1
|
Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Decisional Needs of Veterans With Mild Traumatic Brain Injury Initiating Treatment for Insomnia Disorder and Obstructive Sleep Apnea. J Head Trauma Rehabil 2024:00001199-990000000-00179. [PMID: 39019488 DOI: 10.1097/htr.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
OBJECTIVE We sought to elicit key informant (KI) perspectives regarding decisional needs of Veterans with mild traumatic brain injury (mTBI) who are initiating insomnia disorder and obstructive sleep apnea (OSA) treatment within the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Specifically, we sought to understand: (1) information regarding treatment options that Veterans with mTBI require in order to make an informed decision; and (2) values used to guide decision-making (ie, personally meaningful aspects of the decision used to compare treatment options). SETTING Nationwide VHA PSC sites. PARTICIPANTS Clinicians included VHA providers and policymakers involved in the management of mTBI and/or sleep disorders in the VHA PSC (n = 29). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or OSA within the past year (n = 20). DESIGN Semi-structured interviews with the 49 KIs were recorded and transcribed verbatim. Themes were identified using a descriptive and interpretive approach to qualitative analysis. MAIN MEASURES Not applicable. RESULTS Informational needs identified by both KI groups included information regarding outcomes and downsides of treatment, accessible delivery, treatment candidates, description of diagnosis, and level of commitment. Values used to guide decision-making for both insomnia disorder and OSA treatment included benefits, downsides, and availability of treatments. Values used to decide on insomnia treatments alone included time commitment, intrinsic management of sleep, beliefs regarding mental health treatment, and time course of benefit. Values used to decide on OSA treatment alone included intrusiveness of the treatment, appearance, and impact on bed partners. CONCLUSIONS The current study revealed the decisional needs of Veterans with mTBI who are initiating sleep disorder treatment. Findings can inform the development of decision aids and other efforts aimed at promoting patient-centered management of comorbid mTBI and sleep disorders, thereby improving care quality and clinical outcomes.
Collapse
Affiliation(s)
- Adam R Kinney
- Author Affiliations: Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Department of Veteran Affairs, Aurora, Colorado (Dr Kinney, Dr Brenner, Ms Nance, Dr Mignogna, Ms Cobb, Dr Forster, and Dr Bahraini); Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Kinney, Ms Nance, Dr Mignogna, and Dr Forster); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Brenner); Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, North Carolina (Dr Ulmer); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Dr Ulmer); Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida Tampa, Florida (Dr Nakase-Richardson); and Departments of Physical Medicine and Rehabilitation and Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado (Dr Bahraini)
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Lindberg J, Broström L, Johansson M. An Egalitarian Perspective on Information Sharing: The Example of Health Care Priorities. HEALTH CARE ANALYSIS 2024; 32:126-140. [PMID: 38159128 PMCID: PMC11133185 DOI: 10.1007/s10728-023-00475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically "non-actionable," we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients' comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient's situation and the underlying considerations shaping health care professionals' choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person.
Collapse
Affiliation(s)
- Jenny Lindberg
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden.
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Linus Broström
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden
| | - Mats Johansson
- Department of Clinical Sciences Lund, Medical Ethics, Lund University, BMC I12, Box 117, Lund, 22100, Sweden
| |
Collapse
|
3
|
Kinney AR, Brenner LA, Nance M, Mignogna J, Cobb AD, Forster JE, Ulmer CS, Nakase-Richardson R, Bahraini NH. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med 2024; 20:801-812. [PMID: 38189353 PMCID: PMC11063707 DOI: 10.5664/jcsm.10994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. METHODS Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. RESULTS Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. CONCLUSIONS Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. CITATION Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.
Collapse
Affiliation(s)
- Adam R. Kinney
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Lisa A. Brenner
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Aurora, Colorado
| | - Morgan Nance
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Joseph Mignogna
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Audrey D. Cobb
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
| | - Jeri E. Forster
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Aurora, Colorado
| | - Christi S. Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Risa Nakase-Richardson
- Research Service, James A. Haley Veterans Hospital, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of South Florida, Tampa, Florida
| | - Nazanin H. Bahraini
- Veteran Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado
- University of Colorado, Anschutz Medical Campus, Departments of Physical Medicine and Rehabilitation and Psychiatry, Aurora, Colorado
| |
Collapse
|
4
|
Svendsen SJ, Grov EK, Staats K. Patients' experiences with shared decision-making in home-based palliative care - navigation through major life decisions. BMC Palliat Care 2024; 23:101. [PMID: 38627710 PMCID: PMC11022472 DOI: 10.1186/s12904-024-01434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND This study addresses the issue of shared decision-making (SDM) in a Norwegian home-based palliative care setting. The significance of patient involvement in SDM is widely acknowledged, and many patients want to participate in decisions about care and treatment. Yet, it remains a need for more knowledge regarding the initiators and approaches of SDM in the context of home-based palliative care, particularly from the patients' perspective. The aim of this study is to understand patients' experiences and preferences for SDM in home-based palliative care, seeking to enhance the quality of care and direct the planning of healthcare services. METHODS We used a qualitative explorative design. A hermeneutic approach was employed, and data was collected through in-dept interviews with 13 patients. RESULTS The study uncovered an overarching theme of "Navigating to reach own decisions," comprising three sub-themes: "To be trapped in life without decisions to act on"; "To surrender to others and let others deal with decisions"; "To continue to be oneself without focusing on disease and decision-making". CONCLUSIONS The findings underscore the need for flexible, person-centered approaches in SDM, tailored to the fluctuating health literacy and changing preferences of patients in palliative care settings. Our study contributes to the understanding of SDM in palliative care by highlighting how patients navigate the balance between autonomy and reliance on HCPs. Future research should explore how healthcare systems, including HCPs' roles in the system, can adapt to the patients' dynamic needs, to ensuring that SDM will remain a supportive and empowering process for patients at all stages of their disease.
Collapse
Affiliation(s)
- Sandra Jahr Svendsen
- Lillestrøm Municipality, Lillestrøm, Norway.
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Kjeller, Norway.
| | - Ellen Karine Grov
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet, Norway
| | - Katrine Staats
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Kjeller, Norway
| |
Collapse
|
5
|
Sommer I, Assa S, Bachmann C, Chen 陈未 W, Elcin M, Funk E, Kamisli C, Liu 刘涛 T, Maass AH, Merse S, Morbach C, Neumann A, Neumann T, Quasinowski B, Störk S, Weingartz S, Wietasch G, Weiss Weiß A. Medical Care as Flea Market Bargaining? An International Interdisciplinary Study of Varieties of Shared Decision Making in Physician-Patient Interactions. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38577850 DOI: 10.1080/10401334.2024.2322456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024]
Abstract
Phenomenon: Shared decision making (SDM) is a core ideal in the interaction between healthcare providers and patients, but the implementation of the SDM ideal in clinical routines has been a relatively slow process. Approach: In a sociological study, 71 interactions between physicians and simulated patients enacting chronic heart failure were video-recorded in China, Germany, the Netherlands, and Turkey as part of a quasi-experimental research design. Participating physicians varied in specialty and level of experience. The secondary analysis presented in this article used content analysis to study core components of SDM in all of the 71 interactions and a grounded theory approach to observe how physicians responded actively to patients even though they did not actively employ the SDM ideal. Findings: Full realization of the SDM ideal remains an exception, but various aspects of SDM in physician-patient interaction were observed in all four locations. Analyses of longer interactions show dynamic processes of interaction that sometimes surprised both patient and physician. We observed varieties of SDM that differ from the SDM ideal but arguably achieve what the SDM ideal is intended to achieve. Our analysis suggests a need to revisit the SDM ideal-to consider whether varieties of SDM may be acceptable, even valuable, in their own right. Insights: The gap between the SDM ideal and SDM as implemented in clinical practice may in part be explained by the tendency of medicine to define and teach SDM through a narrow lens of checklist evaluations. The authors support the argument that SDM defies a checklist approach. SDM is not uniform, but nuanced, dependent on circumstances and setting. As SDM is co-produced by patients and physicians in a dynamic process of interaction, medical researchers should consider and medical learners should be exposed to varieties of SDM-related practice rather than a single idealized model. Observing and discussing worked examples contributes to the physician's development of realistic expectations and personal professional growth.
