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Issue 16 - 25 May 2012


1. Shared Decision Making: Vision to Reality
By Barry, Michael; Levin, Carrie; MacCuaig, Morgan; Mulley, Al & Sepucha, Karen. Health Expectations, Mar 2011 Supplement, Vol. 14: p1-5
What is the shared international vision for shared decision making (SDM), and how do we make it a reality? The theme of the 2009 International Shared Decision Making (ISDM) conference arose out of a desire to explore the theoretical underpinnings of engaging patients and providers to ensure that all medical decisions are well informed and take each patients goals and concerns into consideration.

2. Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?
By Sivell, Stephanie; Edwards, Adrian; Elwyn, Glyn; Manstead, Antony S. R. Health Expectations, Mar 2011 Supplement,
Vol. 14: p6-19
To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. Literature search and narrative synthesis of data. Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices. [ABSTRACT FROM AUTHOR].

3. Why values elicitation techniques enable people to make informed decisions about cancer trial participation
By Abhyankar, Purva; Bekker, Hilary L.; Summers, Barbara A.& Velikova, Galina. Health Expectations, Mar 2011 Supplement, Vol. 14: p20-32
Decision aids help patients make informed treatment decisions. Values clarification (VC) techniques are part of decision aids that help patients assimilate the information with their personal values. There is little evidence that these techniques contribute to enhanced decision making over and above the provision of good quality information. To assess whether VC techniques are active ingredients in enhancing informed decision making and explain how and why they work. Participants were randomly assigned to one of three groups: (i) information only, (ii) information plus implicit task, (iii) information plus explicit task. Thirty healthy women from a UK University participated by making a hypothetical choice between taking part in a clinical trial and having the standard treatment for breast cancer. Verbal protocols were elicited by think-aloud method and content analysed to assess informed decision making; a questionnaire was completed after the decision assessing decision preference, perceptions of decisional conflict and ambivalence. Data were analysed using multivariate statistics. No participants changed their decision preference as a result of the VC techniques. Women in the explicit VC group evaluated more information in accord with personal values, expressed lower ambivalence, decisional uncertainty and greater clarity of personal values than those in the implicit VC and control groups. Feelings of ambivalence about both options were related to decisional conflict. Explicit VC techniques are likely to be active ingredients in decision aids. They work by enabling people to deliberate about the decision information in accord with their personal values, which is associated with a better decision experience. [ABSTRACT FROM AUTHOR].

4. Assessing medicare beneficiaries' strength-of-preference scores for health care options: how engaging does the elicitation technique need to be?
By Crump, Trafford; Llewellyn-Thomas, Hilary A. Health Expectations, Mar 2011 Supplement, Vol. 14: p33-45
The objective was to determine if participants' strength-of-preference scores for elective health care interventions at the end-of-life (EOL) elicited using a non-engaging technique are affected by their prior use of an engaging elicitation technique. Medicare beneficiaries were randomly selected from a larger survey sample. During a standardized interview, participants considered four scenarios involving a choice between a relatively less- or more-intense EOL intervention. For each scenario, participants indicated their favoured intervention, then used a 7-point Leaning Scale (LS1) to indicate how strongly they preferred their favoured intervention relative to the alternative. Next, participants engaged in a Threshold Technique (TT), which, depending on the participant's initially favoured intervention, systematically altered a particular attribute of the scenario until the participant switched preferences. Finally, they repeated the LS (LS2) to indicate how strongly they preferred their initially-favoured intervention. Two hundred and two participants were interviewed (189-198 were included in this study). The concordance of individual participants' LS1 and LS2 scores was assessed using Kendall tau-b correlation coefficients; scores of 0.74, 0.84, 0.85 and 0.89 for scenarios 1-4, respectively, were observed. Kendall tau-b statistics indicate a high concordance between LS scores, implying that the interposing engaging TT exercise had no significant effects on the LS2 strength-of-preference scores. Future investigators attempting to characterize the distributions of strength-of-preference scores for EOL care from a large, diverse community could use non-engaging elicitation methods. The potential limitations of this study require that further investigation be conducted into this methodological issue. [ABSTRACT FROM AUTHOR].

