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Mackenzie LJ, Carey ML, Suzuki E, Sanson-Fisher RW, Asada H, Ogura M, D’Este C, Yoshimura M, Toi M. Agreement between patients' and radiation oncologists' cancer diagnosis and prognosis perceptions: A cross sectional study in Japan. PLoS One 2018; 13:e0198437. [PMID: 29883453 PMCID: PMC5993258 DOI: 10.1371/journal.pone.0198437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 05/18/2018] [Indexed: 12/01/2022] Open
Abstract
This study assessed agreement between radiation oncologist- and cancer patient-reported perceptions about cancer diagnosis, time since diagnosis, treatment purpose, and whether life expectancy had been discussed; and described preferences for prognosis discussions. Adult cancer patients receiving radiotherapy at a Japanese hospital were invited to complete a touchscreen tablet survey. Patient survey responses were linked and comparisons made with a survey completed by their radiation oncologist. Among 146 cancer patient-oncologist dyads, there was almost perfect agreement on cancer diagnosis (ĸ = 0.88, 95% CI: 0.82–0.94), substantial agreement on time since diagnosis (ĸ = 0.70, 95% CI: 0.57–0.83) and moderate agreement on whether treatment goal was curative or palliative (ĸ = 0.44, 95% CI: 0.28–0.57; all p’s < 0.0001). Agreement about whether a life expectancy discussion had occurred was less than expected by chance (κ = -0.06, p = 0.9). Radiation oncologists reported that they had spoken to over two thirds of patients about this, whilst less than one third of patients stated that this discussion had occurred with their radiation oncologist. Over half of the patients who had not discussed life expectancy wanted to. Patients had variable preferences for whether they (80%), their radiation oncologist (78%) or their partner/family (52%) should decide whether they discuss their life expectancy. Although patient self-reported information about diagnosis and time since diagnosis appears to be reasonably accurate (compared with clinician-reported information), limitations of self-reported data about prognostic discussions were highlighted by poor agreement between patient- and clinician-reported information about whether prognostic discussions have occurred. Additional support is needed to improve prognosis communication and understanding in radiation oncology settings.
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Affiliation(s)
- Lisa Jane Mackenzie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mariko Leanne Carey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eiji Suzuki
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
| | | | - Hiromi Asada
- Department of Nursing, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Ogura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Acton, Australian Capital Territory, Australia
| | - Michio Yoshimura
- Department of Radiation Oncology and Image Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Toi
- Breast Surgery, Kyoto University Hospital, Kyoto, Japan
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Tsuda S, Nakamura M, Aoki S, Ono H, Takagi M, Ohashi H, Miyachi J, Matsui Y, Ojima T. Impact of Patients' Expressed Wishes on Their Surrogate Decision Makers' Preferred Decision-Making Roles in Japan. J Palliat Med 2018; 21:354-360. [PMID: 29148907 DOI: 10.1089/jpm.2017.0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuji Tsuda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Kikugawa Family Medicine Center, Kikugawa, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | | | | | | | - Junichiro Miyachi
- The Hokkaido Centre for Family Medicine, Hokkaido, Japan
- Center for Medical Education, Kyoto University, Kyoto, Japan
| | | | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Coathup V, Hamakawa N, Finlay T, Bell J, Kaye J, Kato K. Participant-Centric Initiatives and Medical Research: Scoping Review Protocol. JMIR Res Protoc 2017; 6:e245. [PMID: 29233800 PMCID: PMC5743923 DOI: 10.2196/resprot.7407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/30/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background Significant advances in digital technologies have meant that health care data can be collected, stored, transferred, and analyzed for research purposes more easily than ever before. Participant-centric initiatives (PCI) are defined as “tools, programs, and projects that empower participants to engage in the research process” using digital technologies and have the potential to provide a number of benefits to both participants and researchers, including the promotion of public trust in medical research, improved quality of research, increased recruitment and retention, and improved health care delivery. Objective The main objective of this scoping review is to describe the extent and range of PCIs across the United Kingdom, United States, and Japan that are designed to facilitate medical research. Methods The methodological framework described by Levac et al will be applied to this scoping review. We will search electronic databases (MEDLINE, EMBASE, PsychINFO, Cumulative Index to Nursing, and Allied Health Literature and CiNii), grey literature sources, Internet search engines (Google and Bing), and hand search key journals and reference lists of relevant articles. All digital tools and programs will be eligible for inclusion if there is a description of key features and functions that fall within the parameters of a PCI. Only those that play a role in medical research will be included. Results Preliminary searches conducted in MEDLINE and EMBASE retrieved 1820 and 2322 results, respectively. The scoping review will be completed by January 2018. Conclusions The scoping review will be the first to map the extent and range of PCIs currently available across the United Kingdom, United States, and Japan, and will be the first review to contribute to a better understanding of what PCIs patients may benefit from. Researchers and practitioners will be able to use information in this review as a guide for patients and also as a guide for the development of future tools and programs. The results will be disseminated through a peer-reviewed publication and conference presentations.
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Affiliation(s)
- Victoria Coathup
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nao Hamakawa
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Teresa Finlay
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jessica Bell
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kazuto Kato
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Shirazi B, Shekhani SS. Impact of the Word “Cancer”: a Pilot Study on Breast Cancer Patients from Pakistan. Asian Bioeth Rev 2017. [DOI: 10.1007/s41649-017-0017-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yoshizawa G, Sasongko TH, Ho CH, Kato K. Social and Communicative Functions of Informed Consent Forms in East Asia and Beyond. Front Genet 2017; 8:99. [PMID: 28775738 PMCID: PMC5517404 DOI: 10.3389/fgene.2017.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022] Open
Abstract
The recent research and technology development in medical genomics has raised new issues that are profoundly different from those encountered in traditional clinical research for which informed consent was developed. Global initiatives for international collaboration and public participation in genomics research now face an increasing demand for new forms of informed consent which reflect local contexts. This article analyzes informed consent forms (ICFs) for genomic research formulated by four selected research programs and institutes in East Asia – the Medical Genome Science Program in Japan, Universiti Sains Malaysia Human Research Ethics Committee in Malaysia, and the Taiwan Biobank and the Taipei Medical University- Joint Institutional Review Board in Taiwan. The comparative text analysis highlights East Asian contexts as distinct from other regions by identifying communicative and social functions of consent forms. The communicative functions include re-contact options and offering interactive support for research participants, and setting opportunities for family or community engagement in the consent process. This implies that informed consent cannot be validated solely with the completion of a consent form at the initial stage of the research, and informed consent templates can facilitate interactions between researchers and participants through (even before and after) the research process. The social functions consist of informing participants of possible social risks that include genetic discrimination, sample and data sharing, and highlighting the role of ethics committees. Although international ethics harmonization and the subsequent coordination of consent forms may be necessary to maintain the quality and consistency of consent process for data-intensive international research, it is also worth paying more attention to the local values and different settings that exist where research participants are situated for research in medical genomics. More than simply tools to gain consent from research participants, ICFs function rather as a device of social communication between research communities and civic communities in liaison with intermediary agents like ethics committees, genetic counselors, and public biobanks and databases.