Collapse
Affiliation(s)
- Ilka Sommer
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cadja Bachmann
- Office of the Dean of Educational Affairs, Rostock University Medical Center, Rostock, Germany
| | - Wei Chen 陈未
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, PR China
| | - Melih Elcin
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elisabeth Funk
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Caner Kamisli
- Institute of German Studies, University of Hamburg, Hamburg, Germany
| | - Tao Liu 刘涛
- School of Public Affairs, Zhejiang University, Hangzhou, PR China
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Stefanie Merse
- Empathische Interkulturelle Medizinische Kommunikation, University of Duisburg-Essen, Duisburg, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Anja Neumann
- Institute of Healthcare Management and Research, University of Duisburg-Essen, Duisburg, Germany
| | - Till Neumann
- Outpatient Department of Cardiology Cardio-Praxis, Bochum, Germany
| | | | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Weingartz
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Götz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anja Weiss Weiß
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| |
Collapse
|
6
|
Maris MT, Koçar A, Willems DL, Pols J, Tan HL, Lindinger GL, Bak MAR. Ethical use of artificial intelligence to prevent sudden cardiac death: an interview study of patient perspectives. BMC Med Ethics 2024; 25:42. [PMID: 38575931 PMCID: PMC10996273 DOI: 10.1186/s12910-024-01042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD). AIM Explore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD). METHODS Semi-structured, future scenario-based interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission's Ethics Guidelines for Trustworthy AI to structure the interviews. RESULTS Six themes arose from the interviews: the ability of AI to rectify human doctors' limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the 'human touch'; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the 'human touch' in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients' individual contexts and values, in consultation with the patient. CONCLUSION The 'human touch' patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the 'right to a human doctor' is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward.
Collapse
Affiliation(s)
- Menno T Maris
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ayca Koçar
- Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Dick L Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeannette Pols
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Georg L Lindinger
- Institute for Healthcare Management and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Marieke A R Bak
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
7
|
Muralidharan A, Savulescu J, Schaefer GO. AI and the need for justification (to the patient). ETHICS AND INFORMATION TECHNOLOGY 2024; 26:16. [PMID: 38450175 PMCID: PMC10912120 DOI: 10.1007/s10676-024-09754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
This paper argues that one problem that besets black-box AI is that it lacks algorithmic justifiability. We argue that the norm of shared decision making in medical care presupposes that treatment decisions ought to be justifiable to the patient. Medical decisions are justifiable to the patient only if they are compatible with the patient's values and preferences and the patient is able to see that this is so. Patient-directed justifiability is threatened by black-box AIs because the lack of rationale provided for the decision makes it difficult for patients to ascertain whether there is adequate fit between the decision and the patient's values. This paper argues that achieving algorithmic transparency does not help patients bridge the gap between their medical decisions and values. We introduce a hypothetical model we call Justifiable AI to illustrate this argument. Justifiable AI aims at modelling normative and evaluative considerations in an explicit way so as to provide a stepping stone for patient and physician to jointly decide on a course of treatment. If our argument succeeds, we should prefer these justifiable models over alternatives if the former are available and aim to develop said models if not.
Collapse
Affiliation(s)
- Anantharaman Muralidharan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Murdoch Children’s Research Institute, Melbourne, VIC Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - G. Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
8
|
Engelsma C. Sharing a medical decision. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:3-14. [PMID: 38010578 PMCID: PMC10904442 DOI: 10.1007/s11019-023-10179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/29/2023]
Abstract
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
Collapse
Affiliation(s)
- Coos Engelsma
- Department of Ethics, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
9
|
Pereira F, Meyer-Massetti C, Del Río Carral M, von Gunten A, Wernli B, Verloo H. Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study. BMJ Open 2023; 13:e072738. [PMID: 37730411 PMCID: PMC10514617 DOI: 10.1136/bmjopen-2023-072738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
Collapse
Affiliation(s)
- Filipa Pereira
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology, Clinical of General Internal Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - María Del Río Carral
- Institute of Psychology, Research Center for the Psychology of Health, Aging and Sports Examination (PHASE), University of Lausanne, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Boris Wernli
- Swiss Centre of Expertise in the Social Sciences (FORS), University of Lausanne, Lausanne, Switzerland
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/ Wallis, Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
10
|
Caspi A, Tzur Bitan D, Halaly O, Hallaly O, Friedlander A, Barkai G, Zimlichman E, Stein O, Shani M, Amitai Z, Ansbacher T, Weiser M. Technologically assisted intensive home treatment: feasibility study. Front Psychiatry 2023; 14:1196748. [PMID: 37575571 PMCID: PMC10415008 DOI: 10.3389/fpsyt.2023.1196748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction In recent year, many attempts have been made to provide patients with alternatives to psychiatric hospitalization during acute distress. Although several hospitalization alternatives have been offered, most of them still require patients to be distanced from their families, friends, and the social environment. Methods In this report we describe the implementation of a novel approach to psychiatric care termed "Technologically assisted Intensive Home Treatment", where patients arriving to emergency settings are directed to home care with technological aids that enable close monitoring and ongoing contact with their therapists. Results We describe the rationale and treatment principles of the treatment, and provide an elaborative description of the implementation process during the first year of implementation. Discussion Additional attention is given to factors associated with early dropout from the program, in order to inform readers of predictors to optimal care. Limitations and directions for future research and practice are discussed.Clinical Trial Registration: The study was registered in the database of clinical trials (registration number SHEBA-19-6555-MW-CTIL) and in the Ministry of Health (registration number MOH_2022-08-22_011992).
Collapse
Affiliation(s)
- Asaf Caspi
- The Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Ofir Halaly
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Ofri Hallaly
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Avraham Friedlander
- The Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Galia Barkai
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Central Management, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Stein
- Maccabi Health Services, Tel Aviv, Israel
| | - Mordechai Shani
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Ziv Amitai
- The Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Mark Weiser
- The Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Health, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
11
|
Antón M, Cabañes N, Fernández-Meléndez S, Fernández-Nieto M, Jiménez-Ferrera G, Letrán A, Méndez-Brea P, Montoro J, Moreno F, Mur-Gimeno P, Rodríguez-Vázquez V, Rosado A, Sánchez-Guerrero I, Vega-Chicote JM, Vidal C. Shared Decision-Making in Allergen Immunotherapy (AIT) Options Using a Questionnaire for Respiratory Allergic Patients: A Delphi Consensus Study. Patient Prefer Adherence 2023; 17:1771-1782. [PMID: 37520065 PMCID: PMC10378527 DOI: 10.2147/ppa.s409466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach. Patients and Methods A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on "agreement" on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions). Conclusion This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.
Collapse
Affiliation(s)
- Mónica Antón
- Allergy Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Nieves Cabañes
- Allergy Department, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Mar Fernández-Nieto
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Letrán
- Allergy Unit, Centro médico Asisa Doctor Lobatón, Cádiz, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Montoro
- Allergy Department, Hospital de Llíria, Valencia, Spain
- Department of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | | | - Pilar Mur-Gimeno
- Allergy Department, Hospital de Santa Bárbara, Puertollano, Ciudad Real, Spain
| | - Virginia Rodríguez-Vázquez
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Rosado
- Allergy Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Carmen Vidal
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
12
|
Zhang W, Zhou F, Fei Y. Repetitions in online doctor-patient communication: Frequency, functions, and reasons. PATIENT EDUCATION AND COUNSELING 2023; 107:107565. [PMID: 36428169 DOI: 10.1016/j.pec.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/23/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To attain insights into language repetition during online doctor-patient communication (DPC), understand why doctors and patients use repetition, and improve the current deficiencies in online medical platforms. METHODS The study performed a content analysis of 72 sets of textual doctor-patient conversations on the Chinese online medical consultation platform Chunyu Doctor. RESULTS Repetitions occurred 1412 times in the 72 sets of online DPC. Patient self-repetitions were the most prevalent (30.7 %), while patient repetitions of doctors were the least common (17.1 %). Doctors used repetitions for explanations and affirmations. Patients used repetition for emphasis, verification, and turn-taking. The repetition frequencies of doctors and patients were primarily influenced by personal factors. However, doctor-dimension factors exerted a greater impact on the frequency of patient repetitions. CONCLUSIONS The reasons for repetitions in online DPC differ from those offline. Online DPC increases patient initiative and reduces doctor authority. Nevertheless, it could be affected by gender stereotypes generated during offline consultations. Doctors still dominated the conversations but attended sufficiently to the patient discourse. Online DPC is gradually attempting to fulfill the expectations of a new patient-centered healthcare pattern. PRACTICAL IMPLICATIONS The findings yield suggestions for healthcare providers and the designers of online healthcare platforms.
