CTRC Canadian Head Ct Patient Decision Aid consensus Study

General information

Our research project, “The Canadian Head CT Patient Decision Aid Consensus Study”, in collaboration with researchers from Laval University, University of Ottawa, University of Calgary, Dalhousie University and McGill University, aims to involve Canadian experts in the adaptation of the two American shared decision aids to the Canadian context.

The goal of this meeting is to develop consensus on the appropriate information to include in the initial prototype of the Canadian decision aids, followed by creating a scientific committee to gather expert advice to support the process of rapid prototyping for creating decision aids that are adapted to Canadian medical and legal contexts and values.

Shared decision making and decision aid

Shared decision making (SDM) is the preferred approach for making healthcare decisions when more than one reasonable option is available. SDM is the process of interacting with patients in arriving at informed values-based choices when options have features that patients value differently. So, SDM is best described as a conversation between the clinician and the patient in which they figure out together what to do to address the patient’s situation (Kunneman et al., 2016). Likewise, SDM has been advocated as a way to guide conversations between patients / families and the clinical team to achieve “decision quality” (Hess et al., 2015), when “decision quality” is defined as “the extent to which a decision reflects the considered preferences of a well-informed patient and is implemented”(Sepucha et al., 2013).

Patient decision aids or decision aids (DAs) are evidence-based tools designed to facilitate the SDM process and to help patients make specific and deliberated choices among healthcare options. Patient DAs supplement (rather than replace) clinicians’ counselling about options (Stacey et al., 2017). They provide information on the options and help patients clarify and communicate the personal value they associate with different features of the options (The International Patient Decision Aid Standards (IPDAS) Collaboration). Patient DAs prepare patients to make informed, values-based decisions with their practitioner.

According to Stacey et al. (2017), the specific DAs and the type of decision support they provide aim to: 1) explicitly state the decision that needs to be considered; 2) provide evidence-based information about a health condition, the options, associated benefits, harms, probabilities, and scientific uncertainties; and 3) help patients to recognize the values-sensitive nature of the decision and to clarify, either implicitly or explicitly, the value they place on the benefits and harms (Stacey et al., 2017).

“To accomplish this, patient decision aids may describe the options in enough detail that clients can imagine what it is like to experience the physical, emotional, and social effects, or they may guide clients to consider which benefits and harms are most important to them. DAs make the decision being considered explicit, providing a detailed, specific, and personalized focus on options and outcomes for the purpose of preparing people for decision making” (Stacey et al., 2017).

DAs support health care professionals in transmitting evidence-based information about treatment options and patients in communicating their values and preferences regarding those options (Elwyn et al., 2006; Joseph-Williams et al., 2014).

Gaining consensus among participants through the Nominal Group Technique

What is a Nominal Group Technique ? [1][2][3]

Nominal Group Technique (NGT) is "a structured variation of a small-group discussion to reach consensus"[4] within two hours or less. The guidelines for using the Nominal Group Technique (1998) say that "more ideas are expressed by individuals working alone but in a group environment than by individuals engaged in a formal group discussion." Van de Ven and Delbecq (1972) [5] describe a nominal group as a group in name only. The participants do not interact with each other. This technique is especially effective in groups whose members come from a variety of occupations and backgrounds. Contact between participants is restricted to specific steps in the process, so that individuals have sufficient opportunity to come up with their own ideas.

The NGT original author noted that as the size of a group increases, the participation of the members decreases. Thus, a nominal group generally involves eight to 12 participants and a facilitator, but appropriate size for a group is open to debate. Large groups are divided into smaller groups, each led by a facilitator.

The facilitator describes the process to the participants and leads the discussion but does not try to influence the process or the answers. makes sure that everyone in the group has something to write with and "states the issue or problem as one question".

During the meeting, our team will provide the following questions:

Nominal Group Technique: session 1- Head CT Scan with adults (AM)

Two Questions:

• What changes should be made to the proposed American decision support tool decision in order to adapt it for adult mTBI patients in Canadian EDs?