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Affiliation(s)
- Go Yoshizawa
- Graduate School of Medicine, Osaka UniversitySuita, Japan
| | - Teguh H Sasongko
- Division of Human Biology, School of Medicine, International Medical UniversityKuala Lumpur, Malaysia.,Human Research Ethics Committee, Universiti Sains Malaysia Health CampusKubang Kerian, Malaysia
| | - Chih-Hsing Ho
- Institute of European and American Studies, Academia SinicaTaipei, Taiwan
| | - Kazuto Kato
- Graduate School of Medicine, Osaka UniversitySuita, Japan
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Vermeir P, Degroote S, Vandijck D, Van Tiggelen H, Peleman R, Verhaeghe R, Mariman A, Vogelaers D. The patient perspective on the effects of medical record accessibility: a systematic review. Acta Clin Belg 2017; 72:186-194. [PMID: 28056665 DOI: 10.1080/17843286.2016.1275375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. RESULTS Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. CONCLUSION From the patient perspective medical record accessibility contributes to co-management of personal health care.
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Affiliation(s)
- Peter Vermeir
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Sophie Degroote
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique Vandijck
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of Patient Safety, Health Economics & Healthcare Innovation, Hasselt University, Agoralaan (building D), 3590 Diepenbeek, Belgium
| | - Hanne Van Tiggelen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Renaat Peleman
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Rik Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Health Sciences, Department of General Internal Medicine, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Reid KI. Informed Consent in Dentistry. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:77-94. [PMID: 28661282 DOI: 10.1177/1073110517703102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A review of literature regarding informed consent in dentistry reveals a paucity of information and minimal scholarship devoted to this subject. But this begs the question about informed consent somehow being different for dentistry than for medicine or other healthcare delivery. My account draws distinctions where appropriate but is rooted in the premise that informed consent is an ethical construct applicable to vulnerable people as patients independent of what type of treatment or body part being considered. This paper highlights the crucial importance of the process of informed consent and refusal in dentistry, underscoring its important place in oral healthcare. This paper will not address the unique circumstances involving consent in those without capacity or focus on informed consent in the research setting; our focus will be on those patients with full decisionmaking capacity in the clinical setting. I will emphasize the importance of disclosure of treatment options and highlight the benefits of shared-decision-making in the informed consent process.
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Affiliation(s)
- Kevin I Reid
- Kevin I. Reid, D.M.D., M.S., M.A., is a Consultant in Orofacial Pain and Chair of the Program in Pain and Ethics at the Mayo Clinic in Rochester Minnesota
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58
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Hamasaki T, Kato H, Kumagai T, Hagihara A. Association Between Dentist-Dental Hygienist Communication and Dental Treatment Outcomes. HEALTH COMMUNICATION 2017; 32:288-297. [PMID: 27223581 DOI: 10.1080/10410236.2016.1138376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist-dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist-dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist-dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist-dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.
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Affiliation(s)
- Tomoko Hamasaki
- a Department of Nutrition Faculty of Home Economics , Kyushu Women's University , Japan
| | | | | | - Akihito Hagihara
- d Department of Health Services Management and Policy , Kyushu University Graduate School of Medicine
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Yek JLJ, Lee AKY, Tan JAD, Lin GY, Thamotharampillai T, Abdullah HR. Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore. BMC Med Ethics 2017; 18:6. [PMID: 28148256 PMCID: PMC5288849 DOI: 10.1186/s12910-017-0172-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. METHODS A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. RESULTS Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education (p < 0.007), being employed (p < 0.046) and younger age group (p < 0.003) are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea (64.8%), Drowsiness (62.4%) and Surgical Wound Pain (58.8%). Patients ranked Heart Attack (59.3%), Death (53.8%) and Stroke (52.7%) as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist (52.2%), instead of letting the doctor decide (37.1%) or deciding for themselves (10.7%). Discussion with the anaesthetist (61.3%) is the preferred medium of communication compared to reading a pamphlet (23.4%) or watching a video (15.4%). CONCLUSION Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.
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Affiliation(s)
- J L J Yek
- Department of Anaesthesiology, Singapore General Hospital, Singapore, 169608, Singapore
| | - A K Y Lee
- Department of Anaesthesiology, Singapore General Hospital, Singapore, 169608, Singapore
| | - J A D Tan
- Duke-NUS Medical School, Singapore, 169608, Singapore
| | - G Y Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - T Thamotharampillai
- Department of Dermatology, Singapore General Hospital, Singapore, 169608, Singapore.,Centre for Medical Ethics and Professionalism, Singapore Medical Association, Singapore, 169850, Singapore
| | - H R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore, 169608, Singapore. .,Centre for Medical Ethics and Professionalism, Singapore Medical Association, Singapore, 169850, Singapore.
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60
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Aho-Özhan HEA, Böhm S, Keller J, Dorst J, Uttner I, Ludolph AC, Lulé D. Experience matters: neurologists' perspectives on ALS patients' well-being. J Neurol 2017; 264:639-646. [PMID: 28120043 DOI: 10.1007/s00415-016-8382-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022]
Abstract
Despite the fatal outcome and progressive loss of physical functioning in amyotrophic lateral sclerosis (ALS), many patients maintain contentment in life. It has been shown that non-professionals tend to underestimate the well-being of patients with ALS, but professionals' perspective is yet to be studied. In total, 105 neurologists with varying degrees of experience with ALS were included in an anonymous survey. They were asked to estimate the quality of life and depressiveness of ALS patients with artificial ventilation and nutrition. Physicians' estimations were compared with previously reported subjective ratings of ALS patients with life-prolonging measures. Neurologists with significant experience on ALS and palliative care were able to accurately estimate depressiveness and quality of life of ALS patients with life-prolonging measures. Less experienced neurologists' estimation differed more from patients' reports. Of all life-prolonging measures neurologists regarded invasive ventilation as the measure associated with lowest quality of life and highest depressiveness of the patients. Experienced neurologists as well as neurologists with experience in palliative care are able to better empathize with patients with a fatal illness such as ALS and support important decision processes.
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Affiliation(s)
- Helena E A Aho-Özhan
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Böhm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jürgen Keller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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Specker Sullivan L. Dynamic axes of informed consent in Japan. Soc Sci Med 2016; 174:159-168. [PMID: 28043018 DOI: 10.1016/j.socscimed.2016.12.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
Scholarship in cross-cultural bioethics routinely frames Japanese informed consent in contrast to informed consent in North America. This contrastive analysis foregrounds cancer diagnosis disclosure and physician paternalism as unique aspects of Japanese informed consent that deviate from American practices. Drawing on in-depth interviews with 15 Japanese medical professionals obtained during fieldwork in Japan from 2013 to 15, this article complicates the informed consent discourse beyond East-West comparisons premised on Anglo-American ethical frameworks. It expands professional perspectives to include nurses, medical social workers, clinical psychologists, and ethicists and it addresses informed consent for a broad range of conditions in addition to cancer. The results suggest that division of affective labor is an under-theorized dimension of informed consent that is perceived as at odds with principled demands for universal informed consent. These practical tensions are conceptualized as cultural differences, with Japan identified in terms of omakase as practical and supportive and the United States identified in terms of jiko kettei as principled and self-determining. These results have implications for the methodology of cross-cultural bioethics as well as for theories and practices of informed consent in both Japan and the United States. I conclude that responsible cross-cultural work in bioethics must begin from the ground up, incorporating all relevant stakeholder perspectives, attitudes, and experiences.
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Affiliation(s)
- Laura Specker Sullivan
- University of Washington, Box 37, 1414 NE 42nd Street, Seattle, WA 98105-6271, United States; Department of Philosophy, University of Washington, Seattle, WA, United States; University of British Columbia, Canada.
