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P-values of Fisher exact tests for the prediction configural frequency analyses of the exploratory and confirmatorysamples
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Numerous studies examined factors in promoting a patient preference for active participation in treatment decision making with only modest success. The purpose of this study was to identify types of patients wishing to participate in treatment decisions as well as those wishing to play a completely active or passive role based on a Germany-wide sur...
Contexts in source publication
Context 1
... possible prediction types were identified (printed in bold) in the exploratory sample shown in Table 2. Con- sequently, the Fisher exact test of these configurations demonstrated a p-value < 0.05. ...
Context 2
... "need for information" was the only attribute that was marginally higher in the exploratory and con- firmatory subsamples (by 7%) than in the overall study sample of 6318 patients, particular attention was paid to predictor-criterion configurations with low p-values with regard to informational desire. If the predictor-criterion configurations (11121)×1 with P11121 × 1 = 0.040347 and (12221)×1 with P12221 × 1 = 0.018876 (Table 2, confirmatory sample) are therefore taken into account when interpreting the prediction types, the result is that the active role is preferred regardless of the informa- tional desire of patients age 55 and younger with a high educational level. These patients have either a below- average level of trust in their physician together with a negative perception of the physician's PDM style or they have an above-average trust in their physician along with a positive perception of the physician's PDM style. ...
Context 3
... patients have either a below- average level of trust in their physician together with a negative perception of the physician's PDM style or they have an above-average trust in their physician along with a positive perception of the physician's PDM style. Additionally, if the predictor-criterion configurations (22212)×3 with P22212 × 3 = 0.006359 and (22213)×3 with P22213 × 3 = 0.004507 (Table 2, confirmatory sample) are considered, the passive role is preferred regardless of the informational desire of patients with an above-average level of trust in their physician, a positive perception of their physician's PDM style, a low educa- tional level and age older than 56 years (56 to 75 years old or older than 75). It was found that the informa- tional desire of patients was independent of their pre- ferred active or passive control preference. ...
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Citations
... Die Inputforschung in der Versorgungsforschung beschäftigt sich mit der Frage, welche Typen von Patient:innen mit welchem sozioökonomischen Hintergrund und mit welchen Kompetenzen, Erfahrungen, Krankheiten, Bedürfnissen, Präferenzen und Erwartungen in das Versorgungssystem eintreten und welche Patient:innen nicht. Mit diesen und ähnlichen Fragestellungen beschäftigt sich a) die Inanspruchnahmeforschung (Brandes et al. 2009; Ernstmann et al. 2021; Abb. 1 Das Throughput-Modell der Versorgungsforschung. (In Anlehnung an Pfaff 2003) Geyer et al. 2002; Janssen 2014; Klein und von dem, Richter et al. 2002, b) die Präferenzforschung(Löffert et al. 2010;Schmitz et al. 2015), c) die Gesundheitskompetenzforschung Hurrelmann et al. Medizinsoziolog:innen spielen in diesem Zusammenhang die Themen sozial ungleiche Inanspruchnahme und sozial ungleiche Versorgung eine besondere Rolle. ...
Soziologie als Wissenschaft befasst sich mit Analysen der Struktur und Funktion von Gesellschaften und ihren Auswirkungen auf verschiedene Lebensbereiche. Zur vertieften Untersuchung einzelner Lebensbereiche wie Bildung, Recht, Wirtschaft oder Gesundheit und medizinische Versorgung haben sich Teil- bzw. Subdisziplinen des Faches gebildet, so auch die Medizinsoziologie. Sie entwickelte sich in den 1960er Jahren in den USA und in Großbritannien, kurz darauf in vielen weiteren Ländern einschließlich Deutschlands, teilweise unter der erweiterten Bezeichnung ‚Gesundheitssoziologie‘.
... In this adapted version of the CPS, patients are asked to read five different statements about their desired type of participation in the decision-making process (Table 1). Afterwards, they choose the statement that they perceive to be closest to their preferred role in treatment decision-making [26]. They are asked to indicate only their first preference. ...