Collapse
Affiliation(s)
- Wen Zhang
- School of Journalism and Culture Communication, Zhongnan University of Economics and Law, Wuhan 430073, PR China.
| | - Fangzhou Zhou
- Institute of Communication Studies, Communication University of China, Beijing 100024, PR China.
| | - Yifeng Fei
- School of Computer Science and Technology, Dalian University of Technology, Dalian 116024, PR China.
| |
Collapse
|
13
|
O'Hara DV, Yi TW, Lee VW, Jardine M, Dawson J. Digital health technologies to support medication adherence in chronic kidney disease. Nephrology (Carlton) 2022; 27:917-924. [PMID: 36176176 PMCID: PMC9828762 DOI: 10.1111/nep.14113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/24/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
Non-adherence to medications is a critical challenge in the management of people with chronic kidney disease (CKD). This review explores the complexities of adherence in this population, the unique barriers and enablers of good adherence behaviours, and the role of emerging digital health technologies in bridging the gap between evidence-based treatment plans and the real-world standard of care. We present the current evidence supporting the use of digital health interventions among CKD populations, identifying the key research questions that remain unanswered, and providing practical strategies for clinicians to support medication adherence in a digital age.
Collapse
Affiliation(s)
- Daniel V. O'Hara
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia,Department of Renal MedicineRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Tae Won Yi
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia,The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia,Department of Medicine, Clinician Investigator ProgramUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Vincent W. Lee
- Department of Renal MedicineWestmead HospitalSydneyNew South WalesAustralia,Westmead Applied Research Centre, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Meg Jardine
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia,Department of Renal MedicineConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - Jessica Dawson
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia,Department of Nutrition and DieteticsSt George HospitalSydneyNew South WalesAustralia
| |
Collapse
|
14
|
Song Q, Mi Y, Ruan L. Pros and cons factors influence population attitudes toward non-pharmaceutical interventions and vaccination during post–COVID-19. Public Health 2022; 211:88-96. [PMID: 36058200 PMCID: PMC9365865 DOI: 10.1016/j.puhe.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
Objectives Population compliance greatly influences the effectiveness of vaccination and non-pharmaceutical interventions (NPIs) for the curtaining of COVID-19 transmission. We aimed to determine the conceptual framework of potential factors that influence compliance. Study design This was a cross-sectional study. Methods Questionnaires were used to survey population attitudes toward vaccination and NPIs in China. Confirmatory factor analysis of the survey data by structural equation model was used to define the pros and cons factors of attitudes. The strength and direction of each factor’s effect on population attitudes were illustrated by Bayesian network analysis. Results A total of 1700 respondents aged 18–70 years were surveyed with a panel of 34 questionnaires. Of these questionnaires, the confirmatory factor and structural equation model analysis identified five categories contributing to positive attitudes, including response efficiency, willingness and behavior, trust, cues to action, and knowledge, as well as four categories contributing to negative attitudes, including autonomy, perceived barriers, threat, and mental status. Bayesian networks revealed that cues to action produced a driving force for positive attitudes, followed by willingness and behavior, trust, response efficiency, and knowledge, whereas perceived barriers produced a driving force for negative attitudes, followed by autonomy and threat. Conclusions This study established a concise and representative list of questionnaires that could be applied to investigate the conceptual framework of potential pros and cons factors of attitudes toward vaccination and NPIs for COVID-19 prevention. The factors with driving forces should be addressed with a priority to effectively improve population compliance.
Collapse
|
15
|
El-Alti L, Sandman L, Munthe C. Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care. PLoS One 2022; 17:e0275205. [PMID: 36174093 PMCID: PMC9521939 DOI: 10.1371/journal.pone.0275205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
The ethical discourse surrounding patients’ agential capacities, vis-à-vis their active participation in shared decision-making (SDM) in forensic psychiatric (FP) contexts, is an unexplored area of inquiry. The aim of this paper is to explore caregivers’ perceptions of patient agential capacities and institutional pathways and barriers to person centered care (PCC) in the context of FP. Following an exploratory qualitative design, we conducted eight semi-structured interviews with hands-on caregivers at an in-patient FP facility in Sweden. A deductive framework method of analysis was employed, and four themes emerged: “Fundamental Variability in Patient Capacity”, “Patient Participation: Narration or Compliance?”, “Antagonism Rooted in Power Struggles”, and “System Structure Thwarts Patient Release”. While the results generally paint a bleak picture for the possibility of a person-centered FP care, we describe a constrained version of PCC with high-level SDM dynamics which promotes a certain degree of patient empowerment while allowing care strategies, within set restrictions, to promote patient adherence and treatment progress.
Collapse
Affiliation(s)
- Leila El-Alti
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Edinburgh, United Kingdom
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Lars Sandman
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
16
|
DeRosa AP, Demetres MR, McComas RR. Shared Decision-Making Among Women Diagnosed with Breast Cancer: A Phenomenological Study and Exploration into Health Literacy Education. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2022.2093086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Antonio P. DeRosa
- Patient & Community Education, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Ryan R. McComas
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
17
|
Söderberg A, Wallinius M, Munthe C, Rask M, Hörberg U. Patients' Experiences of Participation in High-Security, Forensic Psychiatric Care. Issues Ment Health Nurs 2022; 43:683-692. [PMID: 35130107 DOI: 10.1080/01612840.2022.2033894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The role of patient participation in forensic psychiatric care is unclear, but has been emphasised as important in recent research. This study aims to describe patients' lived experiences of participation in high-security, forensic psychiatric settings. Sixteen patient interviews were performed in this phenomenological study and analysed with a Reflective Lifeworld Research approach (RLR). Results show that participation must be understood in relation to its opposite construct, non-participation. Participation can thus be explained as situations where non-participation is less visible. Actions to develop the training of patient-staff interactions for forensic psychiatric staff to promote patient participation are called for.
Collapse
Affiliation(s)
- Andreas Söderberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Märta Wallinius
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden.,Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden.,Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| |
Collapse
|
18
|
Frank C, Holmberg M, Jernby EE, Hansen AS, Bremer A. Older patients' autonomy when cared for at emergency departments. Nurs Ethics 2022; 29:1266-1279. [PMID: 35727146 PMCID: PMC9442626 DOI: 10.1177/09697330221105637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Older patients in emergency care often have complex needs and may have limited ability to make their voices heard. Hence, there are ethical challenges for healthcare professionals in establishing a trustful relationship to determine the patient’s preferences and then decide and act based on these preferences. With this comes further challenges regarding how the patient’s autonomy can be protected and promoted. Aim To describe nurses’ experiences of dealing with older patients’ autonomy when cared for in emergency departments (EDs). Research design This study adopted reflective lifeworld theory and a phenomenological design. Participants and research context A total of 13 open-ended interviews were performed with nurses working at two EDs in Sweden. Ethical considerations The study was reviewed by the Ethical Advisory Board in South East Sweden and conducted according to the Declaration of Helsinki. All participants gave consent. Findings Nurses’ experiences of dealing with older patients’ autonomy in EDs are characterized by moving in a conflicting uphill struggle, indicating obscure thoughts on how patient autonomy can be protected in an ethically challenging context. The phenomenon is further described with its meaning constituents: ‘Being hampered by prioritization under stress’, ‘Balancing paternalism and patient autonomy’, ‘Making decisions without consent in the patient’s best interests’ and ‘Being trapped by notions of legitimate care needs’. Conclusion Stressful work conditions and lacking organizational strategies in EDs contribute to nurses maintaining unjustified paternalistic care, regardless of the patient’s ability and medical condition, and questioning who has legitimacy for participating in decisions about care. The nurses’ protection and promotion of older patients’ autonomy is dependent on the opportunity, ability and willingness to create a patient relationship where the patient’s voice and preferences are valued as important. Consequently, strategies are needed to improve patient autonomy in EDs based on the idea of ‘relational autonomy’.
