BMC Med Inform Decis Mak - Development of a decision aid to inform patients' and families' renal replacement therapy selection decisions.

Tópicos

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Resumo

CKGROUND: Few educational resources have been developed to inform patients' renal replacement therapy (RRT) selection decisions. Patients progressing toward end stage renal disease (ESRD) must decide among multiple treatment options with varying characteristics. Complex information about treatments must be adequately conveyed to patients with different educational backgrounds and informational needs. Decisions about treatment options also require family input, as families often participate in patients' treatment and support patients' decisions. We describe the development, design, and preliminary evaluation of an informational, evidence-based, and patient-and family-centered decision aid for patients with ESRD and varying levels of health literacy, health numeracy, and cognitive function.METHODS: We designed a decision aid comprising a complementary video and informational handbook. We based our development process on data previously obtained from qualitative focus groups and systematic literature reviews. We simultaneously developed the video and handbook in "stages." For the video, stages included (1) directed interviews with culturally appropriate patients and families and preliminary script development, (2) video production, and (3) screening the video with patients and their families. For the handbook, stages comprised (1) preliminary content design, (2) a mixed-methods pilot study among diverse patients to assess comprehension of handbook material, and (3) screening the handbook with patients and their families.RESULTS: The video and handbook both addressed potential benefits and trade-offs of treatment selections. The 50-minute video consisted of demographically diverse patients and their families describing their positive and negative experiences with selecting a treatment option. The video also incorporated health professionals' testimonials regarding various considerations that might influence patients' and families' treatment selections. The handbook was comprised of written words, pictures of patients and health care providers, and diagrams describing the findings and quality of scientific studies comparing treatments. The handbook text was written at a 4th to 6th grade reading level. Pilot study results demonstrated that a majority of patients could understand information presented in the handbook. Patient and families screening the nearly completed video and handbook reviewed the materials favorably.CONCLUSIONS: This rigorously designed decision aid may help patients and families make informed decisions about their treatment options for RRT that are well aligned with their values.

Resumo Limpo

ckground educ resourc develop inform patient renal replac therapi rrt select decis patient progress toward end stage renal diseas esrd must decid among multipl treatment option vari characterist complex inform treatment must adequ convey patient differ educ background inform need decis treatment option also requir famili input famili often particip patient treatment support patient decis describ develop design preliminari evalu inform evidencebas patientand familycent decis aid patient esrd vari level health literaci health numeraci cognit functionmethod design decis aid compris complementari video inform handbook base develop process data previous obtain qualit focus group systemat literatur review simultan develop video handbook stage video stage includ direct interview cultur appropri patient famili preliminari script develop video product screen video patient famili handbook stage compris preliminari content design mixedmethod pilot studi among divers patient assess comprehens handbook materi screen handbook patient familiesresult video handbook address potenti benefit tradeoff treatment select minut video consist demograph divers patient famili describ posit negat experi select treatment option video also incorpor health profession testimoni regard various consider might influenc patient famili treatment select handbook compris written word pictur patient health care provid diagram describ find qualiti scientif studi compar treatment handbook text written th th grade read level pilot studi result demonstr major patient understand inform present handbook patient famili screen near complet video handbook review materi favorablyconclus rigor design decis aid may help patient famili make inform decis treatment option rrt well align valu

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