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Background: Older adults and Hispanic individuals are increasingly turning to social media platforms to access health-related information. The purpose of this project was to evaluate a social media campaign to disseminate information from decision aids (DAs) on hip and knee osteoarthritis to Spanish-speaking adults., Methods: A social media marketing team helped create an 8-mo campaign posted across 3 social media platforms to promote visits to a Web site offering free multilingual DAs for treatment of hip or knee osteoarthritis. Eight videos featuring Spanish-speaking actors discussing DAs were boosted (i.e., money was paid so posts landed on user's feeds). In this observational study, metrics tracked reach, extended engagement, and number of users accessing the Web site. Videos were qualitatively coded for themes, including pain and benefits of treatment options; biserial correlations assessed relationships between the presence of a code and the metrics. We calculated cost per visitor using the total campaign cost and number of users accessing the Web site., Results: During the campaign, boosted videos reached 83,937 users. Of the users, 22,777 had extended engagement with the videos, and 1,835 users visited our Web site with access to the DAs. Videos that included themes of pain tended to reach more users ( r  = 0.88) and have higher engagement ( r  = 0.70). When videos included the theme of benefits of treatment, more users tended to visit our Web site ( r  = 0.78). The total campaign cost was $25,950, making the cost per Web site visitor $14.14., Conclusions: Social media was a useful, inexpensive tool for disseminating health care information on hip and knee osteoarthritis DAs to predominantly Spanish-speaking adults. Further work should identify how exposure to such social media content affects a viewer's health care attitudes, health care behaviors, and surgical decision making., Highlights: An 8-mo social media campaign was able to reach more than 83,000 users and result in almost 2,000 users accessing a Web site with multilingual decision aids.Social media may be an inexpensive tool for disseminating health care information such as decision aids to Spanish-speaking adults., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KS, KDV, and FM report receiving support from the Patrick and Catherine Weldon Donaghue Medical Research Foundation for the project. AFC reports royalties from Stryker; is a paid consultant for Adaptive Phage Therapeutics, Avanos, BICMD, Convatec, Ethicon, Heraeus, IrriMax, Osteal Therapeutics, Peptilogics, Pfizer, Smith and Nephew, Stryker, and TrialSpark; holds stock or stock options in Hyalex, Irrimax, Osteal Therapeutics, Sonoran, IlluminOss; received research support (outside of this project) from Adaptive Phage Therapeutics, Elute, Peptilogics, Sectra; received support from SLACK Incorporated, UpToDate, Taylor & Francis Group, and Journal of Bone and Joint Surgery; engaged in editorial participation at the Journal of Arthroplasty, Journal of Bone and Joint Infection, Journal of Bone and Joint Surgery, and Arthroplasty Today; and has board appointments at the American Joint Replacement Registry and American Association of Hip and Knee Surgeons. KS reports research funding to her institution from the Patient-Centered Outcomes Research Institute, National Institute on Aging, National Cancer Institute, and Agency for Healthcare Research and Quality, outside the submitted work. LS reports no conflicts of interest. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded through an R3 mechanism from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report., (© The Author(s) 2025.)

