Background. Shared decision making (SDM) involving adolescents with chronic conditions is a triadic process that requires engaging adolescent patients, their parent(s), and their health care provider. We sought to understand the perspectives of parents about these interactions and the parents’ role in SDM. Methods. We conducted semi-structured qualitative interviews with parents of adolescents (aged 12–17 y) with chronic conditions. The interviews focused on parents’ experiences of medical decision making related to their adolescent’s care, followed by experiences of SDM. We specifically addressed key aspects of SDM including information exchange, options, values, and preferences. We coded and analyzed the interviews using thematic content analysis. Results. Twenty-one parents completed an interview (median age 44 y, 91% female, 53% non-White). We identified 4 themes from the data: parents want an executive role, parents as experts, parents’ perceptions of others’ roles, and parents’ necessities for SDM. Parents described wanting to control the level to which their adolescent is involved in SDM based on their perceived knowledge of their adolescent’s capabilities. Parents reported feeling pressure to understand all aspects of potential decisions. Finally, parents underscored the need for trusting relationships between all members of the triad. Conclusions. Parents identify key roles for themselves and others in triadic SDM. By understanding these perspectives, health care providers may be better prepared to promote SDM in the care of adolescents with chronic conditions. Implications. This research has implications for how decisions are shared between providers and families. Valuing parents and including them in decision making has the potential to establish stronger relationships between the family and the care team and reduce parents’ anxiety about their child’s health.HighlightsThis study is the first to explore parents’ perspectives of triadic SDM involving an adolescent with a chronic condition.We identify situations (e.g., non–life-threatening treatment decisions, before an impending transition to adult medicine) in which parents may be more amenable to including their adolescent in the decision process.Understanding parents’ perspectives on decision making can help providers establish strong relationships with the families, which may improve care for adolescents with chronic conditions.

It is feasible for large health systems to automatize text messaging of colorectal cancer (CRC) screening decision aids (DAs) to patients due for CRC screening before a visit with their primary care practitioner.Patients who review a texted CRC screening DA report higher shared decision-making quality and knowledge about CRC screening.Use of CRC DAs may decrease screening via colonoscopy but not overall screening rates.A more intensive intervention than text messaging is likely needed to increase the number of patients who review a CRC screening DA.

Discrete event simulation (DES) is used for the first time to improve the performance of robotic cardiac surgery (RCS), an application that presents unique challenges.The flexible DES model for RCS can parametrize various factors related to both operating rooms and procedures.The impact of these factors is evaluated on a set of KPIs.New insights into the positioning of equipment and personnel in the OR are provided, allowing to formulate informed recommendations for RCS providers.

This study estimates lifetime drinking trajectories from adolescence to old age in the United States.The model uses national survey datasets to simulate real-world alcohol use patterns over time.

Objective. The patient’s perspective in shared decision making has expanded to regulatory decision making for medical devices under the Food and Drug Administration’s Patient Preference Initiative. Methods. Using choice-based conjoint (CBC) procedures, a discrete-choice experiment measure describing the risks and benefits of osseointegration was designed and used in a preference study among 188 adults with lower-limb loss. Our measure included 8 attributes of 1) risks: chance of infection, complete device failure rate, time without prosthesis, activity limitations, and 2) benefits: avoidance of socket problems, limb perception, improved motion with less fatigue, and chance of limiting daily pain, with 3 to 4 levels each. We used a random, full-profile, balanced-overlap design in which 18 CBC conjoint pairs, sociodemographic, and clinical questions were completed. The analysis included random parameters logit with 1,000 Halton draws and latent class. Results. The least important levels, when compared with their respective attribute baseline level, were for avoiding the highest chance (50%) of serious infection (β = −1.32, P < 0.001), highest chance (40%) of complete device failure (β = −0.96, P < 0.001), and longest (9 mo) time without prosthesis (β = −1.12, P < 0.001). The most preferred levels, when compared with their respective attribute baseline level, were to eliminate daily pain (β = 0.87, P < 0.001; β = 0.62, P < 0.001). The preference for avoiding current osseointegration infection risk (10%) was much lower (β = 0.51, P < 0.001), showing that preferences to avoid the actual infection risk are offset by osseointegrations benefits. Latent class analysis showed 2 distinct classes with some risk averse and some with more balanced preferences. Conclusions. The strongest preferences were seen for attributes avoiding complications; however, individuals demonstrated a willingness to make risk–benefit tradeoffs at current risk levels. These findings can guide future regulatory prosthetic decisions and allow better shared decision making to decrease prosthetic abandonment.HighlightsImportance shown to avoid the actual infection risk of osseointegration can be offset by the individual’s importance for the benefits of osseointegration to avoid pain and socket problems and to have rapid device snap on.Individuals also showed they are willing to trade the actual osseointegration device failure rate risks for the likely benefits of osseointegration.Individuals strongly preferred avoiding time without the use of a prosthetic for the time it takes to undergo and recover from the osseointegration procedure, informing the debate for favoring a faster procedure and recovery time if it is safe. However, these preferences were still in the tradeoff range for the benefits of osseointegration.Individuals showed the strongest importance for a potential benefit of osseointegration to reduce the presence of daily pain, which is a likely benefit of the osseointegration procedure, especially when accompanied by targeted muscle reinnervation.We showed considerable heterogeneity across patient preferences, with one group showing a strong importance for avoiding risks but also importance for some benefits of osseointegration and a larger group who showed a more moderate importance across both risks and benefits.