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Shaku F, Tsutsumi M. The Effect of Providing Life Support on Nurses’ Decision Making Regarding Life Support for Themselves and Family Members in Japan. Am J Hosp Palliat Care 2016; 33:917-923. [DOI: 10.1177/1049909115624655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Decision making in terminal illness has recently received increased attention. In Japan, patients and their families typically make decisions without understanding either the severity of illness or the efficacy of life-supporting treatments at the end of life. Japanese culture traditionally directs the family to make decisions for the patient. This descriptive study examined the influence of the experiences of 391 Japanese nurses caring for dying patients and family members and how that experience changed their decision making for themselves and their family members. The results were mixed but generally supported the idea that the more experience nurses have in caring for the dying, the less likely they would choose to institute lifesupport measures for themselves and family members. The results have implications for discussions on end-of-life care.
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Affiliation(s)
- Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Madoka Tsutsumi
- Primary Care and Medical Education, University of Tsukuba, Ibaraki, Japan
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63
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Diouf NT, Menear M, Robitaille H, Painchaud Guérard G, Légaré F. Training health professionals in shared decision making: Update of an international environmental scan. PATIENT EDUCATION AND COUNSELING 2016; 99:1753-1758. [PMID: 27353259 DOI: 10.1016/j.pec.2016.06.008] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/18/2016] [Accepted: 06/12/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To update an environmental scan of training programs in SDM for health professionals. METHODS We searched two systematic reviews for SDM training programs targeting health professionals produced from 2011 to 2015, and also in Google and social networks. With a standardized data extraction sheet, one reviewer extracted program characteristics. All completed extraction forms were validated by a second reviewer. RESULTS We found 94 new eligible programs in four new countries and two new languages, for a total of 148 programs produced from 1996 to 2015-an increase of 174% in four years. The largest percentage appeared since 2012 (45.27%). Of the 94 newprograms, 42.55% targeted licensed health professionals (n=40), 8.51% targeted pre-licensure (n=8), 28.72% targeted both (n=27), 20.21% did not specify (n=19), and 5.32% targeted also patients (n=5). Only 23.40% of the new programs were reported as evaluated, and 21.28% had published evaluations. CONCLUSIONS Production of SDM training programs is growing fast worldwide. Like the original scan, this update indicates that SDM training programs still vary widely. Most still focus on the single provider/patient dyad and few are evaluated. PRACTICE IMPLICATIONS This update highlights the need to adapt training programs to interprofessional practice and to evaluate them.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Matthew Menear
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Geneviève Painchaud Guérard
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada.
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Ryu JY, Bae H, Kenji H, Xiaomei Z, Kwon I, Ahn KJ. Physicians' attitude toward the withdrawal of life-sustaining treatment: A comparison between Korea, Japan, and China. DEATH STUDIES 2016; 40:630-637. [PMID: 27572742 DOI: 10.1080/07481187.2016.1203375] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians' perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status.
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Affiliation(s)
- Ji Yeong Ryu
- a Department of Emergency Medicine , Hallym University Medical Center, Kangdong Sacred Heart Hospital , Seoul , Korea
| | - Hyuna Bae
- b School of Law, Ewha Womans University , Seoul , Korea
| | - Hattori Kenji
- c Graduate School of Medicine, Gunma University , Gunma , Japan
| | - Zhai Xiaomei
- d Research Center for Bioethics, Peking Union Medical College, Chinese Academy of Medical Sciences , Beijing , China
| | - Ivo Kwon
- e School of Medicine, Ewha Womans University , Seoul , Korea
| | - Kyong Jin Ahn
- f Interdisciplinary Program in Bioethics Policy Studies , Ewha Womans University , Seoul , Korea
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Loewenbrück KF, Wach D, Müller SR, Youngner SJ, Burant CJ. Disclosure of adverse outcomes in medicine: A questionnaire study on voice intention and behaviour of physicians in Germany, Japan and the USA. GERMAN JOURNAL OF HUMAN RESOURCE MANAGEMENT-ZEITSCHRIFT FUR PERSONALFORSCHUNG 2016. [DOI: 10.1177/2397002216649858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study contributes to a better understanding of the determinants of voice expressed by physicians in different cultural settings. Voice, captured as disclosure of adverse outcomes and medical errors, is regarded as important for the reduction of the high rate of adverse events in medicine as compared to other high-risk professions. Within a cross-sectional, cross-cultural questionnaire study we explored the impact of selected individual, situational and organisational determinants for disclosure intention, and the behaviour of 251 physicians at three university hospitals in Germany, Japan and the USA. We found disclosure intention to be the lowest in Japan, while no cross-cultural differences existed for disclosure behaviour. Logistic regression analyses showed that culture moderated the effect of disclosure intention on behaviour. Only in Japan was disclosure behaviour a function of the level of disclosure intention. A written mistake disclosure policy encouraged voice behaviour, while internal attribution of medical errors and paternalism discouraged it.
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Abstract
Reflections on my experience of conducting research in Botswana are used to highlight tensions and conflicts that arise from adhering to the western conceptualization of bioethics and the need to be culturally sensitive when carrying out research in one's own culture. Cultural practices required the need to exercise discretionary judgement guided by respect for the culture and decision-making protocols of the research participants. Ethical challenges that arose are discussed. The brokerage role of nurse educators and leaders in contextualizing western bioethics is emphasized.
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Affiliation(s)
- Sheila Shaibu
- University of Botswana, Department of Nursing, Private Bag 00702, Gaborone, Botswana.
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Abstract
This article presents the results of a qualitative study on the ethical aspects of inclusion practice for radiotherapy patients taking part in clinical research. The study focused on the standards and values of this process. Patients and physicians were interviewed about their views and experiences. Analysis of these interviews showed that candidate research participants need better protection from unwanted factors that could influence their choice about participation. Researchers need proper education about regulation, codes and directives in the field of research ethics, and they should be aware of the underlying ethical concepts of these regulations. A sound institutional ethics policy is necessary in order to guide medical staff in decisions about the inclusion of patients in trials.
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Affiliation(s)
- Patricia Jaspers
- Department of Health Ethics and Philosophy, Faculty of Heath Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Hagihara A, Odamaki M, Nobutomo K, Tarumi K. Physician and Patient Perceptions of the Physician Explanations in Medical Encounters. J Health Psychol 2016; 11:91-105. [PMID: 16314383 DOI: 10.1177/1359105306058852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although, in actual practice, physicians have to subjectively judge the level of the explanation that they provide, little is known about this judgment. Therefore, making use of 630 physician-patient pairs in Japan, we investigated the association between patient and physician evaluations of physician explanations of medical test results and diagnoses. We found that the physician’s judgment does not always agree with that of the patient, with regard to the level of explanation necessary. In addition, we first identified factors relating to the accuracy of physician judgments with regard to their explanations to patients. More studies will be necessary to verify the present findings.
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Affiliation(s)
- Akihito Hagihara
- Department of Health Services Management and Policy, Kyushu University, Japan.
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Abstract
In 2003, the first 3-way living kidney donor-swap was performed at Johns Hopkins Hospital in Baltimore, Md. Three new donor protocols including paired donation now allow unrelated individuals to serve as donors. Some ethicists have suggested that emotionally unrelated individuals not be permitted to donate because they will not experience the same satisfaction that a family member who is a donor experiences. Others who frame living donation as an autonomous choice do not see emotionally unrelated or even nondirected donation as ethically problematic. This article uses an ethical framework of principlism to examine living donation. Principles salient to living donation include autonomy, beneficence, and nonmaleficence. The following criteria are used to evaluate autonomous decision making by living donors, including choices made (1) with understanding, (2) without influence that controls and determines their action, and (3) with intentionality. Empirical work in these areas is encouraged to inform the ethical analysis of the new living donor protocols.
