Journal of evaluation in clinical practice
-
Randomized Controlled Trial
Evaluating a web-based personalized decision report for total knee or hip replacement: Lessons learned from patients.
Patient-reported outcomes (PROs) are increasingly used in the context of clinical care, but evaluation of patients' perspectives of PRO-based applications in routine care remains limited. ⋯ Our findings highlight areas of opportunity to further refine this personalized web-based decision report and similar patient-facing PRO applications for routine clinical care. Specific examples include additional tailoring of reports via filterable web-based dashboards and scalable educational supports to facilitate more independent patient understanding and use.
-
Patients look to their clinicians for explanations and treatments that achieve predictable cures with certainty. Clinicians usually respond accordingly. Acknowledging uncertainty, while necessary, is difficult, anxiety-provoking and at times overwhelming for patients and clinicians alike. ⋯ Through the lenses of evidence-based medicine and complexity sciences this paper critically explores the clinical management of three patients diagnosed as having coronary artery disease. They all received the same treatment even though they presented with very different clinical complaints arising from different disease manifestations. Looking at these case studies the authors reflect on the reasons behind this astonishing, but widely seen medical behaviour of 'one size fits all'. They critically reflect the importance of research and evidence in view of a person-centred solution.
-
There is substantial surgeon-to-surgeon variation in offering discretionary surgery. Part of this variation may relate to awareness of, and sensitivity to, mental and social health priorities. This survey-based experiment randomized features of patient scenarios to measure the relative association of a patient's difficult life event (DLE) in the last year on surgeon decision to (1) delay consideration of discretionary surgery and (2) suggest prioritizing mental and social health with appropriate referral. ⋯ The observation that a recent DLE is associated with surgeon delay in offer of discretionary surgery reflects that surgeons may prioritize mental and social health in this context.