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Rosca A, Karzig-Roduner I, Kasper J, Rogger N, Drewniak D, Krones T. Shared decision making and advance care planning: a systematic literature review and novel decision-making model. BMC Med Ethics 2023; 24:64. [PMID: 37580704 PMCID: PMC10426137 DOI: 10.1186/s12910-023-00944-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND AIMS Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process. METHODS In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process. RESULTS The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice. CONCLUSION To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.
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Affiliation(s)
- Ana Rosca
- Clinical ethics, Stadtspital Zürich, Birmensdorferstrasse 497, Zürich, 8063, Switzerland.
| | - Isabelle Karzig-Roduner
- Institute of Biomedical Ethics and History of Medicine, Clinical Ethics, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Oslo metropolitan Universita, Oslo, Norway
| | - Niek Rogger
- University of Applied Sciences Leiden, Leiden, Netherlands
| | - Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Zürich, Switzerland
| | - Tanja Krones
- Institute of Biomedical Ethics and History of Medicine, Clinical Ethics, University of Zürich, University Hospital Zürich, Zürich, Switzerland
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Ecarnot F, Meunier-Beillard N, Seronde MF, Chopard R, Schiele F, Quenot JP, Meneveau N. End-of-life situations in cardiology: a qualitative study of physicians' and nurses' experience in a large university hospital. BMC Palliat Care 2018; 17:112. [PMID: 30290818 PMCID: PMC6173879 DOI: 10.1186/s12904-018-0366-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. METHODS We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses' aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienced end-of-life situations. Interviews were recorded, transcribed and coded using thematic analysis to identify major and secondary themes. RESULTS All physicians (N = 16)(average age 43.5 ± 13 years), 16 nurses (average age 38.5 ± 7.6 years) and 5 nurses' aides (average age 49 ± 7.8 years) participated. Interviews were held between 30 March and 17 July 2017. The main themes to emerge from the physicians' discourse were the concept of cardiology being a very active discipline, and a very curative frame of mind was prevalent. Communication (with paramedical staff, patients and families) was deemed to be important. Advance directives were thought to be rare, and not especially useful. Nurses also reported communication as a major issue, but their form of communication is bounded by several factors (physicians' prior discourse, legislation). They commonly engage in reconciling: between the approach (curative or palliative) and the reality of the treatment prescribed; performing curative interventions in patients they deem to be dying cases causes them distress. The emergency context prevents nurses from taking the time necessary to engage in end-of-life discussions. They engage in comfort-giving behaviors to maximize patient comfort. CONCLUSION Current perceptions and practices vis-à-vis end-of-life situations in our department are individual, heterogeneous and not yet aligned with recommendations of professional societies.
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Affiliation(s)
- Fiona Ecarnot
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France. .,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France.
| | - Nicolas Meunier-Beillard
- Department of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.,Department of Sociology, Centre Georges Chevrier UMR 7366 CNRS, University of Burgundy, 21000, Dijon, France
| | - Marie-France Seronde
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - Romain Chopard
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.,Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000, Dijon, France.,Inserm CIC 1432, Clinical Epidemiology, University of Burgundy, 21000, Dijon, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, 3 Boulevard Fleming, 25000, Besançon, France.,EA3920, University of Burgundy Franche-Comté, 25000, Besançon, France
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