Patient Decision Aid for Extended Duration Thromboprophylaxis for Major Abdominopelvic Cancer Surgery: A Usability Study
Notice bibliographique
Résumé
Background: Clinical guidelines recommend patients receive extended duration thromboprophylaxis for 30 days following major abdominopelvic cancer surgery. There is equipoise regarding this recommendation amongst providers and patients. We developed a risk-stratified patient decision aid (PtDA) for patients undergoing major abdominopelvic cancer surgery considering extended duration thromboprophylaxis. We previously demonstrated the PtDA was acceptable to patients and clinicians and enhanced decision-making quality. However, the PtDA made was difficult to use in the perioperative setting. The objective of this study was to evaluate and improve the usability of the PtDA in the perioperative setting. Methods: We used an iterative process guided by a user-centered design framework. Consecutive patients undergoing major abdominopelvic cancer surgery from two major cancer centers in Canada, The Ottawa Hospital Cancer Center (TOHCC) and CancerCare Manitoba (CCMB), were recruited. Healthcare professionals involved in discharging patients who completed the PtDA were also recruited. Recruitment rate was defined as the number of total patients approached divided by the total eligible patients who consented to be contacted. Eligible and consented patients were invited to complete the PtDA and the Post Study System Usability Questionnaire (PSSUQ), and to record their decision regarding extended duration thromboprophylaxis. Adherence rate was defined as the number of eligible patients thereafter who actually completed the PSSUQ. Usability was also assessed by healthcare professionals discharging patients using the Consolidated Framework for Implementation Research (CFIR) Barrier Buster Tool. Results: Across both sites patients were recruited from November 2023 until May 2024. 108 consecutive patients were approached with study details, 22 refused to be contacted and 7 were ineligible The recruitment rate was 73% (79/108). Of the eligible and consented patients, the adherence rate was 25% (20/79). Overall, 15 patients from TOHCC and 5 from CCMB used the PtDA to help their decision regarding extended duration thromboprophylaxis. Eight (40%) patients were males, and 12 (60%) were females. Out of the 20 patients who used the PtDA, 18 (90%) completed the PSSUQ and reported their decision regarding extended duration thromboprophylaxis: 13 (65%) patients made a decision using our PtDA compared to 5 (25%) who preferred not to decide. Among the 13 who made a decision, 7 (54%) decided not to take extended duration thromboprophylaxis and 6 (46%) decided to take extended duration thromboprophylaxis. Regarding usability, the overall median score was 2 (range 2 - 6) on the PSSUQ. The usefulness subdomain median score was 3 (range 2 - 7). The median quality of information subdomain score was 2 (1 - 7). The median quality of design score was 2 (1 - 7). A total of 15 healthcare professionals were involved in discharging patients who used the PtDA and completed the PSSUQ. All healthcare professionals were resident physicians. Eight (53%) were males and seven (47%) were females. All 15 (100%) completed the follow-up CFIR Tool. From the 12 factors evaluated in the CFIR Tool, healthcare professionals identified a median number of six (range 1-11) facilitators and a median number of one (range 0-8) barrier. The factor most commonly identified as a facilitator was that the use of the PtDA is aligned with the healthcare professional's value, and the factor most commonly identified as a barrier was the lack of access to data to track the changes in outcomes related to the PtDA. Conclusion: The PtDA was found to be usable by patients based on PSSUQ scores. Healthcare professionals reported more facilitators than barriers to using the PtDA in the perioperative setting. However, few patients eligible for the study completed the PtDA in both centers, which may suggest ongoing challenges with implementing PtDAs in the perioperative setting. Additional research is required to assess clinical outcomes associated with its use in routine practice for patients, and address implementation barriers for providers.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,028 | 0,059 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».