Background: The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level., Methods: The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation., Discussion: The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts., Trial Registration: ClinicalTrials.gov NCT06171737. Registered on December 15, 2023., Competing Interests: Declarations. Ethics approval and consent to participate {24}: Ethical approval for the study will be provided by each site individually. The majority of sites approved waiver of written consent to participate in this minimal risk trial, and consent is implied by completion of the survey. Consent for publication {32}: At 6 sites, participants will receive an information sheet reviewing options, benefits, and risks of the trial and consent will be implied by return of the pre-visit survey. At one site, research staff will obtain written consent and at one site research staff will obtain and document verbal consent. Competing interests {28}: NL reports being a consultant for Edwards Lifesciences. CK reports a K23 from NHLBI (K23HL153892). CD reports paid consulting fees from Medtronic and Record Medical. EK reports receiving honoraria from Abbott, Boston Scientific, Edwards, and Medtronic. ND receives research support from the American Heart Association, NIH, AHRQ, and Merck and research funding and consulting for Abiomed. KS reports receiving funding for shared decision-making research from PCORI, AHRQ, and NIH, outside submitted work. KS developed the Shared Decision-Making Process scale (copyright Massachusetts General Hospital) that is being used as an outcome measure in the study. KV reports receiving support for shared decision-making research from PCORI and AHRQ outside submitted work and receiving research funding from Google LLC outside the submitted work. SE reports receiving research funding and consulting fees from Edwards Lifesciences and Medtronic. VT reports advising and research with Artivion, AtriCure, Boston Scientific, Abbott Vascular, CroiValve, Edwards Lifesciences, Medtronic, JenaValve, HighLife, Innovalve, and DASI Simulations. JM reports institutional grant support from the University of Colorado School of Medicine: Philips Medical Systems, Medtronic Corporation. SS reports travel sponsored by the ACC, Global Heart Hub, TCT, and Heart Valve Collaboratory and significant financial interests in Heart Valve Voice US. AN has received institutional research funding and speaker fees from Edwards Lifesciences, which is involved in products for the treatment of aortic stenosis. AB reports receiving honoraria for teaching a course at Edwards Lifesciences. DM, MC, YC, KG, NQ, and DK report no conflicts of interest., (© 2024. The Author(s).)

Importance: Decisions about whether to stop colorectal cancer (CRC) screening tests in older adults can be difficult and may benefit from shared decision-making (SDM)., Objective: To evaluate the effect of physician training in SDM and electronic previsit reminders (intervention) vs reminders only (comparator) on receipt of the patient-preferred approach to CRC screening and on overall CRC screening rates of older adults at 12 months., Design, Setting, and Participants: This was a secondary analysis of the Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) cluster randomized clinical trial. In the PRIMED trial, primary care physicians (PCPs) from 36 primary care practices in Massachusetts and Maine were enrolled between May 1 and August 30, 2019, and were randomized to the intervention group or the comparator group. Patients aged 76 to 85 years who were overdue for CRC screening and did not have a prior diagnosis of CRC enrolled between October 21, 2019, and April 8, 2021. Data analysis was performed between May 24, 2022, and May 10, 2023., Interventions: Primary care physicians in the intervention group completed an SDM training course and received previsit reminders of patients eligible for CRC testing discussion, whereas PCPs in the comparator group received reminders only., Main Outcomes and Measures: The primary outcome was concordance, or the percentage of patients who received their preferred screening approach. Postvisit surveys were administered to assess patient preference for testing, and electronic health record review was used to assess CRC testing at 12 months. Heterogeneity of treatment effect analyses examined interaction between study groups and different factors on concordance rates., Results: This study included 59 physicians and 466 older adults. Physicians had a mean (SD) age of 52.7 (9.4) years and a mean (SD) of 21.6 (10.2) years in practice; 30 (50.8%) were women and 16 (27.1%) reported prior training in SDM. Patients had a mean (SD) age of 80.3 (2.8) years; 249 (53.4%) were women and 238 (51.1%) reported excellent or very good overall health. Patients preferred stool-based tests (161 [34.5%]), followed by colonoscopy (116 [24.8%]) or no further screening (97 [20.8%]); 75 (16.1%) were not sure. The distribution of patient preferences was similar across groups (P = .36). At 12 months, test uptake was also similar for both the intervention group (29 [12.3%] for colonoscopy, 62 [26.3%] for stool-based tests, and 145 [61.4%] for no testing) and the comparator group (32 [13.9%] for colonoscopy, 35 [15.2%] for stool-based tests, and 163 [70.9%] for no testing; P = .08). Approximately half of patients in the intervention group received their preferred approach vs the comparator group (115 of 226 [50.9%] vs 103 of 223 [46.2%]; P = .47). Heterogeneity of treatment effect analyses found significantly higher rates with the intervention vs the comparator for patients with a strong intention to follow through with the preferred approach (adjusted odds ratio [AOR], 1.79 [95% CI, 1.11-2.89]; P = .02, P = .05 for interaction) and for patients who reported more than 5 minutes (AOR, 3.27 [95% CI, 1.25-8.59]; P = .02, P = .05 for interaction) of discussion with their PCP regarding screening. Higher rates were also observed among patients who reported 2 to 5 minutes of discussion with their PCP, although this finding was not significant (AOR, 1.89 [95% CI, 0.93-3.84]; P = .08, P = .05 for interaction)., Conclusions and Relevance: In this secondary analysis of a cluster randomized clinical trial, approximately half of older patients received their preferred approach to CRC screening. Physician training in SDM did not result in higher concordance rates overall but may have benefitted some subgroups. Future work to refine and evaluate clinical decision support (in the form of an electronic advisory or reminder) as well as focused SDM skills training for PCPs may promote high-quality, preference-concordant decisions about CRC testing for older adults., Trial Registration: ClinicalTrials.gov Identifier: NCT03959696.