Collapse
Affiliation(s)
- Catharina Frank
- Faculty of Health and Life Sciences, 249958Linnaeus University, Växjö, Sweden; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Mats Holmberg
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden; Centre for Clinical Research Sörmland, 8097Uppsala University, Eskilstuna, Sweden; Department of Ambulance Service, Region Sörmland, Katrineholm, Sweden
| | | | | | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| |
Collapse
|
19
|
Rodríguez-Prat A, Pergolizzi D, Crespo I, Balaguer A, Porta-Sales J, Monforte-Royo C. Control in patients with advanced cancer: an interpretative phenomenological study. Palliat Care 2022; 21:97. [PMID: 35650600 PMCID: PMC9161471 DOI: 10.1186/s12904-022-00984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background In the context of life-threatening illness, loss of control is argued as a source of suffering and loss of perceived dignity, whereas having control over the dying process has been seen as a way of maintaining personal independence. Little is known about the meaning of control from the patients’ perspectives. Thus, the aim of this study was to explore how patients with advanced cancer understand control, in terms of underlying beliefs, attitudes, and expectations consistent with self-efficacy, in different dimensions of their life, their illness, and their healthcare. Methods We conducted semi-structured qualitative interviews using an interpretive phenomenological analysis approach. Patients with advanced cancer from an oncology unit and a palliative care unit from Barcelona (Spain) were recruited. The inclusion criteria were a) ≥ 18 years old; b) fluency in Spanish or Catalan; c) outpatients diagnosed with advanced cancer; d) Eastern Cooperative Oncology Group (ECOG) between 0 and 3; e) judged by their physician or nurse to be emotionally stable; f) considered to have control over their illness and circumstances according to their responsible physician; and g) signed informed consent. Results We interviewed eight participants (ages ranged from 29 to 70 years, six were female). Two themes were identified: 1) factors that influence the perception of control, with subthemes: uncertainty about future suffering, character traits underlying a need for control; sense of lack of care as a source of loss of control; and 2) perceiving control over an uncontrollable illness, explained by perceived control over subjective wellbeing and adjusting the focus of control. The data allowed us to identify strategies that promote a sense of control in these patients. Conclusions The illness, according to the participants, was experienced as series of losses. However, attention was often focused on areas where they continued to have control. These findings selectively reflect experiences of those who see themselves able to effect outcomes in life, suggesting future research should address how both family members and healthcare professionals can help to empower all patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00984-7.
Collapse
Affiliation(s)
- Andrea Rodríguez-Prat
- Faculty of Humanities, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Iris Crespo
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain.,Palliative Care Unit, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain.
| |
Collapse
|
20
|
Pereira F, Bieri M, Martins MM, del Río Carral M, Verloo H. Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals’ Perspectives. NURSING REPORTS 2022; 12:403-423. [PMID: 35736616 PMCID: PMC9230543 DOI: 10.3390/nursrep12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults’ medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals’ perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.
Collapse
Affiliation(s)
- Filipa Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Correspondence:
| | - Marion Bieri
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
| | | | - María del Río Carral
- Research Center for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland;
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais/Wallis, 1950 Sion, Switzerland; (M.B.); (H.V.)
- Service of Old Age Psychiatry, Lausanne University Hospital, 1008 Prilly, Switzerland
| |
Collapse
|
21
|
Berek K, Paganini C, Hegen H, Bsteh G, Grams A, Auer M, Berger T, Deisenhammer F, Di Pauli F. Natalizumab treatment during pregnancy in multiple sclerosis-clinical and bioethical aspects of an ongoing debate. Wien Med Wochenschr 2022; 172:373-378. [PMID: 35142953 DOI: 10.1007/s10354-022-00913-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Natalizumab is an approved treatment for relapsing remitting multiple sclerosis; however, its safety during pregnancy is not formally proven. CASE PRESENTATION We report a woman with multiple sclerosis being treated with natalizumab before pregnancy. After withdrawal of natalizumab, she suffered a severe, disabling rebound. In agreement with the patient, natalizumab was restarted during pregnancy. Our patient improved substantially and gave birth to a healthy boy. CONCLUSION Use of natalizumab during pregnancy may be an option in highly active multiple sclerosis.
Collapse
Affiliation(s)
- Klaus Berek
- Departmentof Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Paganini
- Department of Christian Philosophy, University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Departmentof Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Departmentof Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Franziska Di Pauli
- Departmentof Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
22
|
Hernández-Leal MJ, Codern-Bové N, Pérez-Lacasta MJ, Cardona A, Vidal-Lancis C, Carles-Lavila M. Development of support material for health professionals who are implementing Shared Decision-making in breast cancer screening: validation using the Delphi technique. BMJ Open 2022; 12:e052566. [PMID: 35105575 PMCID: PMC8808455 DOI: 10.1136/bmjopen-2021-052566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model. OBJECTIVE A Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening. DESIGN A qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1-6-in which 1 meant 'completely disagree' and 6 'completely agree'-with a cut-off point equal to or higher than 4. RESULTS Participants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills. CONCLUSIONS AND APPLICATIONS The first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation.
Collapse
Affiliation(s)
- María José Hernández-Leal
- Economic, Universitat Rovira i Virgili, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| | - Núria Codern-Bové
- Terrassa University School of Nursing and Occupational Therapy (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | - María José Pérez-Lacasta
- Economic, Universitat Rovira i Virgili, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| | - Angels Cardona
- Evaluation and Research in the Field of Social Sciences and Health, Area Q, Barcelona, Spain
| | - Carmen Vidal-Lancis
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, Hospitalet de Llobregat, Spain
| | - Misericòrdia Carles-Lavila
- Economic, Universitat Rovira i Virgili, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| |
Collapse
|
23
|
Kim S, Malova E. From Compliance to Adherence in Diabetes Self-care: Examining the Role of Patient's Potential for Mindful Non-Adherence and Physician-Patient Communication. Am J Health Promot 2022; 36:1094-1103. [PMID: 35081760 DOI: 10.1177/08901171211068401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine the roles of patient mindful non-adherence and physician-patient communication as important factors that facilitate an understanding of the relationship between compliance and adherence in diabetes management. DESIGN A cross-sectional survey Setting: Online data collection Subjects: 365 respondents at least 18 years of age and currently in treatment for diabetes Measures: We measured patients' compliance, adherence, mindfulness, and perceptions about physician-patient communication, as well as their demographic characteristics. ANALYSIS A moderated mediation analysis was conducted to examine the conditioned indirect effect of compliance on adherence. RESULTS The direct effect of compliance on adherence was positive and significant (β = .378, SE = .073, p < .05, BootCI [.234, .521]), but the compliance-adherence association was also partially mediated by patient's potential for mindful non-adherence. A higher level of compliance increased potential for mindful non-adherence (β = .716, SE = .082, p < .05, BootCI [.555, .876]), and, in turn, the increased potential for mindful non-adherence reduced adherence (β = -.107, SE = .045, p < .05, BootCI [-.196, -.018]). This detrimental mediating effect of potential for mindful non-adherence was contingent on the perceived quality of physician-patient communication (index = .076, SE = .038, 95% BootCI [.003, .153]), indicating that the positive perception significantly reduced the negative mediating effect of potential for mindful non-adherence on adherence.
Collapse
Affiliation(s)
- Soyoon Kim
- Communication Studies5452University of Miami - Coral Gables Campus
| | - Ekaterina Malova
- Communication Studies5452University of Miami - Coral Gables Campus
| |
Collapse
|
24
|
Witlox M, Kraaij V, Garnefski N, Bohlmeijer E, Smit F, Spinhoven P. Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial. PLoS One 2022; 17:e0262220. [PMID: 35081130 PMCID: PMC8791485 DOI: 10.1371/journal.pone.0262220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. OBJECTIVE This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms. METHODS The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings. RESULTS Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT. CONCLUSIONS The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations. TRIAL REGISTRATION Netherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.
