Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

When Physicians Support Financial Penalties to Reduce Low-Value Care (and When They Don’t)

Dec. 16, 2017

Despite professional consensus, guidelines, and national campaigns, physicians continue to provide many low-value services. These services are defined as having little to no benefit, little benefit relative to their cost, or outsized potential harm compared to their benefit. Policies have tried to promote high-value care by altering physician compensation, but have had limited success in part because they are rarely based on theories of physician behavior.

Will Decision Aids Save Money?

Jun. 28, 2017

Where you end up may depend on where you start. That’s the perspective taken by LDI Senior Fellow Said Ibrahim in the New England Journal of Medicine, as he discusses how shared decision-making tools and increased patient knowledge affect treatment choice. Specifically, Ibrahim looks at elective joint replacement, and examines how increased use of decision aids affects the choice to pursue either conservative management or total joint replacement.

Nursing leading change to advance health

Jun. 22, 2017

Patricia Polansky, Mary Sue Gorski, Alexia Green, G. Adriana Perez, Robert P. Wise

In Nursing Outlook, Patricia Polansky and colleagues, including Adriana Perez, review current and previous leadership initiatives to increase the number of nurse leaders in health- and health care-related boardrooms. The authors discuss the lack of nurse leaders who are involved in boardroom service, and review efforts that have been made to increase the number of nurses in boardrooms. They focus on three main themes – “Step up and Lead”, “Get a Seat at the Table”, and “Support and Leverage Board Service”, and stress the importance of a clear action plan to elevate nurse...

Association between features of patient-provider discussions and routine prostate-specific antigen testing

Jun. 11, 2017

Joshua Liao, Mark J. Ommerborn, Cheryl R. Clark

In PLoS One, Joshua Liao and colleagues examine the impact of provider recommendations and presence of a personal doctor on routine prostate cancer screening with PSA testing. Although the US Preventive Services Task Force recommends against routine prostate cancer screening, specialty organizations support screening via shared decision making between providers and selected patients. The investigators used the 2013 Behavioral Risk Factor Surveillance System to identify 1,737 men surveyed about their PSA testing decisions. More than 70% of respondents reported some form of...

When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

Jun. 11, 2017

Archana Radhakrishnan, David Grande, Michelle Ross, Nandita Mitra, Justin Bekelman, Christian Stillson, MPH and Craig Evan Pollack

In the Journal of the American Board of Family Medicine, Archana Radhakrishnan, David Grande, Nandita Mitra, Justin Bekelman, and colleagues evaluate how frequently men with localized prostate cancer report receiving help from their primary care provider (PCP) about their treatment, and whether men who do are less likely to receive definitive treatment (either radical prostatectomy or radiotherapy). The investigators mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. A total of 2,386 men responded. Among...

Surgical Site Infection and Colorectal Surgical Procedures: A Prospective Analysis of Risk Factors

Jun. 10, 2017

E. Carter Paulson, Earl Thompson, Najjia Mahmoud

In Surgical Infections, Paulson and colleagues identify risk factors for surgical site infections in patients undergoing elective colorectal surgery. They analyzed data prospectively collected as part of a randomized, blinded trial of skin anti-sepsis, using photodocumentation, patient questionnaires, and blinded review by an attending surgeon to identify infections within 30 days of discharge. From 2011 to 2015, 787 patients undergoing colorectal surgery were analyzed, with an overall infection rate of 21.5%. Four variables--incision length, surgical indication, body mass index,...

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission

May. 22, 2017

Michael E. Detsky, Michael O. Harhay, Dominique F. Bayard, Aaron M. Delman, Anna E. Buehler, Saida A. Kent, Isabella V. Ciuffetelli, Elizabeth Cooney, Nicole B. Gabler, Sarah J. Ratcliffe, Mark E. Mikkelsen, Scott D. Halpern 

In JAMA, Michael Detsky and colleagues, including Michael Harhay and Scott Halpern, examine the accuracy of intensive care unit (ICU) physician and nurses’ predictions about patients’ survival and functional outcomes. Clinician predictions about a patient's chance of survival have been shown to influence decision-making for critically ill patients, yet little is known regarding their accuracy. The study was conducted in five ICUs in three hospitals in Philadelphia, and enrolled patients who spent at least three days in the ICU and required mechanical ventilation, vasopressors, or...

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