• What adult patient population should we target to use our decision aid?

Nominal Group Technique: session 2- Head CT Scan with children (PM)

One Question:

• What changes should be made to the proposed American decision aid in order to adapt it for use in the context of pediatric mTBI patients in Canadian EDs?

Eight-step process to conduct NGT

From this starting point, the group goes through the following steps¹:

1. Silent idea generation, in which participants write down their ideas on cards: each individual is asked to write down a certain number of responses.

2. Round-robin sharing of ideas, in which the facilitator asks each individual to give and explain one response at a time and the facilitator notes each idea on a flipchart. This is repeated until all have stated all of their responses.

3. Discussion and clarification, to allow participants to contrast, clarify and justify the ideas on the flipchart without passing judgement on any of the ideas. Everyone in the group should be clear on the meaning of each item. Participants have to ask contributors to further explain if necessary. If the contributors agree some ideas are the same, delete duplication. However, combining of two or more ideas into one should not be done at this time.

4. Ranking the ideas, usually through a point-rating system. Each group member is asked to rank order their top ten alternatives. Ten being the most important. This may be done by having participants write the rank beside the idea directly on the flip chart or by listing the idea on a 3X5 index card and writing their rank in the bottom right corner of the card. The facilitator collects the cards and records each ranking beside the alternative, assuring anonymous rankings. The ranks for each alternative are averaged.

5. Ranked items are discussed. All items receiving a rank are listed so all participants can view. The ranking of each item is designated. (The higher the total, the higher the rank.) The facilitator leads further discussion and clarification of the ranked items to ensure that all participants understand what is meant by each priority.

6. Second Ranking. From among the ranked items on the previous list, each participant ranks the ten items he now considers most important. This is done silently and independently as in previous step. (This ranking might be limited to five items per person.) The rankings are again averaged.

7. Final rankings are discussed. The group reviews the ranking and discusses the outcome of the activity. Then the prioritized list is recorded.

8. Format for sharing results. Create a table listing all ranked items, beginning with the item ranked the highest. Include a column indicating the total votes each item received and the number of persons casting a vote for that item. This mechanism provides closure for the entire process.

[1] The Health Canada Policy Toolkit for Public Involvement in Decision Making: http://www.hc-sc.gc.ca/ahc-asc/pubs/_public-consult/2000decision/index-eng.php#a69

[2] Assessing the Utility of the Nominal Group Technique as a Consensus-Building Tool in Extension-Led Avian Influenza Response Planning: https://www.joe.org/joe/2013october/rb2.php

[3] Nominal group technique: https://psd.ca.uky.edu/files/nominal.pdf

[4] Gaining consensus among stakeholders through the Nominal Group Technique. (Evaluation Briefs, No. 7). (2006). Retrieved from: http://www.cdc.gov/HealthyYouth/evaluation/pdf/brief7.pdf

[5] Van de Ven, A., & Delbecq, A. L. (1972). A group process model for problem identification and program planning. Journal of Applied Behavioral Science, 7, 466-492.

References

Elwyn, G., O'Connor, A., Stacey, D., Volk, R., Edwards, A., Coulter, A., . . . Bernstein, S. (2006). Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. Bmj, 333(7565), 417.

Hess, E. P., Grudzen, C. R., Thomson, R., Raja, A. S., & Carpenter, C. R. (2015). Shared Decision‐making in the Emergency Department: Respecting Patient Autonomy When Seconds Count. Academic Emergency Medicine, 22(7), 856-864.

Joseph-Williams, N., Newcombe, R., Politi, M., Durand, M.-A., Sivell, S., Stacey, D., . . . Bennett, C. (2014). Toward minimum standards for certifying patient decision aids: a modified Delphi consensus process. Medical Decision Making, 34(6), 699-710.