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Rot I, Wassersug RJ, Walker LM. What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product. Transl Androl Urol 2016; 5:235-47. [PMID: 27141453 PMCID: PMC4837317 DOI: 10.21037/tau.2016.03.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education. Methods International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product). Results No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists. Conclusions ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.
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Affiliation(s)
- Irena Rot
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Richard J Wassersug
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lauren M Walker
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Huang B, Chen H, Deng Y, Yi T, Wang Y, Jiang Y. Diagnosis, disease stage, and distress of Chinese cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:73. [PMID: 27004220 DOI: 10.3978/j.issn.2305-5839.2016.02.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective is to assess how cancer patients know about their diagnosis what they know about their real stage, and the relationship between cancer stage and psychological distress. METHODS A questionnaire including the Distress Thermometer was delivered to 422 cancer inpatients. Multivariate logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Most of patients (68.7%) knew the bad news immediately after diagnosis. Half of patients knew their diagnosis directly from medical reports. Nearly one third of patients were informed by doctors. Cancer stages, which patients believed, differed significantly from their real disease stages (P<0.001). Over half of patients did not know their real disease stages. Patients with stage I-III cancer were more likely to know their real disease stage than patients with stage IV cancer (P<0.001). Distress scores of cancer patients were determined by the real cancer stage (P=0.012), not the stage which patients believed. CONCLUSIONS Although most of participants knew the bad news immediately after diagnosis, less than half of them knew their real disease stage. Patient with stage I-III cancer was more likely to know the real disease stage and had a DT score <4 than patient with stage IV disease.
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Affiliation(s)
- Boyan Huang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Huiping Chen
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yaotiao Deng
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Tingwu Yi
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yuqing Wang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Jiang
- 1 Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China ; 2 Department of Medical Oncology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China ; 3 Department of Palliative Medicine, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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McCarthy SA, Jenn NC, Leng CCK, Hamzah E. What are the experiences and needs of patients and carers receiving community palliative care in Malaysia? A qualitative study. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1179/1743291x14y.0000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mole TB, Begum H, Cooper-Moss N, Wheelhouse R, MacKeith P, Sanders T, Wass V. Limits of 'patient-centredness': valuing contextually specific communication patterns. MEDICAL EDUCATION 2016; 50:359-369. [PMID: 26896021 DOI: 10.1111/medu.12946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/20/2015] [Accepted: 09/24/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT Globally, doctor-patient communication is becoming synonymous with high-quality health care in the 21st century. However, what is meant by 'good communication' and whether there is consensus internationally remain unclear. OBJECTIVES Here, we characterise understandings of 'good communication' in future doctors from medical schools in three contextually contrasting continents. Given locally specific socio-cultural influences, we hypothesised that there would be a lack of global consensus on what constitutes 'good communication'. METHODS A standardised two-phase methodology was applied in turn to each of three medical schools in the UK, Egypt and India (n = 107 subjects), respectively, in which students were asked: 'What is good communication?' Phase I involved exploratory focus groups to define preliminary themes (mean number of participants per site: 17). Phase II involved thematic confirmation and expansion in one-to-one semi-structured interviews (mean number of participants per site: 18; mean hours of dialogue captured per site: 55). Findings were triangulated and analysed using grounded theory. RESULTS The overarching theme that emerged from medical students was that 'good communication' requires adherence to certain 'rules of communication'. A shared rule that doctors must communicate effectively despite perceived disempowerment emerged across all sites. However, contradictory culturally specific rules about communication were identified in relation to three major domains: family; gender, and emotional expression. Egyptian students perceived emotional aspects of Western doctors' communication strikingly negatively, viewing these doctors as problematically cold and unresponsive. CONCLUSIONS Contradictory perceptions of 'good communication' in future doctors are found cross-continentally and may contribute to prevalent cultural misunderstandings in medicine. The lack of global consensus on what defines good communication challenges prescriptively taught Western 'patient-centredness' and questions assumptions about international transferability. Health care professionals must be educated openly about flexible, context-specific communication patterns so that they can avoid cultural incompetence and tailor behaviours in ways that optimise therapeutic outcomes wherever they work around the globe.
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Affiliation(s)
- Tom B Mole
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Hasna Begum
- Department of Primary Care, School of Primary Care, Health Education Yorkshire and the Humber, University of Leeds, Leeds, UK
| | - Nicola Cooper-Moss
- Department of Primary Care, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rebecca Wheelhouse
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
| | - Pieter MacKeith
- Department of Primary Care, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Tom Sanders
- Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Valerie Wass
- Department of Medical Education, Faculty of Health, Keele University, Keele, UK
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Obeidat R, Khrais HI. Jordanian Physicians' Attitudes toward Disclosure of Cancer Information and Patient Participation in Treatment Decision-making. Asia Pac J Oncol Nurs 2016; 3:281-288. [PMID: 27981172 PMCID: PMC5123513 DOI: 10.4103/2347-5625.189811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making. METHODS A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians' views of shared decision making. RESULTS Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians' usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians' comfort level with the shared approach. CONCLUSIONS Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.
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Affiliation(s)
- Rana Obeidat
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
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Lee YK, Lee PY, Cheong AT, Ng CJ, Abdullah KL, Ong TA, Razack AHA. To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles. PLoS One 2015; 10:e0142812. [PMID: 26559947 PMCID: PMC4641697 DOI: 10.1371/journal.pone.0142812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022] Open
Abstract
Aim To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment. Methods Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture. Conclusions A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa.
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Affiliation(s)
- Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
- * E-mail:
| | - Ai Theng Cheong
- Department of Family Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T. A National Survey to Systematically Identify Factors Associated With Oncologists' Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions? Oncologist 2015; 20:1304-11. [PMID: 26446232 DOI: 10.1634/theoncologist.2015-0147] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND End-of-life discussions (EOLds) occur infrequently until cancer patients become terminally ill. METHODS To identify factors associated with the timing of EOLds, we conducted a nationwide survey of 864 medical oncologists. We surveyed the timing of EOLds held with advanced cancer patients regarding prognosis, hospice, site of death, and do-not-resuscitate (DNR) status; and we surveyed physicians' experience of EOLds, perceptions of a good death, and beliefs regarding these issues. Multivariate analyses identified determinants of early discussions. RESULTS Among 490 physicians (response rate: 57%), 165 (34%), 65 (14%), 47 (9.8%), and 20 (4.2%) would discuss prognosis, hospice, site of death, and DNR status, respectively, "now" (i.e., at diagnosis) with a hypothetical patient with newly diagnosed metastatic cancer. In multivariate analyses, determinants of discussing prognosis "now" included the physician perceiving greater importance of autonomy in experiencing a good death (odds ratio [OR]: 1.34; p = .014), less perceived difficulty estimating the prognosis (OR: 0.77; p = .012), and being a hematologist (OR: 1.68; p = .016). Determinants of discussing hospice "now" included the physician perceiving greater importance of life completion in experiencing a good death (OR: 1.58; p = .018), less discomfort talking about death (OR: 0.67; p = .002), and no responsibility as treating physician at end of life (OR: 1.94; p = .031). Determinants of discussing site of death "now" included the physician perceiving greater importance of life completion in experiencing a good death (OR: 1.83; p = .008) and less discomfort talking about death (OR: 0.74; p = .034). The determinant of discussing DNR status "now" was less discomfort talking about death (OR: 0.49; p = .003). CONCLUSION Reflection by oncologists on their own values regarding a good death, knowledge about validated prognostic measures, and learning skills to manage discomfort talking about death is helpful for oncologists to perform appropriate EOLds. IMPLICATIONS FOR PRACTICE Oncologists' own perceptions about what is important for a "good death," perceived difficulty in estimating the prognosis, and discomfort in talking about death influence their attitudes toward end-of-life discussions. Reflection on their own values regarding a good death, knowledge about validated prognostic measures, and learning skills to manage discomfort talking about death are important for improving oncologists' skills in facilitating end-of-life discussions.