Different patients want to take different roles in the treatment decision-making process; these roles can be classified as passive, collaborative, and active. The aim of this study was to investigate the correlation between decision-making preferences among patients with prostate cancer and personal, disease-related, and structural factors. In four survey studies, we asked 7169 prostate cancer patients about their decision-making preferences using the Control Preferences Scale (CPS) and collected clinical, psychological, and quality-of-life measures. Most patients (62.2%) preferred collaborative decision-making, while 2322 (32.4%) preferred an active role, and only 391 (5.5%) preferred a passive role. Age (p < 0.001), data collection mode (p < 0.001), peer-to-peer support (p = 0.018), treatment status (p < 0.001), performed or planned radical prostatectomy (p < 0.001), metastatic disease (p = 0.001), and quality of life (p < 0.001) showed significant associations with patients' preferred decision-making roles. Oncologic risk group, anxiety, and depression were not significant in the model. In particular, younger prostate cancer patients with higher quality of life completing an online survey want to play a more active role in treatment decision-making. Before treatment has started, patients tend to prefer collaborative decision-making. Few prostate cancer patients in Germany prefer a passive role. These patients are mostly older patients, patients with a metastatic disease, and patients who have opted for prostatectomy. Whether this finding reflects a generational effect or a tendency by age group and disease phase should be investigated. Further research is also needed to describe the causalities of these relationships. The CPS offers valuable information for personal counselling and should be applied in clinical routine. In a large group of patients with prostate cancer, we found that there is a strong desire for joint decision-making with the physician before the actual treatment. Especially younger men, men with active online behaviour, and men with a high quality of life want to be actively involved in therapy decision-making processes.
... In further details, our analysis showed a positive association between the frequency of visit and the patient's physical and mental well-being; this might be due to the fact that the patient feels more looked after but also that communication and the contact between doctor and patient are improved, as a result of the frequent visits. A 6 DOI: 10.1159/000509787 good doctor-patient relationship is a key element of shared decision-making in dialysis patients [22], and it is associated with better health outcomes [23,24]. ...
Introduction:
CKD is associated with a reduction of patients' health-related quality of life. Considering the time spent in dialysis, satisfaction with care is essential for patients QOL.
Objective:
Since the possible association between satisfaction with the dialysis care and QOL has never been studied, in this study, we explore this plausible link.
Methods:
One hundred three patients on hemodialysis (HD) and peritoneal dialysis (PD) filled-in patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). QOL was assessed by Kidney Disease Quality of Life-36 and satisfaction by Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) questionnaire. The analysis was conducted on patient-level, considering for single patient sociodemographic characteristics and presence of depression/anxiety. One-way ANOVA was used to compare QOL mean scores for patients who answered "excellent" and for those who answered "other ratings" in CHOICE questionnaire and the Pearson χ2 test to compare the patients' characteristics between these 2 groups of patients.
Results:
The analysis showed a significant positive association between PREM and PROM scores for 8 out of 23 CHOICE items. Six of them were related to the figure of nephrologist, 1 to dialysis access site, and 1 to the social worker support. Significant association (p < 0.05) were between frequency of seeing nephrologist and physical component plus mental component, accuracy of information from nephrologist and burden of disease, accuracy of instructions from nephrologist and burden of disease, coordination between nephrologist and other physicians plus mental component, attention to cleanliness of access site and mental component, amount of dialysis information from staff and burden of disease, information from staff when choosing between HD or PD and physical component plus burden of disease, and ease of seeing social worker and burden of disease.
Conclusions:
The study provides support for the relationship between the care satisfaction and QOL, highlighting the central role of the nephrologist-patient communication in the QOL of dialysis patients.