Collapse
Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| |
Collapse
|
25
|
Amdie FZ, Sawhney M, Woo K. The Weakness of Will: The Role of Free Will in Treatment Adherence. Patient Prefer Adherence 2022; 16:1131-1139. [PMID: 35517044 PMCID: PMC9064064 DOI: 10.2147/ppa.s362706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic disease prevention and management requires a lifelong commitment and adherence to lifestyle modifications, monitoring of symptoms, medication use, and other forms of therapy. Treatment adherence is a crucial and complex concept in patient care provision, and it requires the voluntary active involvement of patients for the best possible outcome. Multiple factors, which may or may not be under the patient's control, can influence treatment adherence. However, adherence or non-adherence to a certain treatment is predominantly influenced by one's sense of agency, values, beliefs, attitudes, and willpower. It is evident that mental states appear to influence patients' decision-making, and the best treatment outcome occurs when a patient identifies their goals, needs, and desires and exercises their decision-making and free will during the course of receiving care. The role of healthcare providers is critical in promoting treatment adherence, thereby enhancing patient outcomes. Thus, this paper highlights the importance of promoting a sense of agency and integrating patients' values, beliefs, attitudes, and intentions during the provision of healthcare. It is indispensable to recognize the individual's ability and initiative to control and manage their illness in the face of challenging socioeconomic and cultural reality. On logical grounds, it is not enough to appreciate the value of free will and mental states, it is also essential to empower and cultivate an individual patient's willpower to make a well-informed, free decision based on their mental state for the most optimal treatment outcomes.
Collapse
Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
26
|
E-santé, digitalisation ou transformation numérique : impact sur les soins de support en oncologie. Bull Cancer 2022; 109:598-611. [DOI: 10.1016/j.bulcan.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
|
27
|
Abstract
What, precisely, are we seeking to achieve in offering 'life-saving' treatment to patients with cancer? Research funding agencies and pharmaceutical industry media releases, and government cancer screening programs all promise that their cancer programs save lives. But everybody dies. The nature of life and death from cancer is explored philosophically in this essay, with particular reference to the quality of life, and its meaning, during the period of prolongation of survival by 'life-saving' cancer care.
Collapse
Affiliation(s)
- J Harvey Turner
- Department of Nuclear Medicine, The University of Western Australia, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
| |
Collapse
|
28
|
Martínez-Martínez C, Sánchez-Martínez V, Ballester-Martínez J, Richart-Martínez M, Ramos-Pichardo JD. A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals. J Psychiatr Ment Health Nurs 2021; 28:721-737. [PMID: 33351223 DOI: 10.1111/jpm.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision-making capabilities and avoiding paternalistic or stigmatizing attitudes. ABSTRACT: Introduction A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community-based mental health services and other healthcare services. Data were analysed using the content analysis method. Results Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.
Collapse
Affiliation(s)
- Concepción Martínez-Martínez
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad Europea, Valencia, Spain.,Faculty of Nursing and Podiatry University of Valencia, Valencia, Spain
| | | | | | - Miguel Richart-Martínez
- Nursing Department, Health Sciences Faculty, University of Alicante, San Vicente del Raspeig, Spain
| | | |
Collapse
|
29
|
Landry JT. Is shared decision-making to blame for the provision of ethically inappropriate treatment? Results of a multi-site study exploring physician understanding of the "shared" model of decision making. J Eval Clin Pract 2021; 27:826-835. [PMID: 32930473 DOI: 10.1111/jep.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
Support for the concept of respect for first-person informed consent and patient autonomy, including the negative right of patients to refuse unwanted interventions has grown, but does not generally include a positive right of patients to receive whatever treatment they request or demand without constraint. Despite this, health-care providers in both Canada and the United States are guilty of providing, in their own opinions, futile or probably futile treatments at the request of patients or their substitute decision-makers. The purpose of this study was to examine whether physicians' understanding of the shared model of medical decision-making - shared decision-making, (SDM) - may be among the reasons why some patients receive treatment understood as ethically inappropriate, including those deemed futile, treatments that are not medically indicated, or those that are not in the patient's best interests to receive. A secondary question asked to study participants was whether they believed their professional college allowed, or further, required them to use shared decision-making in their practice. The initial hypothesis of the researcher in this study was that SDM is not well understood by physicians, and that this lack of understanding, combined with other factors to be discussed in the full text, may result in patients receiving ethically-inappropriate treatment. Results suggest support for this hypothesis, and that SDM should be more closely examined if it is to be pursued as a method of decision making.
Collapse
Affiliation(s)
- Joshua T Landry
- Department of Clinical and Organizational Ethics, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| |
Collapse
|
30
|
Gurtner C, Schols JMGA, Lohrmann C, Halfens RJG, Hahn S. Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:531-548. [PMID: 33191536 DOI: 10.1111/jpm.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Shared decision-making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision-making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: A universal concept and understanding of shared decision-making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision-making refers to a process, and how and whether the patient wishes to participate in the decision-making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision-making process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The process of shared decision-making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision-making and provide additional information, if requested. ABSTRACT INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.
Collapse
Affiliation(s)
- Caroline Gurtner
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine & Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| |
Collapse
|
31
|
Feddersen N, Pape L, Beneke J, Brand K, Prüfe J. Adherence in pediatric renal recipients and its effect on graft outcome, a single-center, retrospective study. Pediatr Transplant 2021; 25:e13922. [PMID: 33227161 DOI: 10.1111/petr.13922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, treatment-adherence gained increasing attention in nearly every area of medicine including transplant medicine. Medication adherence following solid organ transplantation is known to be indispensable for a satisfactory allograft survival. METHODS We examined 60 patients between the ages of four months and 20 years who underwent kidney transplantation at Hannover Medical School between January 2011 and August 2017. Age at transplantation varied from 4 months to 20 years. 12 patients (20%) already underwent their second solid organ transplantation. 5 patients (8.3%) had a combined kidney-liver-transplantation. We used two different methods for rating adherence: An objective one based on the coefficient of variation (CoV%) of immunosuppressant trough levels, and a subjective questionnaire answered by the patients themselves, their parents or legal custodians, the treating pediatrician, as well as by the attending psychologist. RESULTS The CoV% in our study was by-trend higher in those patients who suffered from a biopsy-proven rejection (x̅CoV% = 35.7, σ CoV% = 30.1 in patients with rejection vs. x̅ CoV% = 26.0, σ CoV% = 10.5 in patients without rejection). Furthermore, the psychologist's assessment correlated significantly both with rejections as well as with the formation of de novo donor-specific antibodies (dnDSA) while the pediatrician's rating showed no correlation (Prejections = 0.005 and PdnDSA = 0.03 for psychologist's rating vs. Prejections = 0.50 and PdnDSA = 0.50 for pediatrician). CONCLUSIONS Apart from underlining the importance of medication adherence, the present research stresses the role of a multi-disciplinary treatment approach to support pediatric renal transplant recipients and their families.
Collapse
Affiliation(s)
- Nele Feddersen
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Clinic for Paediatrics III, Essen University Hospital, Essen, Germany
| | - Jan Beneke
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute for Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Jenny Prüfe
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Clinic for Paediatrics III, Essen University Hospital, Essen, Germany
| |
Collapse
|
32
|
Granström E, Wannheden C, Brommels M, Hvitfeldt H, Nyström ME. Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals' experiences from rheumatology care. BMC Health Serv Res 2020; 20:1108. [PMID: 33261602 PMCID: PMC7709268 DOI: 10.1186/s12913-020-05945-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/19/2020] [Indexed: 12/31/2022] Open
Abstract
Background Person-centered care (PCC) emphasize the importance of supporting individuals’ involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies’ relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients. Methods A single case study design was used. The qualitative data consisted of 14 semi-structured interviews and staff meeting minutes, covering the time period 2017–2019. The data were analyzed using conventional content analysis, complemented with document analyses. Results Ten strategies on two levels to operationalize PCC, and three categories of perceived impact were identified. On the individual patient level strategies involved several digital tools focusing on flexible access to care, mutual information sharing and the distribution of initiatives, tasks, and responsibilities from provider to patients. On the unit level, strategies concerned involving patient representatives and individual patients in development of digital services and work practices. The roles of both professionals and patients were affected and the importance of behavioral and cultural change became clear. Conclusions By providing an empirical example from chronic care the study contributes to the knowledge on strategies for achieving PCC, how digital tools and work practices interact, and how they can affect healthcare staff, patients and the unit. A conclusion is that the use of the digital tools, spanning over different dimensions of engagement, facilitated the healthcare professionals’ interaction with patients and the patients’ involvement in their own care. Digital tools complemented, rather than replaced, care practices.