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Affiliation(s)
- Masanori Mori
- Department of Palliative Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Asao Ogawa
- Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Saran Yoshida
- Center for Cancer Control and Information Services, National Cancer Center Hospital, Chuo-ku, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Cheng SY, Suh SY, Morita T, Oyama Y, Chiu TY, Koh SJ, Kim HS, Hwang SJ, Yoshie T, Tsuneto S. A Cross-Cultural Study on Behaviors When Death Is Approaching in East Asian Countries: What Are the Physician-Perceived Common Beliefs and Practices? Medicine (Baltimore) 2015; 94:e1573. [PMID: 26426631 PMCID: PMC4616852 DOI: 10.1097/md.0000000000001573] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The primary aim of this study was to explore common beliefs and practices when death is approaching in East-Asian countries. A cross-sectional survey was performed involving palliative care physicians in Japan, Korea, and Taiwan. Measurement outcomes were physician-perceived frequencies of the following when patient death was approaching: (1) reluctance to take part in end-of-life discussions, (2) role of family members, (3) home death, and (4) circumstances surrounding death. A total of 505, 211, and 207 responses were obtained from Japanese, Korea, and Taiwan physicians, respectively. While 50% of the Japanese physicians reported that they often or very often experienced families as being reluctant to discuss end-of-life issues, the corresponding figures were 59% in Korea and 70% in Taiwan. Two specific reasons to avoid end-of-life discussion, "bad things happen after you say them out loud" and "a bad life is better than a good death" were significantly more frequently observed in Taiwan. Prioritizing the oldest of the family in breaking bad news and having all family members present at the time of death were significantly more frequently observed in Korea and Taiwan. Half of Taiwanese physicians reported they often or very often experienced the patients/family wanted to go back home to die because the soul would not be able to return from the hospital. In all countries, more than 70% of the physicians reported certain family members were expected to care for the patient at home. At the time of death, while no Japanese physicians stated that they often experienced patients wanted a religious person to visit, the corresponding figure in Korean and Taiwan was about 40%. Uncovered expression of emotion was significantly frequently observed in Korean and Taiwan, and 42% of the Japanese physicians reported family members cleaned the dead body of the patient themselves. There seem to be significant intercountry differences in beliefs and practices when death is approaching in East Asian countries. Future studies on direct observations of patients and families are needed.
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Affiliation(s)
- Shao-Yi Cheng
- From the Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan (SYC), Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, South Korea (S-YS), Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Japan (TM), Division of Clinical Psychology, Kyoto University, Kyoto, Japan (YO), Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan (T-YC), Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea (SJK), Department of Social Welfare, Korea National University of Transportation, Chungju City, South Korea (HSK), Department of Family Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan (S-JH), Graduate School of Education, Kyoto University, Kyoto, Japan (TY), Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan (ST)
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Christodoulou G, Goetz R, Ogino M, Mitsumoto H, Rabkin J. Opinions of Japanese and American ALS caregivers regarding tracheostomy with invasive ventilation (TIV). Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:47-54. [PMID: 26343785 DOI: 10.3109/21678421.2015.1069850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Our objective was to learn more about possible factors contributing to the higher rates of tracheostomy with invasive ventilation (TIV) for ALS patients in Japan compared with the United States by eliciting attitudes of caregivers of ALS patients in both countries. One hundred and fifty-four American caregivers from five, geographically-distributed ALS clinics and 66 Japanese caregivers from six sites in Japan completed questionnaires regarding TIV. Results showed that 33% of American caregivers were in favor of TIV for their family member compared to 53% of Japanese caregivers; 44% of American and 37% of Japanese caregivers were undecided; and 22% of American and 10% of Japanese caregivers were opposed (p <.01). Within patient-caregiver dyads, agreement in the American sample was fair, while the Japanese dyads showed poor agreement. Maintaining quality of life and patients reaching a milestone were the most common reasons for favoring TIV in the American and Japanese samples, respectively. Reasons for opposing TIV did not significantly differ. Findings suggest that caregiver preferences may influence actual choices for ALS patients. More frequent endorsement of TIV by Japanese vs. American caregivers is consistent with higher rates of TIV among Japanese patients. The results reflect the importance of caregivers' opinions in patient care.
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Affiliation(s)
| | - Raymond Goetz
- b New York State Psychiatric Institute and Department of Psychiatry , Columbia University , New York , USA
| | - Mieko Ogino
- c Department of Neurology , Kitasato University School of Medicine , Kanagawa , Japan
| | - Hiroshi Mitsumoto
- a Department of Neurology , Columbia University Medical Center , New York , USA
| | - Judith Rabkin
- b New York State Psychiatric Institute and Department of Psychiatry , Columbia University , New York , USA
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Morita T, Oyama Y, Cheng SY, Suh SY, Koh SJ, Kim HS, Chiu TY, Hwang SJ, Shirado A, Tsuneto S. Palliative Care Physicians' Attitudes Toward Patient Autonomy and a Good Death in East Asian Countries. J Pain Symptom Manage 2015; 50:190-9.e1. [PMID: 25827851 DOI: 10.1016/j.jpainsymman.2015.02.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/30/2015] [Accepted: 02/14/2015] [Indexed: 11/20/2022]
Abstract
CONTEXT Clarification of the potential differences in end-of-life care among East Asian countries is necessary to provide palliative care that is individualized for each patient. OBJECTIVES The aim was to explore the differences in attitude toward patient autonomy and a good death among East Asian palliative care physicians. METHODS A cross-sectional survey was performed involving palliative care physicians in Japan, Taiwan, and Korea. Physicians' attitudes toward patient autonomy and physician-perceived good death were assessed. RESULTS A total of 505, 207, and 211 responses were obtained from Japanese, Taiwanese, and Korean physicians, respectively. Japanese (82%) and Taiwanese (93%) physicians were significantly more likely to agree that the patient should be informed first of a serious medical condition than Korean physicians (74%). Moreover, 41% and 49% of Korean and Taiwanese physicians agreed that the family should be told first, respectively; whereas 7.4% of Japanese physicians agreed. Physicians' attitudes with respect to patient autonomy were significantly correlated with the country (Japan), male sex, physician specialties of surgery and oncology, longer clinical experience, and physicians having no religion but a specific philosophy. In all 12 components of a good death, there were significant differences by country. Japanese physicians regarded physical comfort and autonomy as significantly more important and regarded preparation, religion, not being a burden to others, receiving maximum treatment, and dying at home as less important. Taiwanese physicians regarded life completion and being free from tubes and machines as significantly more important. Korean physicians regarded being cognitively intact as significantly more important. CONCLUSION There are considerable intercountry differences in physicians' attitudes toward autonomy and physician-perceived good death. East Asia is not culturally the same; thus, palliative care should be provided in a culturally acceptable manner for each country.
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Affiliation(s)
- Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.
| | - Yasuhiro Oyama
- Division of Clinical Psychology, Kyoto University, Kyoto, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, South Korea
| | - Su Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Sook Kim
- Department of Social Welfare, Korea National University of Transportation, Chungju City, South Korea
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Akemi Shirado
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - Satoru Tsuneto
- Department of Multidisciplinary Cancer Treatment, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACTDecision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.
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Abstract
The author summarizes emerging standards for informed consent as the underpinning of ethical research in humans.