... For example, if there were more women in the sample who experienced MSA as well as one or more other military stressors and who demonstrated diagnostic levels of SUD and PTS than would be expected by chance, then this group of women would be designated as a Type (or an Antitype, if there were fewer of these women than would be expected by chance). CFA is a widely used statistical method the social sciences, especially psychology (e.g., Gutiérrez-Peña, 2012;Loeffert et al., 2010;Martinez-Torteya, Anne Bogat, Von Eye, & Levendosky, 2009; for review see Bogat, von Eye, & Bergman, 2017). In contrast to other commonly used person-centered data analytic techniques (e.g., cluster and latent profile analyses), CFA allows the data analyst to define groups to be compared manually, using existing categorizations (e.g., diagnostic status), rather than deriving categories according to an algorithm. ...
Servicewomen exposed to traumatic stressors over the course of their military service are at increased risk of developing symptoms of substance use disorder (SUD) and posttraumatic stress (PTS). They are also at risk for exposure to military sexual assault (MSA), which is also associated with SUD and PTS symptomology. Research is unclear about the incremental contributions of different forms of traumatic stressors on co-occurring SUD and PTS symptomology. In this study we examined the independent and combined effects of MSA and other military stressors on SUD and PTS symptomology in a sample of female veterans (N=407). Results indicate that MSA and other military stressors exhibit incremental effects on SUD and PTS symptomology. Results further suggest that women exposed to both MSA and other military stressors are at increased risk for developing co-occurring SUD and PTSD. These findings extend previous research on comorbid SUD and PTSD, highlighting the cumulative effects of traumatic stressors on posttraumatic psychopathology, and have implications for future research and clinical practice with female veterans.
... 4 Recovery from the traumatic event, symptom severity and treatment complexity, limited time to deliberate, feeling ill-equipped to make a choice and high levels of trust in physician expertise, evident in the CRMD studies, are factors widely associated with passivity in the decision literature. 20,[84][85][86][87][88] However, passivity was also described among patients contemplating primary prophylactic devices 53,58,61,63 when symptoms may be absent, suggesting that more deliberation time may not increase engagement in decision-making. The clarity of the perceived benefit and risk for primary devices may be a factor. ...
Background:
Complex cardiac rhythm management device (CRMD) therapy provides an important treatment option for people at risk of sudden cardiac death. Despite the survival benefit, device implantation is associated with significant physical and psychosocial concerns presenting considerable challenges for the decision-making process surrounding CRMD implantation for patients and physicians.
Aims:
The purpose of this scoping review was to explore what is known about how adult (>16 years) patients make decisions regarding implantation of CRMD therapy.
Methods:
Published, peer reviewed, English language studies from 2000 to 2016 were identified in a search across eight healthcare databases. Eligible studies were concerned with patient decision-making for first time device implantation. Quality assessment was completed using the mixed methods appraisal tool for all studies meeting the inclusion criteria.
Results:
The findings of eight qualitative and seven quantitative studies, including patients who accepted or declined primary or secondary sudden cardiac death prevention devices, were clustered into two themes: knowledge acquisition and the process of decision-making, exposing similarities and distinctions with the treatment decision-making literature.
Conclusion:
The review revealed some insight in to the way patients approach decision-making but also exposed a lack of clarity and research activity specific to CRMD patients. Further research is recommended to support the development and application of targeted decision support mechanisms.
... Another advantage is that unlike many other methods, CFA does not use a similarity or distance measure to identify types, but takes only types into consideration with identical attribute patterns, which makes its type definition more accurate than any other previous type definition. 11 There has been a large number of tests proposed for use in CFA. The best known of these tests include the binomial test, the component test, and Lehmacker's hypergeometric tests. ...
Configural Frequency Analysis (CFA) is a method for cell‐wise testing in contingency tables whether some model is contradicted. The original idea that lead to CFA is that the cell frequencies in contingency tables can not only be used to evaluate statements about the association structure of the variables that span the table, but are worthy of consideration in their own right. CFA is a method that allows researchers to identify patterns (configurations) of variable categories that occur more often or less often than expected based on some chance model. Each cell in this crossclassification is described by a profile of variable categories. These profiles are called configurations. CFA relates individual observed cell frequencies to their expected counterparts, thereby looking for surprising, that is, statistically significant deviations. When a cross-classification cell contains more cases than expected according to some base model, it is said to constitute a CFA "type". When there are fewer cases than expected, a cell is said to constitute a CFA "antitype". Using CFA, researchers inspect either each configuration in this cross-classification or an a priori specified selection of configurations. A large number of tests has been introduced for CFA which differ in power, in their capabilities to detect types and antitypes. Lehmacher's test always has more power than the other tests. The aim of this study is to provide an introductory review for CFA, a method of categorical data analysis originally introduced as a heuristic method the so-called CFA recently has been developed into an inferential method.