Collapse
Affiliation(s)
- Emma Granström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden.
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Helena Hvitfeldt
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden.,Norrtälje Hospital, FoUU, SE-76129 Norrtälje, Sweden
| | - Monica E Nyström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden.,Department of Epidemiology and Global health, Umeå University, SE-90187 Umeå, Sweden
| |
Collapse
|
33
|
Glasdam S, Jacobsen CB, Boelsbjerg HB. Nurses' refusals of patient involvement in their own palliative care. Nurs Ethics 2020; 27:969733020929062. [PMID: 32627661 PMCID: PMC7564292 DOI: 10.1177/0969733020929062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. AIM To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. METHOD A case study based on an anthropological field study among patients with advanced cancer in Denmark. ETHICAL CONSIDERATIONS Followed the principles of the Helsinki Declaration. FINDINGS Two cases illustrated situations where nurses refused patient involvement in their own case. DISCUSSION Focus on two ethical issues, namely 'including patients' experiences in palliative nursing care' and 'relational distribution of power and knowledge', inspired primarily by Hannah Arendt's concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients' palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned 'thoughtlessness' of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients' invitations to involve them in their own case. CONCLUSION The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that 'thoughtlessness' appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses' ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
Collapse
|
34
|
Jervaeus A, Fritzell K, Hultcrantz R, Wengström Y, Kottorp A. Psychometric properties of the SCREESCO questionnaire used in a colorectal cancer screening programme-A Rasch analysis. J Eval Clin Pract 2020; 26:541-550. [PMID: 31758613 PMCID: PMC7155008 DOI: 10.1111/jep.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/12/2019] [Accepted: 10/02/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is one of the most common cancer diagnoses among both sexes. Sweden has not yet implemented any CRC screening programme, but a study, Screening of Swedish Colons (SCREESCO), is ongoing. The movement within the health care sector towards a more participatory perspective has led to the increased importance of shared decision making (SDM), and this is suggestively applied when deciding upon screening participation. There is no Swedish questionnaire for assessing the level of SDM in relation to CRC screening. Therefore, the CRC screening module of the National Survey of Medical Decisions was translated and culturally adapted into a Swedish context: the SCREESCO questionnaire. AIM The SCREESCO questionnaire requires further evaluation, and therefore, the aim, by using the Rasch approach, was to evaluate the psychometric properties of the SCREESCO questionnaire. METHODS A Rasch partial credit model was chosen to investigate the psychometric properties. The sample consisted of individuals invited to the SCREESCO programme, who have answered the SCREESCO questionnaire. RESULTS Rating scale structures indicated stability for the response structure used. Satisfactory evidence for validity of internal structure was also shown for the whole questionnaire and two of three concepts/subscales, after deletion of a few items. Validity in response processes indicated acceptable, or close to acceptable, findings, while the results for unidimensionality and differential item functioning (DIF) were somewhat mixed. Separation index revealed less satisfactory results, both for the whole questionnaire and the concepts/subscales. CONCLUSION This Rasch analysis of the SCREESCO questionnaire revealed that the questionnaire in its current form has difficulties to assess the level of SDM in relation to CRC screening. The achieved results will guide further evaluation and development with the long-term goal of having a Swedish questionnaire, to be used in the health care sector, assessing the level of SDM in relation to CRC screening.
Collapse
Affiliation(s)
- Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Theme cancer, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kottorp
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois.,Faculty of Health and Society, Malmö University, Malmö, Sweden
| |
Collapse
|
35
|
Patient-reported Outcome Measures: The FACE-Q Skin Cancer Module: The Dutch Translation and Linguistic Validation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2325. [PMID: 31772871 PMCID: PMC6846296 DOI: 10.1097/gox.0000000000002325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/29/2019] [Indexed: 01/30/2023]
Abstract
Background Patient-reported outcome measures are becoming a standard component in the evaluation of surgical treatments. In 2010, the FACE-Q skin cancer module was developed: an English psychometric validated questionnaire that measures both patient quality of life and satisfaction with the surgical experience. The questionnaire consists of 11 subscales with a total of 96 questions. An officially translated version in Dutch is needed for accepted use in the Netherlands. Methods We translated the FACE-Q skin cancer module from English into Dutch in accordance with to the International Society for Pharmacoeconomics and Outcomes Research and World Health Organization guidelines. The translation occurs in three stages. First, a forward translation is performed by two independent professional translators, where discrepancies are solved by a third translator, a subject area expert. Secondly, a backward translation is performed and is compared with the original. Any discrepancies are solved by an expert panel. Version two is then pretested (cognitive debriefing) by 30 patients who have had a resection (Mohs surgery) of non-melanoma skin cancer in the face followed by reconstruction. The results of the pretesting exercise are evaluated and a final version of the translation was produced by the expert panel. Results In the first step, a conceptually equivalent Dutch translation of the FACE-Q was translated. In the second phase, the comparison between the forward and backward translation led to multiple retranslations. In step three, 48 annotations were evaluated by the expert panel, which led to 26 minor changes in items or instructions. Conclusion We created a conceptually and linguistically similar translation of the FACE-Q Skin Cancer Module through a thorough translation and linguistic validation process.
Collapse
|
36
|
Kofahl C. [Collective patient centeredness and patient involvement through self-help groups]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:3-9. [PMID: 30515525 DOI: 10.1007/s00103-018-2856-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Over the last decades, health-related collective mutual aid, such as self-help groups, support groups and patient organizations, has become an important player in Germany's healthcare system. As autonomous collectives of patients and their relatives in manifold indication areas, they act and organize themselves on a voluntary basis. Increasingly, they have a greater say and are turning into collaborators in the development of the healthcare system. Self-help representatives are involved in committees as patient representatives on all political levels, national as well as federal state and local. In these roles they are also spokespersons for the interests of patients and their relatives.Self-help groups (SHGs) and self-help organizations (SHOs) are forming specific patient collectives that are seeking cooperation with the healthcare system. This article is about different forms and possibilities of inpatient and ambulatory healthcare institutions to achieve collective patient centeredness and patient involvement over and above individual patient centeredness. Furthermore, activities of SHGs and SHOs to promote their integration in healthcare structures are discussed.
Collapse
Affiliation(s)
- Christopher Kofahl
- Zentrum für Psychosoziale Medizin, Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| |
Collapse
|
37
|
Fernández-Ballesteros R, Sánchez-Izquierdo M, Olmos R, Huici C, Caprara MG, Santacreu M, Ribera Casado JM, Cruz-Jentoft A. Development and validation of a paternalism and autonomist care assessment. J Adv Nurs 2019; 75:3166-3178. [PMID: 31287167 DOI: 10.1111/jan.14154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022]
Abstract
AIM There is a need for a validated instrument to measure the type of care (paternalism or person-centred) provided for older adults. Since paternalism and person-centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. DESIGN Instrument development. METHODS After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016-2017: senior citizen centres and older adult day care centres. RESULTS The Paternalist/Autonomist Care Assessment (PACA) is a 30-item, behaviour-based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale- PACA-Appraisal) and the occurrence of behaviours (Occurrence of Care in Context- PACA-Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. CONCLUSION The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. IMPACT There are no validated instruments to measure paternalism and person-centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults.
Collapse
Affiliation(s)
| | | | - Ricardo Olmos
- Department of Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Carmen Huici
- Department of Social Psychology and Organizations, National University of Distance Education (UNED), Madrid, Spain
| | - María Giovanna Caprara
- Department of Personality, Evaluation and Psychological Treatments, National University of Distance Education (UNED), Madrid, Spain
| | - Marta Santacreu
- Department Psychology, Universidad Europea Madrid, Madrid, Spain
| | | | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| |
Collapse
|
38
|
El-Alti L, Sandman L, Munthe C. Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions? HEALTH CARE ANALYSIS 2019; 27:45-59. [PMID: 28936750 DOI: 10.1007/s10728-017-0347-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.