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Yamauchi H, Nakagawa C, Yamashige S, Takei H, Yagata H, Yoshida A, Hayashi N, Hornberger J, Yu T, Chao C, Yoshizawa C, Nakamura S. Societal cost-effectiveness analysis of the 21-gene assay in estrogen-receptor-positive, lymph-node-negative early-stage breast cancer in Japan. BMC Health Serv Res 2014; 14:372. [PMID: 25190451 PMCID: PMC4165904 DOI: 10.1186/1472-6963-14-372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 08/29/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Breast-cancer incidence and mortality have been increasing in Japan. Japanese-specific clinical validity and utility data for the 21-gene assay (Oncotype DX® Breast Cancer Assay; Genomic Health, Inc., Redwood City, USA) are now available. The objective of this study was to evaluate the cost-effectiveness of the 21-gene assay for the guidance of adjuvant chemotherapy decisions in estrogen-receptor-positive, lymph-node-negative, early-stage breast cancer patients, from the Japanese societal perspective. METHODS The recurrence risk group distribution by the 21-gene assay result and the assay's influence on adjuvant chemotherapy recommendations were obtained from a study of 104 patients. A state-transition cohort (Markov) model tracked time from surgery until distant recurrence and from distant recurrence to death. Adjuvant chemotherapy benefit by 21-gene assay risk group was based on published clinical validation studies. Direct and indirect medical costs were obtained from the referral centers. Utilities associated with progression and chemotherapy-related adverse events were extracted from literature. Sensitivity analyses assessed the key drivers and robustness of the primary outcomes. RESULTS The 21-gene assay identified 48% of patients as low-risk, 36% as intermediate-risk, and 16% as high-risk. Total acute chemotherapy-related costs decreased by ¥154,066 due to less adjuvant chemotherapy usage. In the high-risk group, adjuvant chemotherapy use increased 18%, leading to survival benefits. Chemotherapy use overall decreased by 19%. Monitoring costs increased by ¥3,744 but recurrence costs declined by ¥46,113 per patient. Use of the 21-gene assay increased quality-adjusted-life-years (QALYs) by 0.241 per patient on average; the net cost per QALY gained was ¥636,752 ($6,368). CONCLUSIONS The 21-gene assay for women with estrogen-receptor-positive, lymph-node-negative, early-stage breast cancer is projected to be cost-effective in Japan.
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Affiliation(s)
- Hideko Yamauchi
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
| | - Chizuko Nakagawa
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
| | - Shinji Yamashige
- />Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
| | - Hiroyuki Takei
- />Division of Breast Surgery, Saitama Cancer Center, Saitama, Japan
| | - Hiroshi Yagata
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
| | - Atsushi Yoshida
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
| | - Naoki Hayashi
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
| | - John Hornberger
- />Cedar Associates LLC, Menlo Park, CA USA
- />School of Medicine, Stanford University, Stanford, CA USA
| | - Tiffany Yu
- />Cedar Associates LLC, Menlo Park, CA USA
| | | | | | - Seigo Nakamura
- />Department of Breast Surgery, St. Luke’s International Hospitalcph, Tokyo, Japan
- />Department of Breast Surgery, Showa University, Tokyo, Japan
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Shin DW, Cho J, Kim SY, Chung IJ, Kim SS, Yang HK, Ahn E, Park BR, Seo H, Park JH. Discordance among patient preferences, caregiver preferences, and caregiver predictions of patient preferences regarding disclosure of terminal status and end-of-life choices. Psychooncology 2014; 24:212-9. [PMID: 25099223 DOI: 10.1002/pon.3631] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 05/31/2014] [Accepted: 07/04/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND The complexity of end-of-life (EOL) communication in cancer care is often increased by family caregivers, who frequently affect the information and decision-making process. We assessed cancer patient preferences (PP), family caregiver preferences (FCP), and family caregiver predictions of patient preferences (FCPPP) regarding the disclosure of terminal status, family involvement in the disclosure process, and EOL choices, and we evaluated the concordances among them. METHODS A national, multicenter, cross-sectional survey of 990 patient-caregiver dyads (participation rate = 76.2%) was performed. A set of paired questionnaires was independently administered to patients and their caregivers. RESULTS While patients and family caregivers had wide spectra of preferences, patients significantly preferred disclosure, direct disclosure by a physician, and palliative care options (all P < 0.001). Family caregiver predictions were similar to PP with regard to terminal disclosure (P = 0.35) but significantly different with regard to family involvement in the disclosure process and EOL choices (P < 0.001). The concordances of PP and FCP (κ = 0.08-0.13), and those of PP and FCPPP (κ = 0.09-0.17), were poor. The concordances of FCP and FCPPP were fair to moderate (κ = 0.35-0.67). Discrepancies between PP and FCP and between PP and FCPPP were associated with dysfunctional family communication. CONCLUSIONS Family caregivers do not generally concur with patients in their preferences, nor do they reliably predict PP. Open dialogue between patient and family caregivers would reduce the discrepancy. More emphasis on incorporating family caregivers in EOL communication is needed from clinical, research, and training perspectives.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea; Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea
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Yoshida S, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y, Dotani C, Nakahara R, Takahashi T, Kato M. Barriers of Healthcare Providers Against End-of-life Discussions with Pediatric Cancer Patients. Jpn J Clin Oncol 2014; 44:729-35. [DOI: 10.1093/jjco/hyu077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Nagao N, Kadooka Y, Asai A. Comparison of ethical judgments exhibited by clients and ethics consultants in Japan. BMC Med Ethics 2014; 15:19. [PMID: 24592932 PMCID: PMC3975850 DOI: 10.1186/1472-6939-15-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. Methods The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. Results As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of “uncertain decisional capacity,” and 23 cases (38.3%) of “withholding of decision-making.” A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants’ reasoning was based on “patient’s preference was ambiguous,” “validity of family as a surrogate,” “estimation of patient preference,” and “patient’s best interest,” whereas the CEC client’s reasoning was based on “consistent family preference was shown/not shown” and “appropriate therapeutic methods to manage patient safety.” Conclusion Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic.
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Affiliation(s)
- Noriko Nagao
- Department of Nursing, Kobe University Graduate School of Health Sciences 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan.
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Richards M, Hori H, Sartorius N, Kunugi H. Cross-cultural comparisons of attitudes toward schizophrenia amongst the general population and physicians: a series of web-based surveys in Japan and the United States. Psychiatry Res 2014; 215:300-7. [PMID: 24374117 DOI: 10.1016/j.psychres.2013.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/19/2013] [Accepted: 12/04/2013] [Indexed: 12/23/2022]
Abstract
Cross-cultural differences in attitudes toward schizophrenia are suggested, while no studies have compared such attitudes between the United States and Japan. In our previous study in Japan (Hori et al., 2011), 197 subjects in the general population and 112 physicians (excluding psychiatrists) enrolled in a web-based survey using an Internet-based questionnaire format. Utilizing the identical web-based survey method in the United States, the present study enrolled 172 subjects in the general population and 45 physicians. Participants' attitudes toward schizophrenia were assessed with the English version of the 18-item questionnaire used in our previous Japanese survey. Using exploratory factor analysis, we identified four factors labeled "social distance," "belief of dangerousness," "underestimation of patients' abilities," and "skepticism regarding treatment." The two-way multivariate analysis of covariance on the four factors, with country and occupation as the between-subject factors and with potentially confounding demographic variables as the covariates, revealed that the general population in the US scored significantly lower than the Japanese counterparts on the factors "social distance" and "skepticism regarding treatment" and higher on "underestimation of patients' abilities." Our results suggest that culture may have an important role in shaping attitudes toward mental illness. Anti-stigma campaigns that target culture-specific biases are considered important.