5. Pictures speak louder than numbers: on communicating medical risks to immigrants with limited non-native language proficiency
By Garcia-Retamero, Rocio & Dhami, Mandeep K. Health Expectations, Mar 2011 Supplement, Vol. 14: p46-57
Medical risk communication has been infrequently studied in immigrants with limited non-native language proficiency, even though they may be at greatest risk of illness. In a study, we examined to what extent Polish immigrants to the UK have difficulties in understanding treatment risk reduction expressed as ratios either in their native language or in a non-native language (English). We further investigated whether this population can be aided by using visual displays to enhance comprehension. A survey was conducted in the UK in spring, 2009, involving a sample of Polish immigrants (n = 96). Estimates of treatment risk reduction, confidence in estimates, and perceptions of treatment effectiveness. When assessing treatment risk reduction, participants often paid too much attention to the number of treated and non-treated patients who died (i.e. numerators) and insufficient attention to the overall number of treated and non-treated patients (i.e. denominators). This denominator neglect was especially noticeable when treatment risk reduction was not expressed in participants' native language. However, provision of visual aids in addition to the numerical information about risk reduction proved to be an effective method for eliminating denominator neglect. The visual aids drew participants' attention to the overall number of treated and non-treated patients and helped them to make more accurate risk estimates. When communicating risks to immigrants with limited non-native language proficiency, we should move beyond the simple, direct translation of health messages that are already being used with the indigenous population to messages that are more appropriate. The use of materials that include visual aids is an effective method of communicating medical risk information to immigrant populations. [ABSTRACT FROM AUTHOR].

6. Patient-physician agreement on the content of CHD prevention discussions
By Behrend, Lindy; Maymani, Hossein; Diehl, Megan; Gizlice, Ziya; Cai, Jianwen & Sheridan, Stacey L Health Expectations, Mar 2011 Supplement, Vol. 14: p58-72
Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. Cross-sectional survey nested within a randomized CHD prevention study. University internal medicine clinic; 24 physicians and 157 patients. Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives. Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making. Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making. [ABSTRACT FROM AUTHOR

7. Conducting implementation research in community-based primary care: a qualitative study on integrating patient decision support interventions for cancer screening into routine practice
By Frosch, Dominick L.; Singer, Kirsty J.; Timmermans, Stefan. Health Expectations, Mar 2011 Supplement, Vol. 14: p73-84
Despite a growing body of evidence supporting the efficacy of patient decision support interventions (DESI), little is known about their implementation in community-based primary care practices. The goal of this study was to explore the feasibility of integrating the use of DESIs for cancer screening in primary care practices serving patients from diverse backgrounds and learn more about the potential barriers and facilitators of integration. 12 community-based primary care practices in metropolitan Los Angeles. Qualitative field notes documented the roles played by staff and physicians in accomplishing project goals, the impact of the programmes on the clinical work-flow in the practices and other noteworthy observations. Practices that were better able to integrate the project had adequate clinic infrastructure, a relatively well-matched patient pool, and positive work and patient care environments. The remaining identified components, including staff facilitation and the physician's role accounted for higher level differences between the clinics, acting as barriers and facilitators that distinguished practices that were able to work independently from those that required more assistance and, to a lesser extent, those clinics that did and those that did not meet the project goals. This study suggests that implementation of DESIs to be used immediately before a consultation is feasible if the practice infrastructure can provide sufficient basic accommodation and physician and staff are dedicated to patient care goals that are implicit in the use of these tools. Overall, the physician's role appeared to be the most important factor in determining whether project integration was successful. [ABSTRACT FROM AUTHOR].

8. What does it take to have sustained use of decision aids? A programme evaluation for the Breast Cancer Initiative
By Feibelmann, Sandra; Yang, Theresa S.; Uzogara, Ekeoma E.& Sepucha, Karen. Health Expectations, Mar 2011 Supplement, Vol. 14: p85-95
The Breast Cancer Initiative (BCI) was started in 2002 to disseminate breast cancer decision aids (PtDAs) to providers. We analysed BCI programme data for 195 sites and determined the proportion of sites involved in each of five stages of dissemination and implementation of PtDAs. We conducted cross-sectional mail and telephone surveys of 79 sites with the most interest in implementation. We examined barriers associated with sustained use of the PtDAs. Since 2002 we attempted contact with 195 sites to join the BCI. The majority indicated interest in using PtDAs 172 of 195 (88%), 93 of 195 signed up for the BCI (48%), 57 of 195 reported distributing PtDAs to at least one patient (57%), and 46 of 195 reported sustained use (24%). We analysed data from interviews with 59 of 79 active sites (75% response rate). The majority of providers 49 of 59 (83%) had watched the PtDAs, and 46 of 59 (78%) distributed them to patients. The most common barriers were lack of a reliable way to identify patients before decisions are made (37%), a lack of time to distribute the PtDAs (22%) and having too many educational materials (15%). Sites that indicated a lack of clinician support as a barrier were significantly less likely to have sustained use compared to sites that didn't (33% vs. 74%, P = 0.02). Community breast cancer providers, both physicians and non-physicians, express a high interest in using PtDAs with their patients. About a quarter of sites report sustained use of the PtDAs in routine care. [ABSTRACT FROM AUTHOR].