Background: For adults aged 76-85, guidelines recommend individualizing decision-making about whether to continue colorectal cancer (CRC) testing. These conversations can be challenging as they need to consider a patient's CRC risk, life expectancy, and preferences., Objective: To promote shared decision-making (SDM) for CRC testing decisions for older adults., Design: Two-arm, multi-site cluster randomized trial, assigning physicians to Intervention and Comparator arms. Patients were surveyed shortly after the visit to assess outcomes. Analyses were intention-to-treat., Participants and Setting: Primary care physicians affiliated with 5 academic and community hospital networks and their patients aged 76-85 who were due for CRC testing and had a visit during the study period., Interventions: Intervention arm physicians completed a 2-h online course in SDM communication skills and received an electronic reminder of patients eligible for CRC testing shortly before the visit. Comparator arm received reminders only., Main Measures: The primary outcome was patient-reported SDM Process score (range 0-4 with higher scores indicating more SDM); secondary outcomes included patient-reported discussion of CRC screening, knowledge, intention, and satisfaction with the visit., Key Results: Sixty-seven physicians (Intervention n=34 and Comparator n=33) enrolled. Patient participants (n=466) were on average 79 years old, 50% with excellent or very good self-rated overall health, and 66% had one or more prior colonoscopies. Patients in the Intervention arm had higher SDM Process scores (adjusted mean difference 0.36 (95%CI (0.08, 0.64), p=0.01) than in the Comparator arm. More patients in the Intervention arm reported discussing CRC screening during the visit (72% vs. 60%, p=0.03) and had higher intention to follow through with their preferred approach (58.0% vs. 47.1, p=0.03). Knowledge scores and visit satisfaction did not differ significantly between arms., Conclusion: Physician training plus reminders were effective in increasing SDM and frequency of CRC testing discussions in an age group where SDM is essential., Trial Registration: The trial is registered on clinicaltrials.gov (NCT03959696)., (© 2022. The Author(s).)

