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The Resource Decisional conflict in peripheral arterial disease : association with treatment choice and health status, Jeremy Burton Provance

Decisional conflict in peripheral arterial disease : association with treatment choice and health status, Jeremy Burton Provance

Creator
Author
Contributor
Summary
Background: Symptom relief in peripheral arterial disease (PAD) can be obtained by invasive options such as endovascular stenting as well as exercise, and PAD medications. Each of these options have their own risks and benefits. A lack of knowledge about treatment options, risks and benefits, and how these matter to the patient, as well as a lack of support relating to treatment decisions can result in decisional conflict. We aimed to (1) document decisional conflict in patients facing PAD treatment decisions; (2) examine site variability in decisional conflict; and (3) examine whether decisional conflict is associated with PAD treatment strategy and 1-year health status outcomes. Methods: The PORTRAIT study is an observational prospective study that enrolled patients with new or an exacerbation of PAD symptoms from 16 PAD specialty clinics in the US, the Netherlands, and Australia. Patients were interviewed before they underwent PAD treatments to document their socio-economic background and their health status (Peripheral Artery Questionnaire -- PAQ). Medical history was abstracted from the medical records. At 3 months, treatment information and decisional conflict (yes/no -- 4-item SURE instrument) information was collected from the patient. One-year follow-up health status information was collected by phone interview. Median odds ratios were calculated to quantify the level of site variability. A multivariable logistic regression model was constructed to examine the association between decisional conflict and primary PAD treatment strategy (invasive vs. non-invasive). A multivariable linear regression model was built to examine the association between decisional conflict and 1-year PAQ summary scores, while adjusting for baseline PAQ summary scores. Results: The unadjusted median odds ratio (MOR) for site variability was 2.01 (95% CI 1.56-3.13; p<0.001), after adjusting for country, the MOR was 1.12 (95% CI 1.00-1.46; p=0.35). After adjustment for site and relevant patient covariates, decisional conflict was associated with lower odds of receiving invasive treatment (OR=0.58; 95% CI 0.34-1.00; p=0.050). Decisional conflict was also associated with lower 1-year health status gains for the PAQ summary score (adjusted B=-4.72; 95% CI -9.38;-0.06; p=0.047), even adjusting for primary PAD treatment strategy. Conclusion: One in five patients facing PAD treatment decisions experience decisional conflict. While there is considerable variation for the occurrence of decisional conflict, it is more common among non-US countries. As compared with patients who do not experience decisional conflict, those reporting conflict are more often managed non-invasively and experience lesser 1-year health status gains, not entirely explained by the primary PAD treatment modality. Increasing knowledge and support for non-invasive PAD treatment options may be ways to reduce decisional conflict in PAD
Language
eng
Work
Publication
Extent
1 online resource (46 pages)
Note
  • "A thesis in Bioinformatics."
  • Advisor: Kim Smolderen
  • Vita
Contents
  • Introduction
  • Methods
  • Results
  • Discussion
Instance
Label
Decisional conflict in peripheral arterial disease : association with treatment choice and health status
Title
Decisional conflict in peripheral arterial disease
Title remainder
association with treatment choice and health status
Statement of responsibility
Jeremy Burton Provance
Creator
Contributor
Author
Degree supervisor
Subject
Genre
Language
eng
Summary
Background: Symptom relief in peripheral arterial disease (PAD) can be obtained by invasive options such as endovascular stenting as well as exercise, and PAD medications. Each of these options have their own risks and benefits. A lack of knowledge about treatment options, risks and benefits, and how these matter to the patient, as well as a lack of support relating to treatment decisions can result in decisional conflict. We aimed to (1) document decisional conflict in patients facing PAD treatment decisions; (2) examine site variability in decisional conflict; and (3) examine whether decisional conflict is associated with PAD treatment strategy and 1-year health status outcomes. Methods: The PORTRAIT study is an observational prospective study that enrolled patients with new or an exacerbation of PAD symptoms from 16 PAD specialty