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Jagpal SK, Alismail A, Lin E, Blackwell L, Ahmed N, Lee MM, Chiarchiaro J. Beyond the Individual: A Multidisciplinary Model for Critical Thinking in the Intensive Care Unit. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:409-417. [PMID: 38764787 PMCID: PMC11102104 DOI: 10.2147/amep.s429982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/19/2024] [Indexed: 05/21/2024]
Abstract
Health profession educators readily identify with the goal of fostering healthcare providers who are critical thinkers focused on quality patient care. In the following paper, we aim to delve into critical thinking at the team level and help educators begin the process of creating a shared mental model focusing on cognition to identify gaps and opportunities for growth in their trainees. We will distinguish between microcognition (an individual's own critical thinking process in a controlled environment), macrocognition (critical thinking process in a real-world environment), and team cognition (the interaction and relationship among team members to augment macrocognition). A common case example will be used to guide the discussion as well as provide a model framework to be used for clinician educators in the future.
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Affiliation(s)
- Sugeet K Jagpal
- Division of Pulmonary, Critical Care and Sleep Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, USA
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Erica Lin
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lauren Blackwell
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA
| | - Nayla Ahmed
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - May M Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, University of South California, Los Angeles, CA, USA
| | - Jared Chiarchiaro
- Division of Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
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Saban M, Dubovi I. A comparative vignette study: Evaluating the potential role of a generative AI model in enhancing clinical decision-making in nursing. J Adv Nurs 2024. [PMID: 38366690 DOI: 10.1111/jan.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIM This study explores the potential of a generative artificial intelligence tool (ChatGPT) as clinical support for nurses. Specifically, we aim to assess whether ChatGPT can demonstrate clinical decision-making equivalent to that of expert nurses and novice nursing students. This will be evaluated by comparing ChatGPT responses to clinical scenarios to those of nurses on different levels of experience. DESIGN This is a cross-sectional study. METHODS Emergency room registered nurses (i.e. experts; n = 30) and nursing students (i.e. novices; n = 38) were recruited during March-April 2023. Clinical decision-making was measured using three validated clinical scenarios involving an initial assessment and reevaluation. Clinical decision-making aspects assessed were the accuracy of initial assessments, the appropriateness of recommended tests and resource use and the capacity to reevaluate decisions. Performance was also compared by timing response generations and word counts. Expert nurses and novice students completed online questionnaires (via Qualtrics), while ChatGPT responses were obtained from OpenAI. RESULTS Concerning aspects of clinical decision-making and compared to novices and experts: (1) ChatGPT exhibited indecisiveness in initial assessments; (2) ChatGPT tended to suggest unnecessary diagnostic tests; (3) When new information required re-evaluation, ChatGPT responses demonstrated inaccurate understanding and inappropriate modifications. In terms of performance, the mean number of words utilized in ChatGPT answers was 27-41 times greater than that utilized by both experts and novices; and responses were provided approximately 4 times faster than those of novices and twice faster than expert nurses. ChatGPT responses maintained logical structure and clarity. CONCLUSIONS A generative AI tool demonstrated indecisiveness and a tendency towards over-triage compared to human clinicians. IMPACT The study shows that it is important to approach the implementation of ChatGPT as a nurse's digital assistant with caution. More study is needed to optimize the model's training and algorithms to provide accurate healthcare support that aids clinical decision-making. REPORTING METHOD This study adhered to relevant EQUATOR guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION Patients were not directly involved in the conduct of this study.
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Affiliation(s)
- Mor Saban
- Nursing Department, Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Dubovi
- Nursing Department, Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Gazaway S, Gutierrez O, Wells R, Nix‐Parker T, Lyas C, Daniel S, Lang‐Lindsey K, Bryant T, Knight R, Odom JN. Exploring the health-related decision-making experiences of people with chronic kidney disease and their caregivers: A qualitative study. Health Expect 2023; 27:e13907. [PMID: 37926914 PMCID: PMC10757106 DOI: 10.1111/hex.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the decision-making experience of patients with chronic kidney disease (CKD) and their caregivers. METHODS This was a qualitative descriptive study of the decision-making experiences of individuals with stage 3-end-stage CKD and their family caregivers. One-on-one, semistructured interviews were conducted using a guide developed and approved by a community advisory group. Data were analyzed using thematic analysis. RESULTS Three themes were identified: (1) decisions triggered by declining health and broad in scope, (2) challenges to decision-making and (3) factors influencing decision-making. Participants' experiences with health-related decision-making demonstrated that decisions were triggered when health declined. Yet, decisions that impact disease progression were being made in stage 3. Decision-making was made difficult due to lack of information, complex co-morbidities, and poor resource utilization. However, the structure and nature of the medical appointment, supportive caregivers, and resources served to remove challenges. CONCLUSION Decision-support interventions must train patients and caregivers to be empowered participants in answer-seeking behaviours upstream of advanced illness. PUBLIC CONTRIBUTIONS This work was conducted in full collaboration with a community advisory board consisting of patients with CKD, caregivers and clinicians. These members are noted in the acknowledgement section, and those who worked with the team to develop the interview guide, study protocols, and manuscript preparation are included as authors. As part of their role, advisory members met monthly, providing input on recruitment, study progress, inclusion of diverse voices and added relevance to study findings.