Dieses Kapitel stellt die vergangenen und gegenwärtigen Beiträge der Medizinsoziologie zur Versorgungsforschung in den Mittelpunkt und gibt einen Ausblick auf die Herausforderungen, die vor der medizinsoziologischen Versorgungsforschung liegen. Das Kapitel stellt insbesondere die moderne Versorgungsforschung in die Tradition der Medizinsoziologie und zeigt auf, welche grundlegenden empirischen und theoretischen Vorleistungen aus der Medizinsoziologie stammen. Das Kapitel zeigt auch die verschiedenen Strömungen in der Medizinsoziologie auf und macht deutlich, dass die Medizinsoziologie mit der Versorgungsforschung einen neuen Weg geht. Dieser kombiniert zwei Strömungen der Medizinsoziologie, die Soziologie der Medizin und die Soziologie in der Medizin und gibt diesen zwei Strömungen unter Nutzung sozialepidemiologischer Methoden ein praxisorientiertes Ziel: die Verbesserung des Gesundheits- und Versorgungssystems. Damit steht die Medizinsoziologie auf zwei Beinen: einem analytischen und einem praktisch-verändernden. Für ein Fach ist es auf Dauer zentral und überlebenswichtig, dass es auch Problemlösungen für die Gesellschaft anbieten kann. Das ist das Programm der medizinsoziologischen Versorgungsforschung und ihr Beitrag zur Medizinsoziologie.
More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients' and families' diverse needs can strengthen systematic efforts to improve ACP.
In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes.
Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, "Prior experiences with ACP," revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, "Factors that may affect perspectives on ACP," included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, "Recommendations for discussing ACP," included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how.
Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may affect patient perspectives regarding ACP. This study's findings may inform clinical practice and will be useful in designing prospective intervention studies to improve patient and family experiences at the end of life.
Copyright © 2015 by the American Society of Nephrology.
Patient decision-making role preference (DMRP) is a patient's preferred degree of control when making medical decisions. This descriptive qualitative study aimed to explore Malaysian patients' views on their DMRP. Between January 2011 and March 2012, 22 individual face-to-face in-depth interviews were conducted with patients with type 2 diabetes who were deciding about insulin initiation. The interviews were audio-recorded and analysed using a thematic approach. The age range of participants was 28–67 years old with 11 men. Ten patients preferred to make the decision themselves, six patients indicated that the clinician should make the decision and only one patient expressed a preference for a collaborative role. The following factors influenced DMRP: trust in clinicians, responsibility for diabetes care, level of knowledge and awareness, involvement of family and personal characteristics. In conclusion, the concept of shared decision-making is still alien, and a more participative communication style might help to facilitate patients' expression of DMRP.
Most patients starting dialysis can choose between peritoneal dialysis and haemodialysis. There is little evidence proving that one form of dialysis is better than the other; although there may be an early advantage to peritoneal dialysis (PD) in young patients with residual function this effect is short-lived. Technique failure develops after years on PD so dialysis modality will often change during a long dialysis career. Quality of life studies, which must be interpreted carefully, indicate that patients require information about the impact of dialysis on their lifestyle as well as health-related outcomes so that they can choose the most suitable dialysis modality. Increasing numbers of frail elderly patients are starting dialysis; support in the home by nursing staff may facilitate the use of PD in this group. In the UK guidelines prioritise the patient's choice of dialysis modality (where feasible) based on good quality predialysis education. Cost of treatment is generally lower on PD, which is particularly recommended for patients with residual renal function and few comorbidities.