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Affiliation(s)
- Misty Richards
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan; Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles (UCLA), Los Angeles, CA 90024, USA; Fulbright Foundation, New York, NY 10025, USA
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan.
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502, Japan
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Laxmi S, Khan JA. Does the cancer patient want to know? Results from a study in an Indian tertiary cancer center. South Asian J Cancer 2014; 2:57-61. [PMID: 24455553 PMCID: PMC3876664 DOI: 10.4103/2278-330x.110487] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The disclosure of the diagnosis of cancer is a distressing and complex issue. Families and doctors still do not tell patients when they have cancer in the belief that the patient does not want to know and telling him would lead to fear and depression. The aim of this survey was to evaluate the information needs of Indian cancer patients. MATERIALS AND METHODS A cross-sectional survey of 300 patients' views was conducted with the help of an adaptation of Cassileth's Information Needs questionnaire. RESULTS A majority of cancer patients exhibited a strong need for information about illness and treatment. Ninety-four percent wanted to know if their illness was cancer. Most patients also wanted to know the chance of cure (92%). Age, education, and type of treatment significantly affect information preferences. Gender did not have an effect on information needs. CONCLUSION This study showed that most of the patients wanted to know about their illness, treatment, side-effects, and chances of cure.
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Affiliation(s)
- Shekhawat Laxmi
- Department of Palliative Care, Bhagwan Mahaveer Cancer Hospital, JLN Marg, Malviya Nagar, Jaipur, India
| | - Joad Anjum Khan
- Department of Palliative Care, Bhagwan Mahaveer Cancer Hospital, JLN Marg, Malviya Nagar, Jaipur, India
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Kimura T, Imanaga T, Matsuzaki M. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings. TOHOKU J EXP MED 2014; 232:21-6. [PMID: 24441967 DOI: 10.1620/tjem.232.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.
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Affiliation(s)
- Takuma Kimura
- Department of General Medicine, Kitasato University School of Medicine
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Hammami MM, Al-Gaai EA, Al-Jawarneh Y, Amer H, Hammami MB, Eissa A, Qadire MA. Patients' perceived purpose of clinical informed consent: Mill's individual autonomy model is preferred. BMC Med Ethics 2014; 15:2. [PMID: 24406020 PMCID: PMC3897892 DOI: 10.1186/1472-6939-15-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 09/18/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although informed consent is an integral part of clinical practice, its current doctrine remains mostly a matter of law and mainstream ethics rather than empirical research. There are scarce empirical data on patients' perceived purpose of informed consent, which may include administrative routine/courtesy gesture, simple honest permission, informed permission, patient-clinician shared decision-making, and enabling patient's self decision-making. Different purposes require different processes. METHODS We surveyed 488 adults who were planning to undergo or had recently undergone written informed consent-requiring procedures. Perceptions of informed consent purpose (from norm and current practice perspectives) were explored by asking respondents to rank (1 = most reflective) 10 randomly-presented statements: "meaningless routine", "courtesy gesture" "litigation protection", "take away compensation rights", "inform patient', "make sure patient understand", "document patient's decision", "discover patient's preferences", "have shared decision", and "help patient decide". RESULTS Respondents' mean (SD) age was 38.3 (12.5); 50.4% were males, 56.8% had ≥ college education, and 37.3% had undergone a procedure. From the norm perspective, the least reflective statement was "meaningless routine" (ranked 1-3 by 2.6% of respondents) and the most reflective statements were "help patient decide", "make sure patient understand", and "inform patient" (ranked 1-3 by 65%, 60%, and 48% of respondents with median [25%,75%] ranking scores of 2 [1,5], 3 [2,4], and 4 [2,5], respectively). Compared to their counterparts, males and pre-procedure respondents ranked "help patient decide" better, whereas females and post-procedure respondents ranked "inform patient" better (p = 0.007 to p < 0.001). Age was associated with better ranking of "help patient decide" and "make sure patient understand" statements (p < 0.001 and p = 0.002, respectively), which were ranked 1-3 by only 46% and 42% of respondents from the current practice perspective (median ranking score 4 [2,6], p < 0.001 vs. norm perspective for both). CONCLUSIONS 1) the informed consent process is important to patients, however, patients vary in their views of its purpose with the dominant view being enabling patients' self decision-making, 2) males, pre-procedure, and older patients more favor a self decision-making purpose, whereas females and post-procedure patients more favor an information disclosure purpose, and 3) more self decision-making and more effective information disclosure than is currently practiced are desired. An informed consent process consistent with Mill's individual autonomy model may be suitable for most patients.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Eman A Al-Gaai
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
| | - Yussuf Al-Jawarneh
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
| | - Hala Amer
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
| | - Muhammad B Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
| | - Abdullah Eissa
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
| | - Mohammad Al Qadire
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh 11211, Saudi Arabia
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Tan A, Seah A, Chua G, Lim TK, Phua J. Impact of a palliative care initiative on end-of-life care in the general wards: a before-and-after study. Palliat Med 2014; 28:34-41. [PMID: 23630054 DOI: 10.1177/0269216313484379] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions. AIM A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010. DESIGN Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families. SETTINGS/PARTICIPANTS This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714). RESULTS There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation. CONCLUSIONS A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
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Affiliation(s)
- Adeline Tan
- 1Department of Medicine, Alexandra Hospital (Jurong Health Services), Singapore
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Palace J. Partnership and consent in MS treatment choice. J Neurol Sci 2013; 335:5-8. [DOI: 10.1016/j.jns.2013.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/05/2013] [Accepted: 09/03/2013] [Indexed: 11/28/2022]
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Assessing medical decision making capacity among cancer patients: Preliminary clinical experience of using a competency assessment instrument. Palliat Support Care 2013; 13:1529-33. [DOI: 10.1017/s1478951513000588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObject:This study investigates the usefulness of the Structured Interview for Competency and Incompetency Assessment Testing and Ranking Inventory (SICIATRI) for cancer patients, which is a structured interview that assesses a patient's competency in clinical practice.Methods:The SICIATRI, originally developed to measure patients' competency to give informed consent, were administered referred cancer patients who needed for assessing medical decision making capacity. The usefulness of the SICIATRI was investigated retrospectively. Recommendation for modification of the SICIATRI for cancer patients if applicable were made by the research team.Results:Among the 433 cancer patients referred for psychiatric consultation, 12 were administered the SICIATRI and all of the administration were conducted without big problems. All patients were 60 years or older. The most common purpose for competency evaluation was to analyze patients' understanding of the anti-cancer treatment proposed by oncologists, followed by their refusal of the treatment. Half of the patients (n = 6) were diagnosed with delirium and three among them were judged as having the most impaired status of a patient's competency. Two patients (17%) were diagnosed with major depression and another two (17%) were mental retardation and each one patient was diagnosed with dementia and past history of alcohol dependence. Among 6 patients without delirium 5 subjects including a dementia patient were judged as fully competent. Total of 5 small potential modifications of the SICIATRI for its use with Japanese cancer patients were recommended.Significance of results:Our experience suggests that the SICIATRI is a useful instrument for psycho-oncology clinical practice.
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Ng CJ, Lee PY, Lee YK, Chew BH, Engkasan JP, Irmi ZI, Hanafi NS, Tong SF. An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context. BMC Health Serv Res 2013; 13:408. [PMID: 24119237 PMCID: PMC3852442 DOI: 10.1186/1472-6963-13-408] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/09/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients' desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. METHODS In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. RESULTS There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient' programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. CONCLUSION In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.
