcribed and analyzed with qualitative content analysis. Card game results were coded on a 10-point-scale, and sums and means for criteria were calculated. Results: Six criteria with two sub-criteria emerged from the analysis; social relationships (indirect contact, direct contact), cognitive training (passive, active), organization of care (decentralized structures and no shared decision making, centralized structures and shared decision making), assistance with daily activities (professional, family member), characteristics of care professionals (empathy, education and work experience) and physical activities (alone, group). Dementia-sensitive wording and balance between comprehensibility vs. completeness of the (sub)criteria emerged as additional themes. Conclusions: Our formative study provides initial data about patient-relevant criteria of PCC to design a quantitative patient preference instrument. Future research may want to consider the balance between (sub)criteria comprehensibility vs. completeness.


Subject(s)
Dementia , Patient Preference , Analytic Hierarchy Process , Caregivers/psychology , Dementia/psychology , Dementia/therapy , Humans , Patient-Centered Care/methods , Qualitative Research , Research Design
7.
BMC Med Ethics ; 23(1): 53, 2022 05 20.
Article in English | MEDLINE | ID: covidwho-1902384

ABSTRACT

BACKGROUND: Rapid ethical access to personal health information (PHI) to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences. METHODS: A total of 183 patients in the pandemic cohort completed the survey via email, and responses were compared to the distinct pre-pandemic cohort (n = 222); all were patients of a large Canadian cancer center. The survey covered (a) broad versus study-specific consent; (b) opt-in versus opt-out contact approach; (c) levels of comfort sharing with different recipients; (d) perceptions of commercialization; and (e) options to track use of information and be notified of results. Four focus groups (n = 12) were subsequently conducted to elucidate reasons motivating dominant preferences. RESULTS: Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples (90% vs. 79%, p = 0.009), sharing information with the health care institution (97% vs. 83%, p < 0.001), sharing information with researchers at other hospitals (85% vs. 70%, p < 0.001), sharing PHI provincially (69% vs. 53%, p < 0.002), nationally (65% vs. 53%, p = 0.022) and internationally (48% vs. 39%, p = 0.024) compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts (50% vs. 51% uncomfortable, p = 0.58). Significantly more pandemic cohort patients expressed a wish to track use of PHI (75% vs. 61%, p = 0.007), and to be notified of results (83% vs. 70%, p = 0.012). Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved. CONCLUSIONS: In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort (~ 50%) remained unchanged. Focus groups identified that the ability to track and receive results of studies using one's PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises.


Subject(s)
COVID-19 , Health Records, Personal , COVID-19/epidemiology , Canada , Follow-Up Studies , Humans , Informed Consent , Pandemics , Patient Preference
8.
Muscle Nerve ; 66(2): 142-147, 2022 08.
Article in English | MEDLINE | ID: covidwho-1858881

ABSTRACT

INTRODUCTION/AIMS: It is unknown if patients with neuromuscular diseases prefer in-person or virtual telemedicine visits. We studied patient opinions and preference on virtual versus in-person visits, and the factors influencing such preferences. METHODS: Telephone surveys, consisting of 11 questions, of patients from 10 neuromuscular centers were completed. RESULTS: Five hundred and twenty surveys were completed. Twenty-six percent of respondents preferred virtual visits, while 50% preferred in-person visits. Sixty-four percent reported physical interaction as "very important." For receiving a new diagnosis, 55% preferred in-person vs 35% reporting no preference. Forty percent were concerned about a lack of physical examination vs 20% who were concerned about evaluating vital signs. Eighty four percent reported virtual visits were sufficiently private. Sixty eight percent did not consider expenses a factor in their preference. Although 92% were comfortable with virtual communication technology, 55% preferred video communications, and 19% preferred phone calls. Visit preference was not significantly associated with gender, diagnosis, disease severity, or symptom management. Patients who were concerned about a lack of physical exam or assessment of vitals had significantly higher odds of selecting in-person visits than no preference. DISCUSSION: Although neither technology, privacy, nor finance burdened patients in our study, more patients preferred in-person visits than virtual visits and 40% were concerned about a lack of physical examination. Interactions that occur with in-person encounters had high importance for patients, reflecting differences in the perception of the patient-physician relationship between virtual and in-person visits.