2 Articles that you can download yourself - Free on the web

9. How to Turn Your Dissertation, Thesis, or Paper into a Publication
Posted on April 17, 2012 by SAGE Publications
By Camille Gamboa, SAGE US PR & Conventions Assistant
Part 1: Where do you go from here?
In our first “How To” post, we provided steps for how to get a publication-ready paper in a scholarly journal. With some help from experienced academics and authors, now we’ll talk about how to turn your thesis, dissertation chapter, or simply a stellar paper that you’re proud of into a publication.

10. How to Turn Your Dissertation, Thesis, or Paper into a Publication (Part Three)
Posted on May 22, 2012 by SAGE Publications
By Camille Gamboa, SAGE US PR & Conventions Assistant
While it may feel like you are choosing between children, because your work is so expansive, it is probably best to choose only a portion or a chapter of your work to publish in a journal or adapt into a book. So how do you decide which part is best? Dr. Sarah-Louise Quinnell, an experienced social scientist and blogger for phd2published, offers some key questions to ask yourself which we’ve adapted with some insights of our own:

Journal - Table of Contents

11. From Canadian Nurse, March 2012, Volume 108, Number 3
. Ferguson-Pare appointed to Order of Canada; NP numbers up, but employment trends concerning
11B. Fast answers with new device [Hand-held device that can detect biomarkers associated with cancer]; Faster genome sequencing; Deep brain stimulation eases parkinson's symptoms; Mid-career surgeons provide best results; Red wine health benefits questioned; Prescribing antipsychotics for insomnia a dangerous choice
The Research File
. Expanding the care team to improve drug adherence
. Nursing your community garden
Promising Practices
. Pathways to Housing: A response to homelessness in Calgary
11F. Why advocacy matters [The conditions in which clients live can go unknown by health-care professionals]
11G. Focusing your care: Working with clients with vision loss
11H. Mindful matters [Mental Health Nursing]
Ask the Expert
11I. Taking control of your financial future
11J. Cancer and Sex: Out in the open
11K. Relationships are the antidote to toxic stress
11L. Milk products play a key role in preventing type 2 diabetes

A Residential Retreat

12. Everyday Mindfulness for Health Professionals
1-6 July 2012
Venue: Mana Retreat Centre, Coromandel
The Royal New Zealand College of General Practitioners RNZCGP) has approved this programme for up to 40 hours endorsed CME for General Practice Education Programme
Stage 2, (GPEP2) and Maintenance of Professional Standards (MOPS) purposes.
Register at:
Registration closes: 31 May 2012
Accommodation is limited to 30 participants.

News - National

13. Extra support for vulnerable youth
Paula Bennett - 24 May, 2012
Budget 2012 includes an $18.3 million investment over the next four years in mental health services for children and young people, Youth Affairs Minister Paula Bennett says. “Young people can be among our most vulnerable and need specific support to address their needs,” she says. “I’m pleased to be putting more funding into mental health services for young people, including youth workers and One-Stop Shops.” Twelve youth-focused One-Stop Shops will deliver a range of health and social services around the country. This funding will boost these services to meet the demand of mild to moderate mental health issues.

14. Tobacco excise rise part of wider programme
Tariana Turia - 24 May, 2012
Tobacco excise taxes will increase by 10 per cent a year on 1 January in each of the next four years as part of a wider government programme to prevent young people from taking up smoking and encourage existing smokers to quit, Associate Health Minister Tariana Turia says. This will be in addition to the annual inflation-indexed increases in tobacco excise, and follows a 40 per cent increase in excise since April 2010. Budget 2012 also provides $20 million over the next four years for a new innovation fund, Pathway to Smoke-Free 2025, for programmes to discourage smoking uptake and help more New Zealanders give up.

15. Fund to improve health of Pasifika communities
Tariana Turia - 24 May, 2012
A new $6 million Pacific Innovation Fund will help improve the health of Pasifika people, Associate Health Minister Tariana Turia says. “The fund recognises the need to design responsive services across health, education, housing, justice, social services, employment, and lifestyle. “The fund, to be invested over four years, is aligned to the vision of Whanau Ora for Pasifika people,” Mrs Turia says

16. Budget 2012: $144m more for disability support
Tony Ryall, Tariana Turia15 May, 2012
Budget 2012 will make available $143.7 million over the next four years to improve the lives of people with disabilities.Speaking at the New Zealand Federation of Disabilities Information Centres’ Conference in Queenstown today, Health Minister Tony Ryall says the $143.7 million is made up of $132.7 million in new investment and $11.0 million in savings. The disabilities sector receives the largest share of new health funding in the budget, other than DHBs

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