Med Decis Making - Adherence and decision AIDS: a model and a narrative review.

Tópicos

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Resumo

CKGROUND: Patient adherence to medication or lifestyle interventions is a serious concern. Interventions to improve adherence exist, but their effects are usually small. Several authors suggested that decision aids may positively affect adherence.OBJECTIVE: . This presentation examines the role of decision aids in adherence research through development of a model and a narrative review.METHODS: andRESULTS: . I: A model was developed to organize pathways relating decision aids and adherence. There is clinical evidence for these pathways, suggesting that decision aids may potentially improve adherence. The model is helpful when considering measures to study decision aids and adherence. II: A narrative review of decision aids and adherence was done. A systematic search resulted in 11 randomized studies. Two studies, both in the hypertension management domain, were positive. Shortcomings were identified regarding the range of adherence measures, the sample size, and theSTUDY DESIGN: It is argued that outcomes for the option "nonadherent" behavior should be described explicitly in the decision aid to inform patients about the costs and benefits of nonadherent behavior.CONCLUSIONS: . A relation between decision aids and adherence is plausible in view of the psychological and medical literature. A systematic search showed that experimental evidence relating decision aids and adherence is inconclusive. Rigorous trials on this topic are worthwhile. Such trials should employ adequate sample sizes, multiple adherence measures, and a control arm delivering usual care. The decision aid should describe the option "being nonadherent" and its outcomes.

Resumo Limpo

ckground patient adher medic lifestyl intervent serious concern intervent improv adher exist effect usual small sever author suggest decis aid may posit affect adherenceobject present examin role decis aid adher research develop model narrat reviewmethod andresult model develop organ pathway relat decis aid adher clinic evid pathway suggest decis aid may potenti improv adher model help consid measur studi decis aid adher ii narrat review decis aid adher done systemat search result random studi two studi hypertens manag domain posit shortcom identifi regard rang adher measur sampl size thestudi design argu outcom option nonadher behavior describ explicit decis aid inform patient cost benefit nonadher behaviorconclus relat decis aid adher plausibl view psycholog medic literatur systemat search show experiment evid relat decis aid adher inconclus rigor trial topic worthwhil trial employ adequ sampl size multipl adher measur control arm deliv usual care decis aid describ option nonadher outcom

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