Subject(s)
Patient Preference , Telemedicine , Communication , Humans , Surveys and Questionnaires
9.
Int J Environ Res Public Health ; 19(8)2022 04 15.
Article in English | MEDLINE | ID: covidwho-1792705

ABSTRACT

Objective: This study aims to investigate the differences in public vaccination preference for the COVID-19 vaccine with different personality characteristics. Methods: Based on the Big Five Personality Inventory (BFI-10), a total of 1200 respondents were categorized by personality characteristics using Latent Profile Analysis (LPA). The preference of members the public with different personality characteristics for COVID-19 vaccination was investigated based on a discrete choice experiment (DCE). Results: All respondents were divided into three groups, named the General and Stable type (79.67%), Conscientious and Agreeable type (9.5%), and Open and Extroverted type (10.83%). For the percentage importance of vaccine attributes, both the General and Stable type and Conscientious and Agreeable type respondents considered cost to be the most important (41.93% and 34.95% respectively). However, the Open and Extroverted type respondents considered efficacy as the most important (31.05%). In our conditional logit model (CLOGIT), for vaccine adverse effects, the General and Stable type and Conscientious and Agreeable type respondents preferred "very mild", while the Open and Extroverted type preferred "mild" (OR:1.108, 95%CI 0.977-1.256). The Open and Extroverted type had a higher willingness to pay (WTP) for the most preferred vaccine level compared to the other types. Conclusions: The Open and Extroverted respondents have the highest willingness to vaccinate. The General and Stable type and Conscientious and Agreeable respondents think that the cost of the vaccine is the most important attribute, and prefer the mildest side effects. The Open and Extroverted type think that vaccine efficacy is the most important attribute, prefer "mild" side effects, and have higher willingness to pay for their favorite vaccine level.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , China , Choice Behavior , Humans , Patient Preference , Personality , Surveys and Questionnaires , Vaccination
10.
BMC Musculoskelet Disord ; 23(1): 312, 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1770518

ABSTRACT

BACKGROUND: Guidance for choosing face-to-face vs remote consultations (RCs) encourages clinicians to consider patient preferences, however, little is known about acceptability of, and preferences for RCs, particularly amongst patients with musculoskeletal conditions. This study aimed to explore the acceptability of, and preferences for, RC among patients with osteoporosis and rheumatoid arthritis. METHODS: Three UK qualitative studies, exploring patient experiences of accessing and receiving healthcare, undertaken during the pandemic, with people with osteoporosis and rheumatoid arthritis. Study team members agreed a consistent approach to conduct rapid deductive analysis using the Theoretical Framework of Acceptability (TFA) on transcripts from each data set relating to RC, facilitated by group meetings to discuss interpretations. Findings from the three studies were pooled. RESULTS: Findings from 1 focus group and 64 interviews with 35 people were included in the analysis. Participants' attitudes to RC, views on fairness (ethicality) and sense-making (intervention coherence) varied according to their needs within the consultation and views of the pandemic. Some participants valued the reduced burden associated with RC, while others highly valued non-verbal communication and physical examination associated with face-to-face consults (opportunity costs). Some participants described low confidence (self-efficacy) in being able to communicate in RCs and others perceived RCs as ineffective, in part due to suboptimal communication. CONCLUSIONS: Acceptability of, and preferences for RC appear to be influenced by societal, healthcare provider and personal factors and in this study, were not condition-dependant. Remote care by default has the potential to exacerbate health inequalities and needs nuanced implementation.


Subject(s)
COVID-19 , COVID-19/epidemiology , Focus Groups , Humans , Patient Preference , Qualitative Research , Referral and Consultation
11.
Dermatol Surg ; 48(6): 636-641, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1764684