clinics in the US, the Netherlands, and Australia. Patients were interviewed before they underwent PAD treatments to document their socio-economic background and their health status (Peripheral Artery Questionnaire -- PAQ). Medical history was abstracted from the medical records. At 3 months, treatment information and decisional conflict (yes/no -- 4-item SURE instrument) information was collected from the patient. One-year follow-up health status information was collected by phone interview. Median odds ratios were calculated to quantify the level of site variability. A multivariable logistic regression model was constructed to examine the association between decisional conflict and primary PAD treatment strategy (invasive vs. non-invasive). A multivariable linear regression model was built to examine the association between decisional conflict and 1-year PAQ summary scores, while adjusting for baseline PAQ summary scores. Results: The unadjusted median odds ratio (MOR) for site variability was 2.01 (95% CI 1.56-3.13; p<0.001), after adjusting for country, the MOR was 1.12 (95% CI 1.00-1.46; p=0.35). After adjustment for site and relevant patient covariates, decisional conflict was associated with lower odds of receiving invasive treatment (OR=0.58; 95% CI 0.34-1.00; p=0.050). Decisional conflict was also associated with lower 1-year health status gains for the PAQ summary score (adjusted B=-4.72; 95% CI -9.38;-0.06; p=0.047), even adjusting for primary PAD treatment strategy. Conclusion: One in five patients facing PAD treatment decisions experience decisional conflict. While there is considerable variation for the occurrence of decisional conflict, it is more common among non-US countries. As compared with patients who do not experience decisional conflict, those reporting conflict are more often managed non-invasively and experience lesser 1-year health status gains, not entirely explained by the primary PAD treatment modality. Increasing knowledge and support for non-invasive PAD treatment options may be ways to reduce decisional conflict in PAD
Cataloging source
UMK
http://library.link/vocab/creatorDate
1991-
http://library.link/vocab/creatorName
Provance, Jeremy Burton
Degree
M.S.
Dissertation note
(School of Medicine).
Dissertation year
2017.
Granting institution
University of Missouri-Kansas City,
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
  • theses
http://library.link/vocab/relatedWorkOrContributorName
Smolderen, Kim G.
http://library.link/vocab/subjectName
  • Peripheral vascular diseases
  • Medical care
  • Peripheral Arterial Disease
  • Decision Making
Label
Decisional conflict in peripheral arterial disease : association with treatment choice and health status, Jeremy Burton Provance
Instantiates
Publication
Copyright
Note
  • "A thesis in Bioinformatics."
  • Advisor: Kim Smolderen
  • Vita
Antecedent source
not applicable
Bibliography note
Includes bibliographical references (pages 42-45)
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
black and white
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Contents
Introduction -- Methods -- Results -- Discussion
Control code
989070247
Dimensions
unknown
Extent
1 online resource (46 pages)
File format
one file format
Form of item
online
Level of compression
mixed
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Quality assurance targets
not applicable
Specific material designation
remote
System control number
(OCoLC)989070247
System details
  • The full text of the thesis is available as an Adobe Acrobat .pdf file; Adobe Acrobat Reader required to view the file
  • Mode of access: World Wide Web
Label
Decisional conflict in peripheral arterial disease : association with treatment choice and health status, Jeremy Burton Provance
Publication
Copyright
Note
  • "A thesis in Bioinformatics."
  • Advisor: Kim Smolderen
  • Vita
Antecedent source
not applicable
Bibliography note
Includes bibliographical references (pages 42-45)
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
black and white
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Contents
Introduction -- Methods -- Results -- Discussion
Control code
989070247
Dimensions
unknown
Extent
1 online resource (46 pages)
File format
one file format
Form of item
online
Level of compression
mixed
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations.
Quality assurance targets
not applicable
Specific material designation
remote
System control number
(OCoLC)989070247
System details
  • The full text of the thesis is available as an Adobe Acrobat .pdf file; Adobe Acrobat Reader required to view the file
  • Mode of access: World Wide Web

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