Thousands of colonoscopies were canceled during the initial surge of the COVID-19 pandemic. As facilities resumed services, some patients were hesitant to reschedule. The purpose of this study was to determine whether a decision aid plus telephone coaching would increase colorectal cancer (CRC) screening and improve patient reports of shared decision making (SDM). A randomized controlled trial assigned adults aged 45-75 without prior history of CRC who had a colonoscopy canceled from March to May 2020 to intervention (n = 400) or usual care control (n = 400) arms. The intervention arm received three-page decision aid and call from decision coach from September 2020 through November 2020. Screening rates were collected at 6 months. A subset (n = 250) in each arm was surveyed 8 weeks after randomization to assess SDM (scores range 0-4, higher scores indicating more SDM), decisional conflict, and screening preference. The sample was on average, 60 years old, 53% female, 74% White, non-Hispanic, and 11% Spanish speaking. More intervention arm patients were screened within 6 months (35% intervention vs 23% control, p < 0.001). The intervention respondents reported higher SDM scores (mean difference 0.7 [0.4, 0.9], p < 0.001) and less decisional conflict than controls (-21% [-35%, -7%], p = 0.003). The majority in both arms preferred screening versus delaying (68% intervention vs. 65% control, p = 0.75). An SDM approach that offered alternatives and incorporated patients' preferences resulted in higher screening rates. Patients who are overdue for CRC screening may benefit from proactive outreach with SDM support., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background. Early in the COVID-19 pandemic colonoscopies for colorectal cancer (CRC) screening were canceled. Patient perceptions of the benefits and risks of routine screening relative to health concerns associated with the COVID-19 pandemic were unknown. Purpose. Assess patient anxiety, worry, and interest in CRC screening during the COVID-19 pandemic. Methods. A random sample of 200 patients aged 45 to 75 y with colonoscopy cancellation due to COVID-19 in March to May 2020 were surveyed. Anxiety, COVID-19 and CRC risk perceptions, COVID-19 and CRC worry, likelihood of following through with colonoscopy in the next month, and interest in alternatives to colonoscopy were assessed. Subsequent screening was tracked for 12 mo. Results. Respondents ( N  = 127/200, 63.5%) were on average 60 y old, female (59%), college educated (62% college degree or more), and White (91%). A substantial portion of patients (46%) stated they may not follow through with a colonoscopy in the next month. There was greater interest in stool-based testing than in delaying screening (48% v. 26%). Women, older patients, and patients indicating tolerance of uncertainty due to complexity reported they were less likely to follow through with colonoscopy in the next month. Greater interest in stool-based testing was related to lower perceptions of CRC risk. Greater interest in delaying screening was related to less worry about CRC and less tolerance of risk. Over 12 mo, 60% of participants completed screening. Patients who stated they were more likely to screen in the next month were more likely to complete CRC screening ( P  = 0.01). Conclusions. Respondents who had a colonoscopy canceled during the COVID-19 pandemic varied in interest in rescheduling the procedure. A shared decision-making approach may help patients address varying concerns and select the best approach to screening for them., Highlights: In the wake of the first wave of the COVID-19 pandemic, almost half of patients stated they were not likely to follow through with a colonoscopy in the short term, about half were interested in screening with a stool-based test, and only one-quarter were interested in delaying screening until next year.Patients who perceived themselves at higher risk of colorectal cancer were less interested in stool-based testing, and patients who were more worried about colorectal cancer were less interested in delaying screening.A shared decision-making approach may be necessary to tailor screening discussions for patients during subsequent waves of the pandemic, other occasions where resources are limited and patient preferences vary, or where patients hold conflicting views of screening., Competing Interests: With regard to potential conflicts of interest for this study, Dr. Atlas reports a grant from the National Cancer Institute, and Dr. Richter reports approximately 25% income derived from performing colonoscopy. All other authors report no conflicts outside receiving grant funding through their institution from PCORI for this study., (© The Author(s) 2022.)