Background. Shared decision making (SDM) is an essential component of patient-centered care and especially important in high-risk populations, such as older adults. Although surgery has unique risks and the potential to cause permanent disability, which can affect the patient’s quality of life, SDM is underused before surgery to explore these tradeoffs. This study’s aim is to characterize the priorities, barriers, resources, and age-specific considerations for SDM in older adults undergoing surgery. Study Design. Five semi-structured focus groups were completed from February 2022 to April 2022 with 24 participants including older adult surgical patients and caregivers as well as providers involved in the care of older adult surgical patients (e.g., surgery, intensive care, geriatrics, and palliative care). Interviews were transcribed, and qualitative thematic analysis was conducted. Results. Six major themes were identified and explored: components of SDM, barriers to SDM, importance of SDM, preparation for SDM, age-specific considerations, and suggestions for improvement. Results showed differing opinions between patients and providers about important information in the SDM process, minimal preparation for SDM in both groups, and difficulties around defining outcomes for this population, particularly in the emergent setting. Conclusion. This study identifies critical components of SDM, perceived barriers, preparation and training for SDM, as well as unique considerations in older adults from the perspectives of both patients and providers. Opportunities to improve SDM include dissemination of resources, training of surgical providers, and utilization of other providers as well as patient-centered discussions about postoperative outcomes. This highlights important areas for future work and particularly the utility of SDM tools and training for surgeons.HighlightsCritical components of shared decision making (SDM) identified in this study include understanding patient values, building trust, understanding the patient’s baseline function, and defining possible treatment outcomes.Specific components of SDM in older adults include navigating companions to conversations and the challenges of navigating potential postoperative changes to cognitive or physical function.Possible areas to improve SDM include improved dissemination of SDM resources; the importance of communication skills and empathy and an emphasis on additional training for this, particularly for trainees; improved engagement of patients in the SDM process; and using other care team members such as palliative care and social work when appropriate.

This study found a moderate number of studies assessing strategies for evaluating sets of probabilities conveying information such as risks and benefits.Evidence is moderate that although presenting sets of probabilities in table versus sentences may not affect behavioral intentions, people may prefer tables.Contrary to previous studies about probability feelings, moderate evidence suggested that narratives may not affect effectiveness feelings.Evidence was insufficient to draw conclusions regarding contrast, identification, and trust outcomes, and no studies assessed recall, categorization, computation, or discrimination outcomes.

Most lung cancer screening (LCS) interventions evaluated to date have been educational in nature and focused primarily on shared decision making or the initial uptake of screening, with some interventions demonstrating statistically significant improvements in patient knowledge and initial LCS order/uptake.A critical gap in knowledge remains regarding how to effectively support LCS eligibility assessment as well as adherence to annual screening and appropriate diagnostic testing.Findings underscore the need for the field to expand beyond education-focused interventions and incorporate multilevel targets when designing interventions to support high-quality LCS in practice.

Our simulation optimization framework was used to design weekly schedules for random screening tests and masking within K-12 schools to mitigate COVID-19 infections.We considered multiple objectives and applied the NSGA-II algorithm to find a Pareto solution set.Based on local context and preferences, decision makers can trade off testing and masking to achieve a similar number of end-of-semester infections.When a few weeks of masks are mandated, it is best to use them at the beginning of a semester.

Clinicians do not feel their undergraduate or graduate medical education has properly prepared them to engage with AI in patient care.We provide a preliminary framework for deploying AI models in primary care-based cancer screening.This framework may have implications for health system governance and provider reimbursement in the age of AI.