Collapse
Affiliation(s)
- Leila El-Alti
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Olof Wijksgatan 6, Box 200, 40530, Gothenburg, Sweden.
| | - Lars Sandman
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics, and Theory of Science, University of Gothenburg, Olof Wijksgatan 6, Box 200, 40530, Gothenburg, Sweden
| |
Collapse
|
39
|
Lee L, El-Den S, Horne R, Carter SR. Patient satisfaction with information, concerns, beliefs and adherence to topical corticosteroids. PATIENT EDUCATION AND COUNSELING 2019; 102:1203-1209. [PMID: 30928342 DOI: 10.1016/j.pec.2019.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/14/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Adherence to topical corticosteroids (TCS) for inflammatory skin conditions is sub-optimal. This Australian study aimed to test the hypothesis that patients who are more satisfied with the level of information they receive about TCS, are less concerned about using TCS and more adherent to healthcare professionals' instructions. METHODS Individuals who were prescribed or had used TCS in the past month were invited to complete an online cross-sectional survey. Reliability and validity of multi-item scales were tested using confirmatory factor analysis. Self-reported adherence to TCS was measured with MARS-5. Multivariate regression with mediation analyses was used to explore relationships between variables. RESULTS Mediation analyses of 195 survey (64.4%) responses was performed. Overall satisfaction with information about TCS action and usage (SIMS-AU) (mean = 60.7%) was higher than potential concerns (SIMS-PC) (mean = 48.2%). Analysis revealed that the SIMS subscales were highly correlated (α = 0.57, p < 0.05). Higher overall SIMS scores were predictive of stronger beliefs that TCS was beneficial, fewer concerns about TCS and better adherence. CONCLUSION Being more satisfied with TCS information was associated with having more favourable disposition towards TCS and higher adherence. PRACTICE IMPLICATIONS Healthcare professionals should identity areas of dissatisfaction with medication information and tailor their counselling accordingly.
Collapse
Affiliation(s)
- Ling Lee
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Sarira El-Den
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College, London, United Kingdom
| | - Stephen R Carter
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
| |
Collapse
|
40
|
Mahmood S, Hazes JMW, Veldt P, van Riel P, Landewé R, Bernelot Moens H, Pasma A. The Development and Evaluation of Personalized Training in Shared Decision-making Skills for Rheumatologists. J Rheumatol 2019; 47:290-297. [PMID: 30936289 DOI: 10.3899/jrheum.180780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Many factors influence a patient's preference in engaging in shared decision making (SDM). Several training programs have been developed for teaching SDM to physicians, but none of them focused on the patients' preferences. We developed an SDM training program for rheumatologists with a specific focus on patients' preferences and assessed its effects. METHODS A training program was developed, pilot tested, and given to 30 rheumatologists. Immediately after the training and 10 weeks later, rheumatologists were asked to complete a questionnaire to evaluate the training. Patients were asked before and after the training to complete a questionnaire on patient satisfaction. RESULTS Ten weeks after the training, 57% of the rheumatologists felt they were capable of estimating the need of patients to engage in SDM, 62% felt their communication skills had improved, and 33% reported they engaged more in SDM. Up to 268 patients were included. Overall, patient satisfaction was high, but there were no statistically significant differences in patient satisfaction before and after the training. CONCLUSION The training was received well by the participating rheumatologists. Even in a population of rheumatologists that communicates well, 62% reported improvement. The training program increased awareness about the principles of SDM in patients and physicians, and improved physicians' communicative skills, but did not lead to further improvement in patients' satisfaction, which was already high.
Collapse
Affiliation(s)
- Sehrash Mahmood
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands. .,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology.
| | - Johanna M W Hazes
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Petra Veldt
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Piet van Riel
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Robert Landewé
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Hein Bernelot Moens
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| | - Annelieke Pasma
- From the Amsterdam Rheumatology and Immunology Center, Amsterdam; Erasmus Medical Center, Department of Rheumatology, Rotterdam; Reinier de Graaf Gasthuis, Department of Rheumatology, Delft; Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen; Ziekenhuis Groep Twente, Department of Rheumatology, Almelo, the Netherlands.,S. Mahmood, MSc, Amsterdam Rheumatology and Immunology Center; J.M. Hazes, MD, PhD, Erasmus Medical Center, Department of Rheumatology; P. Veldt, MD, PhD, Reinier de Graaf Gasthuis, Department of Rheumatology; P. van Riel, MD, PhD, Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare; R. Landewé, MD, PhD, Amsterdam Rheumatology and Immunology Center; H. Bernelot Moens, MD, PhD, Ziekenhuis Groep Twente, Department of Rheumatology; A. Pasma, PhD, Erasmus Medical Center, Department of Rheumatology
| |
Collapse
|
41
|
Enzo A, Okita T, Asai A. What deserves our respect? Reexamination of respect for autonomy in the context of the management of chronic conditions. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:85-94. [PMID: 29845419 DOI: 10.1007/s11019-018-9844-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle-respect for autonomy-is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient's decisions, behaviors, emotions, or life-style regardless of his or her "autonomous" capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities.
Collapse
Affiliation(s)
- Aya Enzo
- Department of Medical Ethics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Taketoshi Okita
- Department of Medical Ethics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Atsushi Asai
- Department of Medical Ethics, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| |
Collapse
|
42
|
Rasoal D, Kihlgren A, Skovdahl K. Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach. BMC Geriatr 2018; 18:312. [PMID: 30547755 PMCID: PMC6293571 DOI: 10.1186/s12877-018-0996-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. Method This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis. Results The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. Conclusions This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.
Collapse
Affiliation(s)
- Dara Rasoal
- School of Health, Care and Social Welfare, Mälardalen University, Högskoleplan 1, 721 23, Västerås, Sweden.
| | - Annica Kihlgren
- Institution of Health and Medical Sciences, Örebro University, Faultetsgatan 1, 701 82, Örebro, Sweden
| | - Kirsti Skovdahl
- Faculty for Health and Social Sciences, University in South-Eastern Norway, Post box 235, 3603, Kongsberg, Norway
| |
Collapse
|
43
|
Lim D, Jung J. Racial-Ethnic Variations in Potentially Inappropriate Psychotropic Medication Use Among the Elderly. J Racial Ethn Health Disparities 2018; 6:436-445. [DOI: 10.1007/s40615-018-00541-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
|
44
|
Mertens BJ, Kwint HF, van Marum RJ, Bouvy ML. Are multidose drug dispensing systems initiated for the appropriate patients? Eur J Clin Pharmacol 2018; 74:1159-1164. [PMID: 29770839 PMCID: PMC6096704 DOI: 10.1007/s00228-018-2478-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE It is unknown if multidose drug dispensing (MDD) systems are initiated for the appropriate patients. Therefore, the objective of this study was to compare the medication management problems of patients who were about to start with a MDD system (MDD patients) and patients who continued manually dispensed medication (non-MDD users) in order to identify if the appropriate patients receive a MDD system. METHODS Patient interviews (semi-structured) were conducted by 44 community pharmacists at the patient's home. Patients over 65 years of age, home dwelling and using at least five chronic drugs, were eligible for the study. An assessment tool was developed including 22 potential medication management problems, covering four domains: functional (7), organizational (7), medication adherence (6), and medication knowledge (2). Median scores were calculated with the interquartile range. Additionally, cognitive function was assessed with the Mini-Cog and frailty using the Groningen Frailty Indicator. RESULTS One hundred eighty-eight MDD users and 230 non-MDD users were interviewed. MDD users were older, more often female, and using more drugs. Forty-two percent of the MDD users were possibly cognitively impaired and 63% were assessed as frail compared to 20 and 27% respectively of the non-MDD users. MDD users had more potential organizational problems (3 vs. 1; p < 0.01), functional problems (2 vs. 1; p < 0.01), medication adherence problems (1 vs. 0; p < 0.01), and medication knowledge problems (1 vs. 0; p < 0.01) compared to non-MDD users. Seventy percent of the MDD users scored six or more potential medication management problems while this was 22% among non-MDD users. CONCLUSIONS The majority of MDD systems were initiated for patients who experienced multiple potential medication management problems suggesting a decreased medication management capacity.