Background: This study examined the performance of the shared decision-making (SDM) Process scale in patients with depression, compared alternative wording of two items in the scale and explored performance in younger adults., Methods: A web-based non-probability panel of respondents with depression aged 18-39 (younger) or 40-75 (older) who talked with a health-care provider about starting or stopping treatment for depression in the past year were surveyed. Respondents completed one of two versions of the SDM Process scale that differed in the wording of pros and cons items and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider or together). A subset of respondents completed a retest survey by 1 week. We examined how version and age group impacted SDM Process scores and calculated construct validity and retest reliability. We hypothesized that patients with higher SDM Process scores would show less decisional conflict using the SURE scale (range = 0-4); top score = no conflict versus other and less regret (range 1-4; higher scores indicated more regret)., Results: The sample (N = 494) was majority White, non-Hispanic (82%) and female (72%), 48% were younger and 23% had a high school education or less. SDM Process scores did not differ by version (P = 0.09). SDM Process scores were higher for younger respondents (M = 2.6, SD = 1.0) than older respondents (M = 2.3, SD = 1.1; P = 0.001). Higher SDM Process scores were also associated with no decisional conflict (M = 2.6, SD = 0.99 vs. M = 2.1, SD = 1.2; P < 0.001) and less decision regret (r = -0.18, P < 0.001). Retest reliability was intraclass correlation coefficient = 0.81., Conclusions: The SDM Process scale demonstrated validity and retest reliability in younger adults, and changes to item wording did not impact scores. Although younger respondents reported more SDM, there is room for improvement in SDM for depression treatment decisions., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To assess the impact of patient health literacy, numeracy, and graph literacy on perceptions of hypertension control using different forms of data visualization., Materials and Methods: Participants (Internet sample of 1079 patients with hypertension) reviewed 12 brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure (BP) data. We examined how variations in mean systolic blood pressure, BP standard deviation, and form of visualization (eg, data table, graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change. We also measured patient's health literacy, subjective and objective numeracy, and graph literacy., Results: Judgments about hypertension data presented as a smoothed graph were significantly more positive (ie, hypertension deemed to be better controlled) then judgments about the same data presented as either a data table or an unsmoothed graph. Hypertension data viewed in tabular form was perceived more positively than graphs of the raw data. Data visualization had the greatest impact on participants with high graph literacy., Discussion: Data visualization can direct patients to attend to more clinically meaningful information, thereby improving their judgments of hypertension control. However, patients with lower graph literacy may still have difficulty accessing important information from data visualizations., Conclusion: Addressing uncertainty inherent in the variability between BP measurements is an important consideration in visualization design. Well-designed data visualization could help to alleviate clinical uncertainty, one of the key drivers of clinical inertia and uncontrolled hypertension., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Clinical guidelines recommend patients with aortic stenosis (AS) being considered for transcatheter aortic valve implantation or surgical aortic valve replacement to participate in shared decision-making (SDM) with a heart valve team (HVT). Data supporting these recommendations are limited. This project gathered data on feasibility and preliminary efficacy of a decision aid (DA) in decision-making for patients with severe AS deciding between transcatheter aortic valve implantation and surgical aortic valve replacement., Methods: This institutional review board-approved randomized pilot trial assigned eligible patients to receive either the American College of Cardiology's DA for patients with AS or usual care. Patients were surveyed after their visit regarding knowledge, treatment-preference concordance, SDM (SDM process and CollaboRATE Scales), and decisional conflict. Patients were followed for 3 months to collect data on treatment received., Results: Of 62 patients approached, 59 (95%) consented and participated. The average age of participants was 72 years, they were 100% white, and 32% of them were female. Intervention patients had higher knowledge scores (75.6 vs 65.5) and more frequently reported CollaboRATE top scores (67% vs 33%) than usual care patients. No other group comparisons reached significance. Patients who saw both members of the HVT before survey completion reported higher SDM process scores than those who saw only 1 specialist (3.1 vs 2.4)., Conclusions: The study exceeded enrollment targets, indicating feasibility. Results suggest the American College of Cardiology's DA improved patient knowledge and communication scores. Patients who met with both members of the HVT reported higher SDM. These observations highlight the importance of SDM and multidisciplinary HVT assessment in the management of severe AS., (© 2022 The Authors.)

Background: Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals., Methods: A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected. Patients were mailed a survey including measures of Shared Decision Making (SDMP scale) and Informed, Patient-Centered (IPC) decisions. We examined decision-making across sites, surgeons, and conditions, and whether the decision-making measures were associated with better health outcomes. Analyses were adjusted for clustering of patients within surgeons., Results: Six hundred forty-six surveys (74% response rate) were returned with sufficient responses for analysis. Patients who had TJR reported lower SDMP scores than patients who had spine surgery (2.2 vs. 2.8; p < 0.001). Patients who had TJR were more likely to make IPC decisions (OA = 70%, Spine = 41%; p < 0.001). SDMP and IPC scores varied widely across surgeons, but the site was not predictive of SDMP scores or IPC decisions (all p > 0.09). Higher SDMP scores and IPC decisions were associated with larger improvements in global health outcomes for patients who had TJR, but not patients who had spine surgery., Conclusions: Measures of shared decision making and decision quality varied among patients undergoing common elective orthopedic procedures. Routine measurement of shared decision making provides insight into areas of strength across these different orthopedic conditions as well as areas in need of improvement., (© 2021. The Author(s).)