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Affiliation(s)
- Chirk-Jenn Ng
- University Malaya Primary Care Research Group, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Yein Lee
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Malaysia
| | - Yew-Kong Lee
- University Malaya Primary Care Research Group, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Malaysia
| | - Julia P Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zarina-Ismail Irmi
- Department of Family Medicine, Faculty of Medicine and Health Science, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nik-Sherina Hanafi
- University Malaya Primary Care Research Group, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng-Fah Tong
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Vučemilo L, Ćurković M, Milošević M, Mustajbegović J, Borovečki A. Are physician-patient communication practices slowly changing in Croatia? -- a cross-sectional questionnaire study. Croat Med J 2013; 54:185-91. [PMID: 23630146 PMCID: PMC3641876 DOI: 10.3325/cmj.2013.54.185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim To explore physician-patient communication practices during the process of obtaining informed consent in a hospital setting in Croatia. Methods Two hundred and fifty patients (response rate 78%) from five tertiary level hospitals in Zagreb, Croatia, anonymously filled in the questionnaire on informed consent and communication practices by Nemcekova et al in the period from April to December 2011. Results Eighty five percent of patients received complete, understandable information, presented in a considerate manner. Patients in surgical departments received a higher level of information than those in internal medicine departments. Patients were informed about health risks of the proposed treatments (in 74% of cases) and procedures (76%), health consequences of refusing a medical intervention (69%), and other methods of treatment (46%). However, patients pointed out a number of problems in physician-patient communication. Conclusion Communication practices during informed consent-obtaining process in hospitals in Zagreb are based on a model of shared decision-making, but paternalistic physician-patient relationship is still present. Our results indicate that Croatia is undergoing a transition in the physician-patient relationship and communication.
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Affiliation(s)
- Luka Vučemilo
- Institute for Ear, Nose and Throat Disease and Head and Neck Surgery, University Hospital Merkur, Zajceva 19, Zagreb, Croatia.
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96
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Arcand M, Brazil K, Nakanishi M, Nakashima T, Alix M, Desson JF, Morello R, Belzile L, Beaulieu M, MPM Hertogh C, T van der Steen J, Toscani F. Educating families about end-of-life care in advanced dementia: acceptability of a Canadian family booklet to nurses from Canada, France, and Japan. Int J Palliat Nurs 2013; 19:67-74. [DOI: 10.12968/ijpn.2013.19.2.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marcel Arcand
- Research Center on Ageing, Sherbrooke (CDRV), and Department of Family Medicine, University of Sherbrooke, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | | | - Taeko Nakashima
- Institute for Health Economics and Policy (IHEP) Tokyo, Japan
| | - Michel Alix
- Département de Gériatrie et de Gérontologie, Centre Hospitalier de La Rochelle, France
| | | | - Rémy Morello
- Unite de Biostatistique et Recherche Clinique, Centre Hospitalier Universitaire de Caen, France
| | | | | | | | - Jenny T van der Steen
- EMGO Institute for Health and Care Research, Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Franco Toscani
- Lino Maestroni-Palliative Medicine Research Institute, Cremona, Italy
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97
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Nwankwo KC, Anarado AN, Ezeome ER. Attitudes of cancer patients in a university teaching hospital in southeast Nigeria on disclosure of cancer information. Psychooncology 2012; 22:1829-33. [DOI: 10.1002/pon.3220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/01/2012] [Accepted: 10/11/2012] [Indexed: 11/05/2022]
Affiliation(s)
- K. C. Nwankwo
- Radiation Oncology Unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - Agnes N. Anarado
- Oncology Nursing unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
| | - E. R. Ezeome
- Surgical Oncology unit; Oncology Center, University of Nigeria Teaching Hospital; Enugu Nigeria
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Papadimos TJ, Maldonado Y, Tripathi RS, Kothari DS, Rosenberg AL. An overview of end-of-life issues in the intensive care unit. Int J Crit Illn Inj Sci 2012; 1:138-46. [PMID: 22229139 PMCID: PMC3249847 DOI: 10.4103/2229-5151.84801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers. It involves topics from economics to existentialism, and surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Here, we present a comprehensive overview of issues in the care of patients at the end-of-life stage that may cause physicians and other healthcare providers, medical, ethical, social, and philosophical concerns in the intensive care unit.
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Affiliation(s)
- Thomas J Papadimos
- Department of Anesthesiology, Division of Critical Care Medicine, The Ohio State University Medical Center, Columbus OH 43210, USA
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Malhotra C, Chan A, Do YK, Malhotra R, Goh C. Good end-of-life care: perspectives of middle-aged and older Singaporeans. J Pain Symptom Manage 2012; 44:252-63. [PMID: 22658472 DOI: 10.1016/j.jpainsymman.2011.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/01/2011] [Accepted: 09/09/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Understanding preferences for end-of-life care is important for planning and improving services that provide such care. However, little is known about the perspective of Singaporeans regarding good end-of-life care. OBJECTIVES To identify the key components of good end-of-life care as perceived by middle-aged and older Singaporeans (≥50 years). METHODS Nine focus groups were conducted with a total of 63 participants. Preferences regarding end-of-life care were discussed. Thematic analysis was conducted on the transcribed results of the focus groups. RESULTS Eight components of good end-of-life care were identified: 1) have physical comfort at the end of life, 2) avoid inappropriate prolongation of the dying process, 3) maintain sensitivity toward religious and spiritual beliefs, 4) avoid burden on the family, 5) avoid expensive care, 6) be cared for by a trustworthy doctor, 7) maintain control over care decisions, and 8) achieve a sense of completion. CONCLUSION Eight components of good end-of-life care involving the person, family, and health services were identified among middle-aged and older Singaporeans. A focus on better management of pain, training of caregivers and doctors, shared decision making, and availability of affordable care may improve care at the end of life.
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Affiliation(s)
- Chetna Malhotra
- Program in Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore.
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The physician–patient relationship in treatment decision making at the end of life: A pilot study of cancer patients in a Southeast Asian society. Palliat Support Care 2012; 11:13-9. [DOI: 10.1017/s1478951512000429] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:The traditional relationship between patient and physician in East Asian society has often been described as “paternalistic.” However, in an increasingly Westernized world, our knowledge of how patients perceive the role of the physician in their decision making regarding treatment is lacking.Objective:This article is part of a larger pilot study exploring the patient–physician dynamic on decision making among Southeast Asian palliative cancer patients. We explore: (1) influence of physicians, (2) the effect of symptom control and quality of life, and (3) dynamics and communication of physicians.Design:An interviewer-administered questionnaire was distributed, with 18 questions related to physician–patient interactions asked. Most questions followed a three point scale: “agree,” “neutral,” and “disagree,” and spontaneous answers beyond this framework were recorded.Setting/Participants:Thirty patients from the palliative care service were interviewed, including inpatients at Singapore General Hospital and those attending outpatient clinics at the National Cancer Centre.Results:Patients said that they themselves and their physicians were the main influences (80% each), over family members (48.3%). Some patients (26.7%) felt that symptoms were not well controlled, and 42.9% identified low mood or anxiety. Some patients (44.8%) felt that their condition had an effect on decision making. Most patients (89.3%) had a good relationship with the staff, with >80% being comfortable with discussions held. However, 20.7% of patients felt dissatisfied with the information provided, and 62.1% of patients wanted full disclosure of information.Significance of results:Patients appeared to place highest regard in both autonomy and physician input in making decisions, accompanied by an increased desire for more information. These reflect deviation away from traditional thinking of paternalistic doctoring in East Asia.
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