Collapse
Affiliation(s)
- Bram J. Mertens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- SIR Institute for Pharmacy Practice and Policy, Leiden, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands
| | - H. F. Kwint
- SIR Institute for Pharmacy Practice and Policy, Leiden, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands
| | - Rob J. van Marum
- Geriatric Department, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
- Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Marcel L. Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
- SIR Institute for Pharmacy Practice and Policy, Leiden, Theda Mansholtstraat 5b, 2331 JE Leiden, The Netherlands
| |
Collapse
|
45
|
Lau SR, Kriegbaum M. Medication non-adherence in the context of situated uncertainty: Moving beyond simple, dichotomous approaches. Res Social Adm Pharm 2018; 14:742-748. [DOI: 10.1016/j.sapharm.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/18/2023]
|
46
|
The Digital Drag and Drop Pillbox: Design and Feasibility of a Skill-based Education Model to Improve Medication Management. J Cardiovasc Nurs 2018; 32:E14-E20. [PMID: 28282304 PMCID: PMC5559183 DOI: 10.1097/jcn.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: We present the design and feasibility testing for the “Digital Drag and Drop Pillbox” (D-3 Pillbox), a skill-based educational approach that engages patients and providers, measures performance, and generates reports of medication management skills. Methods: A single-cohort convenience sample of patients hospitalized with heart failure was taught pill management skills using a tablet-based D-3 Pillbox. Medication reconciliation was conducted, and aptitude, performance (% completed), accuracy (% correct), and feasibility were measured. Results: The mean age of the sample (n = 25) was 59 (36–89) years, 50% were women, 62% were black, 46% were uninsured, 46% had seventh-grade education or lower, and 31% scored very low for health literacy. However, most reported that the D-3 Pillbox was easy to read (78%), easy to repeat-demonstrate (78%), and comfortable to use (tablet weight) (75%). Accurate medication recognition was achieved by discharge in 98%, but only 25% reported having a “good understanding of my responsibilities.” Conclusions: The D-3 Pillbox is a feasible approach for teaching medication management skills and can be used across clinical settings to reinforce skills and medication list accuracy.
Collapse
|
47
|
Wigfall LT, Tanner AH. Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:67-73. [PMID: 27251634 PMCID: PMC5135653 DOI: 10.1007/s13187-016-1052-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study is to examine the relationship between health literacy, health-care engagement, and shared decision-making (SDM). We analyzed Health Information National Trends Survey 4 (cycle 3) data for 1604 information seekers who had one or more non-emergency room health-care visits in the previous year. SDM was more than two times higher among adults who "always" versus "usually/sometimes/never" take health information to doctor visits (OR = 2.54; 95 % CI 1.19-5.43). There was a twofold increase in SDM among adults who were "completely/very confident" versus "somewhat/a little/not confident" about finding health information (OR = 2.03; 95 % CI 1.37-3.02). Differences in SDM between adults who understood health information and those who had difficulty understanding health information were not statistically significant (OR = 1.39; 95 % CI 0.93-2.07). A Healthy People 2020 goal is to increase SDM. Previous research has suggested that SDM may improve health outcomes across the continuum of care. Only about half of adults report always being involved in health-care decisions. Even more alarming is the fact that SDM has not increased from 2003 to 2013. Our findings suggest that increasing health literacy has the potential to increase health-care engagement and subsequently increase SDM. Effective intervention strategies are needed to improve health literacy and promote health-care engagement.
Collapse
Affiliation(s)
- Lisa T Wigfall
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 237, 29208, Columbia, SC, USA.
- South Carolina Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 237, 29208, Columbia, SC, USA.
| | - Andrea H Tanner
- School of Journalism and Mass Communications, University of South Carolina, 800 Sumter Street, Office 322, Columbia, 29208, SC, USA
| |
Collapse
|
48
|
Finlay KA, Peacock S, Elander J. Developing successful social support: An interpretative phenomenological analysis of mechanisms and processes in a chronic pain support group. Psychol Health 2018; 33:846-871. [PMID: 29300123 DOI: 10.1080/08870446.2017.1421188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The experience of long-term membership of a successful chronic pain support group (CPSG) was explored to identify; (i) factors associated with social support, and; (ii) ways that health care professionals (HCPs) could help CPSGs become more effective and supportive. DESIGN Interpretative Phenomenological Analysis enabled exploration of participants' experiences of membership and rationales for continued attendance. MAIN OUTCOME MEASURES Twelve participants (four males, eight females), recruited from a regional CPSG, completed semi-structured interviews lasting from 45 to 120 minutes. Following verbatim transcription, idiographic then cross-case analyses were undertaken. RESULTS Three superordinate themes emerged: (1) Investing in the new normal; (2) The nurturing environment; (3) Growth facilitation through social evolution. Increased investment and identification with membership, generated snowballing social engagement, enhancing pain management/well-being through collective humour and peer-to-peer support. Explicit guidance by HCPs in early stages of group formation/development, and subsequent implicit influences on group attitudes and actions, promoted the group's development into its current healthy, supportive state. CONCLUSION Contrary to stereotypes, membership offered positive respite from chronic pain through collective coping. Successful CPSGs forge an independent identity, fostering strong group investment and an ability to live well with chronic pain. HCPs can provide a stabilising foundation for CPSGs to develop positively and supportively.
Collapse
Affiliation(s)
- Katherine A Finlay
- a Department of Psychology, School of Science and Postgraduate Medicine , University of Buckingham , Buckingham , UK
| | - Sue Peacock
- b Department of Health Psychology , Milton Keynes Hospital NHS Foundation Trust , Milton Keynes , UK
| | - James Elander
- c Centre for Psychological Research , University of Derby , Derby , UK
| |
Collapse
|
49
|
Acerini CL, Segal D, Criseno S, Takasawa K, Nedjatian N, Röhrich S, Maghnie M. Shared Decision-Making in Growth Hormone Therapy-Implications for Patient Care. Front Endocrinol (Lausanne) 2018; 9:688. [PMID: 30524377 PMCID: PMC6262035 DOI: 10.3389/fendo.2018.00688] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/02/2018] [Indexed: 12/19/2022] Open
Abstract
Several studies have shown that adherence to growth hormone therapy (GHT) is not optimal. There are several reasons why patients may not fully adhere to their treatment regimen and this may have implications on treatment success, patient outcomes and healthcare spending and resourcing. A change in healthcare practices, from a physician paternalistic to a more patient autonomous approach to healthcare, has encouraged a greater onus on a shared decision-making (SDM) process whereby patients are actively encouraged to participate in their own healthcare decisions. There is growing evidence to suggest that SDM may facilitate patient adherence to GHT. Improved adherence to therapy in this way may consequently positively impact treatment outcomes for patients. Whilst SDM is widely regarded as a healthcare imperative, there is little guidance on how it should be best implemented. Despite this, there are many opportunities for the implementation of SDM during the treatment journey of a patient with a GH-related disorder. Barriers to the successful practice of SDM within the clinic may include poor patient education surrounding their condition and treatment options, limited healthcare professional time, lack of support from clinics to use SDM, and healthcare resourcing restrictions. Here we discuss the opportunities for the implementation of SDM and the barriers that challenge its effective use within the clinic. We also review some of the potential solutions to overcome these challenges that may prove key to effective patient participation in treatment decisions. Encouraging a sense of empowerment for patients will ultimately enhance treatment adherence and improve clinical outcomes in GHT.
Collapse
Affiliation(s)
- Carlo L. Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Carlo L. Acerini
| | - David Segal
- Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Sherwin Criseno
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kei Takasawa
- Department of Paediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | - Mohamad Maghnie
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
| |
Collapse
|
50
|
Wood B, Russell VL, El-Khatib Z, McFaul S, Taljaard M, Little J, Graham ID. "They Should Be Asking Us": A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening. Glob Qual Nurs Res 2018; 5:2333393618783632. [PMID: 30014003 PMCID: PMC6041998 DOI: 10.1177/2333393618783632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 01/13/2023] Open
Abstract
In this study, we examine from multiple perspectives, women's shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a "decision," which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.
Collapse
Affiliation(s)
| | | | - Ziad El-Khatib
- Karolinska Institutet, Stockholm, Sweden
- Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | | | - Monica Taljaard
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | |
Collapse
|