Background: A high quality treatment decision means patients are informed and receive treatment that matches their goals. This research examined the reliability and validity of the Depression Decision Quality Instrument (DQI), a survey to measure the extent to which patients are informed and received preferred treatment for depression., Methods: Participants were aged 18 and older from 17 US cities who discussed medication or counseling with a physician in the past year, and physicians who treated patients with depression who practiced in the same cities. Participants were mailed a survey that included the Depression-DQI, a tool with 10 knowledge and 7 goal and concern items. Patients were randomly assigned to either receive a patient decision aid (DA) on treatment of depression or no DA. A matching score was created by comparing the patient's preferred treatment to their self-reported treatment received. Concordant scores were considered matched, discordant were not. We examined the reliability and known group validity of the Depression-DQI., Results: Most patients 405/504 (80%) responded, 79% (320/405) returned the retest survey, and 60% (114/187) of physicians returned the survey. Patients' knowledge scores on the 10-item scale ranged from 14.6 to 100% with no evidence of floor or ceiling effects. Retest reliability for knowledge was moderate and for goals and concerns ranged from moderate to good. Mean knowledge scores differentiated between patients and physicians (M = 63 [SD = 15] vs. M = 81 [SD = 11], p < 0.001), and between patients who did and didn't receive a DA (M = 64 [SD = 16] vs. M = 61 [SD = 14], p = 0.041). 60.5% of participants received treatment that matched their preference. Based on the multivariate logistic regression, 'avoiding taking anti-depressants' was the only goal that was predictive of taking mediation (OR = 0.73 [0.66, 0.80], p < 0.01). Shared Decision Making Process scores were similar for those who matched their preference and those who didn't (M = 2.18 [SD = 0.97] vs. M = 2.06 [SD = 1.07]; t(320) =  - 1.06, p = 0.29). Those who matched had lower regret scores (matched M = 1.72 [SD = 0.74] vs. unmatched M = 2.32 [SD = 0.8]; t(301) =  - 6.6, p < .001)., Conclusions: The Depression DQI demonstrated modest reliability and validity. More work is needed to establish validity of the method to determine concordance., Trial Registration: NCT01152307., (© 2021. The Author(s).)

Background: Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension., Methods: We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States., Results: A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements., Conclusions: We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension., (© 2021. The Author(s).)

Importance: Thresholds for initiating statin therapy should be informed by patients' preferences., Objective: To define the preference distribution for statin therapy across the spectrum of cardiovascular disease (CVD) risk after participants were informed about the benefits and harms of statin therapy., Design, Setting, and Participants: A cross-sectional survey was conducted from May 13 to June 2, 2020. Participants included 304 individuals aged 40 to 75 years drawn from a nonprobability opt-in panel who had not taken a statin or proprotein convertase subtilisin/kexin type 9 inhibitor in the past 3 years and knew the results of their total cholesterol, high-density lipoprotein cholesterol, and blood pressure measurements., Exposures: Personalized 10-year CVD risk with and without statin therapy and potential harms of statins., Main Outcomes and Measures: The primary outcome was self-reported preference for statin therapy., Results: The 304 participants had a mean (SD) age of 54.8 (9.9) years; 152 were women (50.0%), 130 (42.8%) non-White, 50 (16.6%) had a high school degree or less education, and 153 (50.8%) reported never needing help reading health materials. When asked their preference for using statin therapy after reviewing their benefit and risk information, 45% of the participants reported they would definitely or probably choose statin therapy. As the risk increased, the proportion who would choose statin therapy generally increased (from 31.1% for a risk <5% to 82.6% for a risk >50%). The minimum risk threshold had to increase to 20% before 75% of respondents in that risk group would want statin therapy. For participants with a risk greater than 10%, the desire to use statin therapy decreased as participants' health literacy, subjective numeracy, and knowledge scores increased., Conclusions and Relevance: In this study, preferences for statin therapy for primary prevention of CVD appeared to vary across the spectrum of 10-year cardiovascular risk, but they were relatively flat at intermediate levels of risk. This preference distribution suggests a broad risk range for shared decision-making.

