Dataset Information

Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.

ABSTRACT:

Objective

Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.

Design

Qualitative interviews using a basic descriptive approach.

Setting

Canada.

Participants

Practicing cardiovascular and orthopaedic physicians.

Main outcome measures

Level, processes and determinants of PE in medical device discussions and decisions.

Results

Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice.

Conclusions

This study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.

SUBMITTER: Gagliardi AR

PROVIDER: S-EPMC5412024 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.

Gagliardi Anna R AR Lehoux Pascale P Ducey Ariel A Easty Anthony A Ross Sue S Bell Chaim M CM Trbovich Patricia P Takata Julie J Urbach David R DR

International journal for quality in health care : journal of the International Society for Quality in Health Care 20170401 2

<h4>Objective</h4>Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.<h4>Design</h4>Qualitative interviews using a basic descriptive approach.<h4>Setting</h4>Canada.<h4>Participants</h4>Practicing cardiovascular and ort ...[more]

PMID: 28453827

Similar Datasets

Project description:ObjectivesPhysician relationships with device industry representatives have not been previously assessed. This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI) is a concern and how it is managed.DesignA descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites, and interviewed about their relationships with device industry representatives. Sampling was concurrent with data collection and analysis. Data were analyzed and discussed using constant comparative technique by all members of the research team.ResultsTwenty-two physicians (10 cardiovascular, 12 orthopedic) were interviewed. Ten distinct representative roles were identified: purchasing, training, trouble-shooting, supplying devices, assisting with device assembly and insertion, supporting operating room staff, mitigating liability, conveying information about recalls, and providing direct and indirect financial support. Participants recognized the potential for COI but representatives were present for the majority of implantations. Participants revealed a tension between physicians and representatives that was characterized as "symbiotic", but required physicians to be vigilant about COI and patient safety, particularly because representatives varied regarding disclosure of device defects. They described a concurrent tension between hospitals, whose policies and business practices were focused on cost-control, and physicians who were required to comply with those policies and use particular devices despite concerns about their safety and effectiveness.ConclusionsGiven the potential for COI and threats to patient safety, further research is needed to establish the clinical implications of the role of, and relationship with device industry representatives; and whether and how hospitals do and should govern interaction with representatives, or support their staff in this regard.

Dataset Information

Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.

Similar Datasets

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