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused an increasing shift toward the utilization of telehealth services. There are limited data on patient preferences for these services in dermatologic surgery. OBJECTIVE: To evaluate patient preferences regarding telehealth in dermatologic surgery for pre- and postsurgical care. METHODS: A survey was administered to patients in an academic dermatology practice. RESULTS: Two hundred twenty-four patients participated. An in-person presurgical consultation was preferred by 62.1%, and a postsurgical in-person visit was preferred by 67.7%. The most commonly cited reason was desire for physical interaction with their surgeon. For each 10-year increase in age, there was a 1.26-fold and 1.12-fold increase in preference for in-person consultation and follow-up, respectively. Eighty-seven percent felt safe during office visit, and 41% reported no anxiety regarding fear of contracting COVID-19. The proportion of patients preferring in-person pre- or postsurgical visits was similar regardless of sex, presence of an immunocompromising condition, prior dermatologic surgery, anxiety level for contracting COVID-19, and perceived level of office safety. CONCLUSION: A majority of patients prefer in-person visits for pre- and postsurgical care. Older patients have a greater preference for in-person care. Anxiety level regarding COVID-19 and perceived level of office safety were not related to preference for in-person visits.


Subject(s)
COVID-19 , Telemedicine , COVID-19/epidemiology , Dermatologic Surgical Procedures , Humans , Pandemics , Patient Preference
12.
Heart ; 108(7): 558-564, 2022 04.
Article in English | MEDLINE | ID: covidwho-1741653

ABSTRACT

OBJECTIVE: To provide insight into professionals' perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS). METHODS: A semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data. RESULTS: Four primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients' wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS. CONCLUSIONS: Professionals struggle to make highly complex treatment decisions part of SDM and to embed patients' expectations of treatment and patients' preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.


Subject(s)
Aortic Valve Stenosis , Decision Making, Shared , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/therapy , Communication , Decision Making , Humans , Patient Participation , Patient Preference
13.
BMC Prim Care ; 23(1): 33, 2022 02 22.
Article in English | MEDLINE | ID: covidwho-1703260

ABSTRACT

BACKGROUND: The Hybrid Patient Care system integrates telehealth and in-clinic consultation. While COVID-19 increased telehealth use, healthcare providers are still seeking the best combination of virtual and in-clinic consultation. Understanding patients' tele-consultation-related preferences is vital for achieving optimal implementation. The discrete choice experiment (DCE) is the stated preference technique for eliciting individual preferences and is increasingly being used in health-related applications. The study purpose was to evaluate attributes and levels of the DCE regarding patients' preferences for telemedicine versus traditional, in-clinic consultation in primary care during the COVID-19 pandemic, in order to facilitate successful implementation. METHODS: A three-phase structure was used in the qualitative stage of the DCE: (1) a literature review and preparation of interview guides; (2) Eight focus group interviews comprised of 26 patients and 33 physicians; and (3) Attribute selection: a ranking exercise among 48 patients. The Think Aloud technique, in which respondents are asked to verbalize their thoughts, was used in the focus groups. Interview data were analyzed by thematic analysis. RESULTS: Eight attributes were proposed by the patients in the focus groups. The four most important attributes were then selected in pre-testing, and are described in this study: Availability, time until the appointment, severity of the medical problem, patient-physician relationship, and flexible reception hours. CONCLUSIONS: This study has a theoretical contribution in post-COVID-19 patients' preferences in Hybrid Medicine patient care. This provides a foundation to assess the rigors of this stage and provide additional evidence to the limited existing literature on attributes development for DCE patient preferences.


Subject(s)
COVID-19 , Telemedicine , Choice Behavior , Humans , Pandemics , Patient Preference , Primary Health Care , Referral and Consultation , SARS-CoV-2
14.
Intern Med J ; 52(5): 763-769, 2022 05.
Article in English | MEDLINE | ID: covidwho-1701983

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has had a major impact on healthcare services with many changes to telehealth care delivery. More information is needed about the patient perspective of telehealth in hospital services and the potential costs and benefits for patients. AIM: To measure patients' evaluation of telehealth, preferences for telehealth versus in-person appointments, and potential cost savings by patient characteristics. METHODS: A cross-sectional online survey (including patient and appointment characteristics, telehealth evaluation, preferences for care and costs) of adult patients using video telehealth in four metropolitan tertiary hospital services in Melbourne, Victoria. RESULTS: A total of 1045 patients (median age 44 years; interquartile range 29-59) participated with an overall response rate of 9.2%. For 98.7% patients, telehealth was convenient, 96.4% stated that it saved time, 95.9% found telehealth acceptable to receive care and 97.0% found that telehealth improved their access to care. Most (62.6%) preferred in-person consultations, although 86.9% agreed that telehealth was equivalent to an in-person consultation. Those in regional and rural areas were less likely to prefer in-person consultations. Patients attending for medical reasons were less likely to prefer in-person consultation compared with patients with surgical reasons. Patient preference to telehealth was independent of level of education, appointment type, self-rated health status and socio economic status. Patients saved an average of A$120.9 (standard deviation A$93.0) per appointment, with greater cost savings for patients from low and middle socio economic areas and regional or rural areas. CONCLUSION: Telehealth video consultations were largely evaluated positively with most patients considering the service to be as good as in-person. Understanding patient preference is critical to consider when implementing telehealth as mainstream across hospital health services.