Kunneman, M., Montori, V. M., Castaneda-Guarderas, A., & Hess, E. P. (2016). What Is Shared Decision Making? (and What It Is Not). Acad Emerg Med, 23(12), 1320-1324. doi:10.1111/acem.13065

Sepucha, K. R., Borkhoff, C. M., Lally, J., Levin, C. A., Matlock, D. D., Ng, C. J., . . . Thomson, R. (2013). Establishing the effectiveness of patient decision aids: key constructs and measurement instruments. BMC Med Inform Decis Mak, 13 Suppl 2, S12. doi:10.1186/1472-6947-13-s2-s12

Stacey, D., Legare, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., . . . Trevena, L. (2017). Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev, 4, CD001431. doi:10.1002/14651858.CD001431.pub5

The International Patient Decision Aid Standards (IPDAS) Collaboration. What are patient decision aids? Retrieved from http://ipdas.ohri.ca/what.html

Introduction

1. Patrick Archambault's presentation

Key speakers presentations

1. Dr Melnick, E

2. Dr Hess, E

3. Dr Lang, E

Some important documents to review before the meeting

1. English consent form (please read and sign)

2. Formulaire de consentement en français (svp lire et signer)

3. Pediatric decision aid

4. Adult decision aid

5. Link to Dr Erik Hess video[1]

6. Primer for clinicians (Dr Erik Hess)

7. Journal Articles

a. The evidence base for shared decision making and DAs (O'Connor et al., 2004)

b. SDM in EDs: (Melnick et al., 2016)

c. Development of a decision aid for adults: (Melnick et al., 2015a)

d. Head CT decision aid for parents of children with minor head trauma (Hess et al , 2014)

8. Canadian CT Head Rule

9. Canadian CT Head Rule limitations

10. Canadian CT Head Rule online calculator

11. Alberta Health Services Calculator (Dr Eddy Lang)

12. Choosing Wisely Infographics and presentation (Dr Eddy Lang)

- Memorandum (Emergency Strategic Clinical Network)

- Information Sheet Physicians Choosing Wisely And directions to the Google translate piece

- Information Sheet Nursing Choosing Wisely

- mTBI Patient Storyboard Choosing Wisely

- Dr Eddy Lang Choosing Wisely Presentation

13. Understanding the Head CT scan overuse for minor head injuries (Melnick et al., 2015b)

14. Understanding the Canadian adult Head CT scan rule trial (Curran et al., 2013)

15. For Participants attending by videoconference: Canadian Head CT Patient Decision Aid Consensus Study May 25th Link to Go To Meeting

CTRC Canadian Head Ct Patient Decision Aid consensus Study

jeu. 25 mai 2017 07:30 - 15:30 EDT

Here is the link to access the meeting

https://global.gotomeeting.com/join/831765053

You can also call in (but we suggest that you connect via internet)

Canada: +1 (647) 497-9353

Access code: 831-765-053

First GoToMeeting ? Perform a system test before:https://care.citrixonline.com/g2m/getready

THE CONSENSUS MEETING DAY PROGRAM

THURSDAY, MAY 25, 8 H 30 To 17

LIST OF PARTICIPANTS

TRAVEL

We will leave travel plans up to you to get to Quebec City. We will reimburse the fees incurred in accordance with the Laval University norms (https://www.sf.ulaval.ca/methodesadmin/ch8.html#4) (please keep your boarding passes, invoices and gas receipts).

Parking is free at the hotel. Room rates include access to indoor and outdoor parking for entire stay.

Electric vehicle charging stations are also available.

