Accepted Manuscript Decision Aides for Shared Decision Making in Barrett’s Surveillance Aanand D. Naik , MD Hashem B. El-Serag , MD, MPH

PII: DOI: Reference:

S1542-3565(14)00714-9 10.1016/j.cgh.2014.05.004 YJCGH 53820

To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 4 May 2014 Please cite this article as: Naik AD, El-Serag HB, Decision Aides for Shared Decision Making in Barrett’s Surveillance, Clinical Gastroenterology and Hepatology (2014), doi: 10.1016/j.cgh.2014.05.004. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. All studies published in Clinical Gastroenterology and Hepatology are embargoed until 3PM ET of the day they are published as corrected proofs on-line. Studies cannot be publicized as accepted manuscripts or uncorrected proofs.

ACCEPTED MANUSCRIPT

Decision Aides for Shared Decision Making in Barrett’s Surveillance

Hashem B. El-Serag, MD, MPH1,3 Professor of Medicine

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Aanand D. Naik, MD1,2 Associate Professor of Medicine and Health Policy

1. Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center

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2. Department of Medicine (Health Services Research), Baylor College of Medicine

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3. Department of Medicine (Gastroenterology and Hepatology), Baylor College of Medicine

Corresponding Author:

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Aanand D. Naik, MD Associate Professor of Medicine and Health Policy, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center (152) 2002 Holcombe Blvd Houston, Texas 77030 713-794-8541 [email protected]

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Acknowledgments

This work was supported in part by the Houston Center for Innovations in Quality, Effectiveness

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and Safety (CIN 13-413).

The authors have no conflicts of interest to declare.

Word Count: 1302 References: 20

Key Words: Decision Aides; Shared Decision Making; Values Clarification; Barrett’s Esophagus; Cancer Screening and Surveillance

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Using Decision Aides for Shared Decision Making Medical decision making is a central function of the clinical encounter, and patients are playing increasingly substantial roles in these decisions.1 Shared decision making is the

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incorporation of patients preferences, goals, and choices into diagnostic and treatment planning. Formal processes for shared decision making are frequently recommended prior to cancer screening and surveillance.2 Patient decision aids are tools designed to support patients through the shared decision making process given the difficulty most patients report with

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medical decisions.3 Patient decision aides come in many forms including leaflets and booklets,

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video or audio guides, and interactive media and are used either during or prior to medical encounters. Patient decision aides are particularly useful for medical decisions that are deemed preference sensitive. Preference sensitive decisions involve two or more options whose clinical efficacy are equivalent but have important trade-offs related to side effects, intermediate outcomes, or burdens to daily life.4 For preference sensitive decisions, the ethically optimal

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process is one that empowers patients to makes decisions consistent with their values, goals, and preferences.

The study by Yachimski et al.5 in the current issue of Clinical Gastroenterology and

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Hepatology is an important contribution to the growing literature on shared decision making in Gastroenterology and Hepatology. 2 The authors describe the development and validation of a

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decision support tool for cancer surveillance specific to Barrett’s Esophagus (BE). The two BE treatment methods compared in this study are surveillance endoscopy with ablation, and chemoprevention with aspirin. Surveillance endoscopy for BE can be followed by progressively more effective techniques to ablate the pre-cancerous lesions. Radiofrequency ablation during surveillance endoscopy is now recommended for BE with low- and high-grade dysplasia, and even among high-risk patients with nondysplastic BE.6 Evidence from observational studies suggests that aspirin and selective cyclooxygenase-2 inhibitors (coxibs) can also reduce the risk

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of progression of BE to esophageal cancer.7 Clinical practice guidelines recommend the use of aspirin as a chemoprevention agent among patients with cardiovascular risk factors.6 The authors used a questionnaire with accompanying visual aides to elicit preferences

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for surveillance endoscopy versus oral chemoprevention among patients with nondysplastic BE. Study participants favored surveillance endoscopy significantly more than oral chemotherapy (78% versus 53%, P

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