Subject(s)
COVID-19 , Telemedicine , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Pandemics , Patient Preference , Tertiary Care Centers
15.
Ir J Med Sci ; 191(6): 2445-2447, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1641002

ABSTRACT

BACKGROUND: The debate on current doctors' attire in Irish hospital resurfaced alongside COVID-19, as a shift in doctors' attire from professional attire to scrubs was observed. AIM: The current study aimed to explore whether COVID-19 has changed the way in which hospital doctors perceive their personal attire, and whether this group wish for changes implemented during COVID-19 to become permanent. METHODS: Hospital doctors (n = 151), across all specialties and seniority at University Hospital Galway (UHG), filled out a ten-point online questionnaire exploring their experience of and attitudes towards hospital attire during COVID-19. Data collected and analysed in August-September 2020. RESULTS: Seventy-six percent (119) changed their attire during COVID-19 to scrubs (54% to hospital provided; 22% to private). Thirty-eight percent (56) reported feeling uncomfortable with bringing clothing home, highlighting the infection control risk. Seventy-four per cent (110) wanted the change to scrubs as standard attire to become permanent (65% to hospital provided; 9% to private). Thirty-two percent (47) noted a change in patients' perception when wearing scrubs. CONCLUSION: Hospital doctors changed their attire during COVID-19, and 75% would like these changes to become permanent. Most (67%) did not notice a change in their patient's perception of them, raising questions about the longstanding beliefs surrounding 'professional attire'. A large number of doctors are also worried about bringing clothing home. The humble hospital scrubs have shown their worth amidst the COVID-19 pandemic. Why not continue to wear them?


Subject(s)
COVID-19 , Physician-Patient Relations , Humans , Clothing , Patient Preference , Pandemics , Surveys and Questionnaires , Hospitals
16.
Health Expect ; 25(3): 959-970, 2022 06.
Article in English | MEDLINE | ID: covidwho-1639175

ABSTRACT

OBJECTIVES: The global coronavirus disease 2019 (COVID-19) pandemic has not been well controlled, and vaccination could be an effective way to prevent this pandemic. By accommodating attribute nonattendance (ANA) in a discrete choice experiment (DCE), this paper aimed to examine Chinese public preferences and willingness to pay (WTP) for COVID-19 vaccine attributes, especially the influence of ANA on the estimated results. METHODS: A DCE was designed with four attributes: effectiveness, protection period, adverse reactions and price. A random parameter logit model with an error component (RPL-EC) was used to analyse the heterogeneity of respondents' preferences for COVID-19 vaccine attributes. Two equality constraint latent class (ECLC) models were used to consider the influence of ANA on the estimated results in which the ECLC-homogeneity model considered only ANA and the ECLC-heterogeneity model considered both ANA and preference heterogeneity. RESULTS: Data from 1,576 samples were included in the analyses. Effectiveness had the highest relative importance, followed by adverse reactions and protection period, which were determined by the attributes and levels presented in this study. The ECLC-heterogeneity model improved the goodness of fit of the model and obtained a lower probability of ANA. In the ECLC-heterogeneity model, only a small number of respondents (29.09%) considered all attributes, and price was the most easily ignored attribute (64.23%). Compared with the RPL-EC model, the ECLC-homogeneity model obtained lower WTPs for COVID-19 vaccine attributes, and the ECLC-heterogeneity model obtained mixed WTP results. In the ECLC-heterogeneity model, preference group 1 obtained higher WTPs, and preference groups 2 and 3 obtained lower WTPs. CONCLUSIONS: The RPL-EC, ECLC-homogeneity and ECLC-heterogeneity models obtained inconsistent WTPs for COVID-19 vaccine attributes. The study found that the results of the ECLC-heterogeneity model considering both ANA and preference heterogeneity may be more plausible because ANA and low preference may be confused in the ECLC-homogeneity model and the RPL-EC model. The results showed that the probability of ANA was still high in the ECLC-heterogeneity model, although it was lower than that in the ECLC-homogeneity model. Therefore, in future research on DCE (such as the field of vaccines), ANA should be considered as an essential issue. PUBLIC CONTRIBUTION: Chinese adults from 31 provinces in mainland China participated in the study. All participants completed the COVID-19 vaccine choice questions generated through the DCE design.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , COVID-19/prevention & control , Choice Behavior , Humans , Patient Preference , Surveys and Questionnaires , Vaccination
17.
JAMA Netw Open ; 4(12): e2141233, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1596574