Background: Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness., Methods: A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management., Results: Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure 'story' and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care., Conclusions: Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users' needs, and addressing additional stakeholders' needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.

Background: Patients' behaviors play a key role in chronic disease management, but how effective they are may depend on how engaged they feel. The objective was to develop a short measure of how much patients felt engaged in self-managing a chronic condition. Online test of a three-question series followed by a survey of physicians and their eligible diabetic patients. Physicians answered: 1) how well the physician thought the patient was managing his/her diabetes, and 2) how much effort the physician thought the patient was putting in. Each patient was mailed a survey that included three questions on self-management. Six hundred six patients from a national online consumer panel with diabetes or obesity, and 35 physicians from 3 primary care practices and a sample of 243 of their diabetic patients. Respondents were asked three questions about how much they thought their behavior could affect their health condition, how confident they were that they could do what was needed, and how involved they were in decisions about managing their condition. These items were summed to create a WELL score. Descriptive statistics and correlation coefficients were used to describe item relationships. Generalized Estimating Equations were used to predict how well the physician thought the patient was managing their diabetes and patient effort., Results: Correlations among the three patient-reported items ranged from - 0.01 to 0.45. The WELL score was correlated with an existing measure of patient activation commitment (r = .43, p < 0.001) and found to be a significant predictor of physicians' ratings of how much effort patients devoted to condition management (b = 0.02, p = 0.001, OR = 1.02) after adjusting for confounders. The WELL score didn't predict physicians' ratings of how effective patients were (b = 0.003, p = .526, OR = 1.004) after their A1c score had been taken into account., Conclusion: Patients' WELL scores predicted physicians' ratings of patient effort in diabetes self-management.

Background: Despite recommendations to screen adults for depression in primary care, little is known about how people across education levels decide to treat their depression and factors that influence their decision., Methods: We conducted a secondary analysis of a national, probability-based web survey in English-speaking adults aged 40 or older living in the United States who reported they discussed starting or continuing an antidepressant with their clinician in the past 2 years. Respondents answered questions about knowledge, decision-making process, and demographics. Education level was analyzed using 5 ordered categories. The Shared Decision Making (SDM) Process score was used to assess patient involvement. Descriptive statistics, χ 2 tests, analysis of variance, and regression models were used to describe the data and test associations., Results: Of the 5682 people invited, 3396 answered questions about health decisions (59.8% response rate) and 385 reported discussing antidepressants. The mean percentage of knowledge questions answered correctly increased as education level increased ( P = .008). The mean SDM Process score also increased with education ( P = .001). There was an association between education and who made the treatment decision, suggesting that for respondents with less education, the clinician was more likely to decide ( P = .001). Respondents with less education were less likely to report they would definitely make the same decision again ( P = .000)., Conclusions: Those with less education were even less informed, had lower SDM Process scores and were less likely to think they made the right decision about antidepressants. There is a need to ensure patients are better informed about and involved in treatment for depression., Competing Interests: Conflict of interest: none., (© Copyright 2020 by the American Board of Family Medicine.)

Objectives: This retrospective study evaluates infant bed-sharing at a Missouri family practice with OB care., Methods: After Institutional Review Board (IRB) approval, data were extracted from the first four well-child visits of 2374 infants between Sept. 2003 and Dec. 20 11., Results: Bed-sharing decreased after 2005 (25%, 39%, respectively, p = 0.000). For infants who bed-shared, the frequency of bed-sharing did not decline., Conclusions: Nearly 20% of infants bed-share before the first visit; safe sleep prenatal education is warranted.