TRAVEL AROUND QUEBEC CITY

· Bus (Réseau de transport de la Capitale - RTC): http://www.rtcquebec.ca/

· Taxi (Taxi Coop): http://www.taxicoop-quebec.com/

· Tel. : (418) 525-5191

· Taxi Laurier: http://www.taxilaurier.ca/

· Tél. : (418) 651-2727

· Taxi Coop Ste-Foy Sillery: http://www.taxicoopstefoysillery.com/

· Tél. : (418) 653-7777

QUEBEC CITY

Quebec City tourism official web page: http://www.quebecregion.com/

Fun for adults and top tourist attractions:

· Grand Allée (bars and overpriced tourist trap restaurants): http://www.quebecregion.com/en/quebec-city-and-area/grande-allee/

· Better restaurants and less tourist trap: http://www.quebecregion.com/en/shopping-centres-commercial-streets/quartier-des-arts-de-quebec-sdc-montcalm/

Places to eat

· Café du Monde : http://www.lecafedumonde.com/english/home.html?lang=EN - it has a great view of the St-Lawrence Seaway

· Panache (very high end restaurant in Auberge St Antoine hotel): https://saint-antoine.com/en/photos/restaurant-panache/

· Chez Boulay (next to Hotel Victoria): http://chezboulay.com/?lang=en

· Batinses (refined Quebec food): http://batinse.com/

· L’Affaire est Ketchup (in St-Roch area): https://www.facebook.com/laffaireest.ketchup/

· Nina Pizzaria (in St-Roch area): http://ninapizzanapolitaine.ca/

· Café Clocher Penché: http://www.clocherpenche.ca/en (great suppers, but also well known for amazing weekend brunches)

· Le Cercle: http://le-cercle.ca/menu/

Places to have fun with kids

· Museum of Civilisation: https://www.mcq.org/en

· Museum of Fine Arts (they have activities for Children on Saturday and Sunday: https://www.mnbaq.org/en/activities/calendar): https://www.mnbaq.org/en

· Plains of Abraham: http://www.ccbn-nbc.gc.ca/en/

· Promenade Champlain: walking, biking, rollerblading along the St-Lawrence: http://www.capitale.gouv.qc.ca/parcs-et-places-publiques/parcs/promenade-samuel-de-champlain

· Quartier Petit Champlain: http://www.quartierpetitchamplain.com/en/ (walking, shopping, soaking up French culture)

· Aquarium de Québec: http://www.sepaq.com/ct/paq/

· Boat trip and Double Decker tour : http://www.croisieresaml.com/en/plan-your-cruise/quebec/cruise-2-days-hop-on-hop-off-combo/detail/

· Day trip to village of Baie Saint-Paul (one hour drive from Quebec City)

· Day trip to Ile d’Orleans and the Montmorency waterfalls (higher than Niagara Falls AND you can walk across the top!) (20 minutes’ drive outside of Quebec City)

· Day trip to Parc de la Jacques Cartier Provincial Park - Hiking, canoeing (30 min north of Quebec city) : http://www.sepaq.com/pq/jac/

· Day trip to Bora Park (North of Quebec City approx. 40 min): http://www.valcartier.com/fr/parc-aquatique-interieur/

ALT HOTEL

Web page: http://www.althotels.com/en/quebec/

Address: Alt Hotel Quebec, 1200 Germain-Des-Prés Avenue, Quebec (Quebec) G1V 3M7

Phone number: 418 658-1224 Toll-free reservations +1 800 463-5253

Alt Hotel is located approximately 20 minutes from Quebec City's Jean Lesage International Airport and 10 minutes from Quebec City’s train and bus station in Old Quebec.

Taxis are available directly outside the airport exit.

Arrival and departure policies

The arrival time is 3 p.m. and the departure time is 12 p.m. (noon). Except on Sundays when there is no check-out time. Children under 12 years old stay free. Pets are allowed (additional fee of $30 per stay apply).

Cancellation Policy:

Reservations must be cancelled or modified before 4PM, local time, on the arrival date to avoid a penalty charge equivalent to one night plus applicable taxes.

ROOM

ROOM MEETING: SALON GERMAIN

Equipment on site:

● Free Wi-Fi

● Flat-screen TV or projection screen, state-of-the-art technology

● Pens and notepads, flip charts, water

● Catering service