ABSTRACT

Importance: The COVID-19 pandemic led to the implementation of alternative care modalities (eg, teleconsultations and task shifting) that will continue to be implemented in parallel to traditional care after the pandemic. An ideal balance between alternative and traditional care modalities is unknown. Objectives: To quantify the ideal postpandemic balance between alternative and traditional care modalities among patients with chronic illness and to qualify the circumstances in which patients consider it appropriate to replace traditional care with alternative care. Design, Setting, and Participants: This survey study invited 5999 adults with chronic illness in ComPaRe, a French nationwide e-cohort of adults with chronic conditions who volunteer their time to participate in research projects, to participate in this study, which was performed from January 27 to February 23, 2021. Main Outcomes and Measures: Participants rated the ideal proportion at which they would use 3 alternative care modalities instead of the traditional care equivalent on a 0% to 100% scale (with 0% indicating using alternative care modalities for none of one's future care and 100% indicating using alternative care modalities for all of one's future care) of their overall future care: (1) teleconsultations, (2) online symptom-checkers to react to new symptoms, and (3) remote monitoring to adapt treatment outside consultations. The median ideal proportion of alternative care use was calculated. Perceived appropriate circumstances in which each alternative modality could replace traditional care were collected with open-ended questions. Analyses were performed on a weighted data set representative of patients with chronic illness in France. Results: Of the 5999 invited individuals, 1529 (mean [SD] age, 50.3 [14.7] years; 1072 [70.1%] female) agreed to participate (participation rate, 25.5%). Participants would choose teleconsultations for 50.0% of their future consultations (IQR, 11.0%-52.0%), online symptom-checkers over contacting their physician for 22.0% of new symptoms (IQR, 2.0%-50.0%), and remote monitoring instead of consultations for 52.3% of their treatment adaptations (IQR, 25.4%-85.4%). Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities (eg, prescription renewal and addressing acute or minor complaints), 25 patient characteristics (eg, stable chronic condition and established patient-physician relationship), and 11 required characteristics of the alternative care modalities (eg, quality assurance). Conclusions and Relevance: Results of this survey study suggest that after the pandemic, patients would choose alternative over traditional care for 22% to 52% of the time across different care needs. Participants proposed 67 criteria to guide clinicians in replacing traditional care with alternative care. These findings provide a guide for redesigning care in collaboration with patients after the pandemic.


Subject(s)
COVID-19 , Chronic Disease/therapy , Delivery of Health Care/methods , Pandemics , Patient Acceptance of Health Care , Patient Preference , Adult , Female , France , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine
18.
J Med Internet Res ; 23(2): e22841, 2021 02 23.
Article in English | MEDLINE | ID: covidwho-1574897

ABSTRACT

BACKGROUND: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. OBJECTIVE: This study aims to visualize and measure patients' heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. METHODS: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables' coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. RESULTS: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis "accuracy" attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. CONCLUSIONS: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People's preferences for the "accuracy" and "diagnostic expenses" attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration.


Subject(s)
Artificial Intelligence , Diagnosis , Patient Preference , Physicians , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , China , Choice Behavior , Diagnostic Techniques and Procedures/economics , Female , Health Expenditures , Humans , Latent Class Analysis , Logistic Models , Male , Middle Aged , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , Time Factors , Young Adult
19.
JAMA Netw Open ; 4(12): e2136405, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1544183

ABSTRACT

Importance: Telehealth use greatly increased in 2020 during the first year of the COVID-19 pandemic. Patient preferences for telehealth or in-person care are an important factor in defining the role of telehealth in the postpandemic world. Objective: To ascertain patient preferences for video visits after the ongoing COVID-19 public health emergency and to identify patient perceptions of the value of video visits and the role of out-of-pocket cost in changing patient preference for each visit modality. Design, Setting, and Participants: This survey study was conducted using a nationally representative sample of adult members of the RAND American Life Panel. The data were obtained from the American Life Panel Omnibus Survey, which was fielded between March 8 and 19, 2021. Main Outcomes and Measures: Preferences for video visits vs in-person care were analyzed in the survey. The first question was about participants' baseline preference for an in-person or a video visit for a nonemergency health issue. The second question entailed choosing between the preferred visit modality with a cost of $30 and another modality with a cost of $10. Questions also involved demographic characteristics, experience with video visits, willingness to use video visits, and preferences for the amount of telehealth use after the COVID-19 pandemic. Results: A total of 2080 of 3391 sampled panel members completed the survey (participation rate, 61.3%). Participants in the weighted sample had a mean (SE) age of 51.1 (0.67) years and were primarily women (1079 [51.9%]). Most participants (66.5%) preferred at least some video visits in the future, but when faced with a choice between an in-person or a video visit for a health care encounter that could be conducted either way, more than half of respondents (53.0%) preferred an in-person visit. Among those who initially preferred an in-person visit when out-of-pocket costs were not a factor, 49.8% still preferred in-person care and 23.5% switched to a video visit when confronted with higher relative costs for in-person care. In contrast, among those who initially preferred a video visit, only 18.9% still preferred a video visit and 61.7% switched to in-person visit when confronted with higher relative costs for video visits. Conclusions and Relevance: This survey study found that participants were generally willing to use video visits but preferred in-person care, and those who preferred video visits were more sensitive to paying out-of-pocket cost. These results suggest that understanding patient preferences will help identify telehealth's role in future health care delivery.


Subject(s)
COVID-19 , Delivery of Health Care/methods , Pandemics , Patient Preference , Telemedicine/methods , Adult , Female , Humans , Male , Middle Aged , Patient Preference/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires , United States , Videoconferencing
20.
Female Pelvic Med Reconstr Surg ; 27(12): 719-725, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1526238

ABSTRACT

OBJECTIVE: Preoperative counseling can affect postoperative outcomes and satisfaction. We hypothesized that patient preparedness would be equivalent after preoperative counseling phone calls versus preoperative counseling office visits before prolapse surgery. METHODS: This was an equivalence randomized controlled trial of women undergoing pelvic organ prolapse surgery. Participants were randomized to receive standardized counseling via a preoperative phone call or office visit. The primary outcome was patient preparedness measured on a 5-point Likert scale by the Patient Preparedness Questionnaire at the postoperative visit. A predetermined equivalence margin of 20% was used. Two 1-sided tests for equivalence were used for the primary outcome. RESULTS: We randomized 120 women. The study was concluded early because of COVID-19 and subsequent surgery cancellations. There were 85 participants with primary outcome data (43 offices, 42 phones). Mean age was 62.0 years (±1.0) and 64 (75.3%) had stage III or stage IV prolapse. The primary outcome, patient preparedness measured at the postoperative visit, was equivalent between groups (office, n = 43 [97.7%]; phone, n = 42 [97.6%], P < 0.001). Most women reported they would have preferred a phone call (n = 66, 65.5%) with more women in the phone group expressing this preference than the office group (office 40.5% vs phone 90.5%, P < 0.001). Ultimately, nearly all women (96.5%) were satisfied with their method of counseling. CONCLUSIONS: Preoperative counseling phone calls were equivalent to office visits for patient preparedness for pelvic organ prolapse surgery. This study demonstrates patient acceptance of phone calls for preoperative counseling. Telehealth modalities should be considered as an option for preoperative patient counseling.


Subject(s)
Counseling/methods , Office Visits , Patient Education as Topic/methods , Pelvic Organ Prolapse/surgery , Telephone , Early Termination of Clinical Trials , Female , Humans , Middle Aged , Patient Preference , Patient Satisfaction , Preoperative Care
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