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Affiliation(s)
- Shena Gazaway
- Division Family, Commuity, & Health Systems, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Orlando Gutierrez
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tamara Nix‐Parker
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Claretha Lyas
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Shawona Daniel
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katina Lang‐Lindsey
- Department of Social Work, Psychology and CounselingAlabama A&M UniversityHuntsvilleAlabamaUSA
| | | | | | - James N. Odom
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Wang M, Perzynski A, Ronis S. Bringing community oriented primary care into an academic training setting: A qualitative study. Prev Med Rep 2023; 35:102313. [PMID: 37752984 PMCID: PMC10518791 DOI: 10.1016/j.pmedr.2023.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 09/28/2023] Open
Abstract
Objectives Identify patient-informed strategies through which an urban resident continuity clinic can implement the principles of community oriented primary care (COPC). Methods As part of a larger sequential mixed methods study supporting implementation evaluation of a new urban academic medical center in Cleveland, Ohio, semi-structured telephone interviews using a descriptive phenomenological approach were conducted spring 2021 with patients to explore perspectives regarding community involvement by healthcare providers and what they want clinicians to know about their community. A constant comparative analysis of emerging themes was used to analyze the thematic contents of interviews. Results Twenty-one participants completed interviews. Almost all thought clinicians' community involvement is important. Thematic guidance from participants highlighted that clinicians should be: (1) knowledgeable about the Black experience, (2) seen in the community outside the clinic, and (3) aware that "knowing my community is knowing me." Conclusions Design with a target community in mind is a necessary but not sufficient step to implement COPC in practice. The visibility of clinicians in community settings is essential for COPC.
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Affiliation(s)
- Mia Wang
- Case Western Reserve School of Medicine, Department of Population and Quantitative Health Sciences, Cleveland, OH, United States
| | - Adam Perzynski
- Case Western Reserve School of Medicine, Department of Population and Quantitative Health Sciences, Cleveland, OH, United States
| | - Sarah Ronis
- University Hospitals, Rainbow Center for Child Health and Policy, Cleveland, OH, United States
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Epstein RM, Beach MC. "I don't need your pills, I need your attention:" Steps toward deep listening in medical encounters. Curr Opin Psychol 2023; 53:101685. [PMID: 37659284 DOI: 10.1016/j.copsyc.2023.101685] [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: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 09/04/2023]
Abstract
Patients highly value being listened to, taken seriously, heard, and understood; indeed, listening to patients is essential to alleviate suffering. Yet listening as a clinical skill has been virtually ignored in the training of physicians. In this paper, we synthesize literature related to listening in medicine and explore the internal and external challenges and complexity of listening - including the need to listen with a diagnostic as well as a relational ear to take in physical symptoms, emotions, and contexts - often in chaotic and time-pressured environments. We suggest physicians focus on the development of "deep listening" skills, involving cultivating curiosity, openness, reflective self-questioning, and epistemic reciprocity; we also suggest how to ensure patients know they are being listened to.
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Affiliation(s)
- Ronald M Epstein
- Center for Communication and Disparities Research, Departments of Family Medicine and Medicine (Palliative Care), Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 1381 South Avenue, Rochester, NY 14620, USA.
| | - Mary Catherine Beach
- Department of Medicine (General Internal Medicine), School of Medicine, Berman Institute of Bioethics, Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21287, USA
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Verheijden M, Giroldi E, van den Eertwegh V, Luijkx M, van der Weijden T, de Bruin A, Timmerman A. Identifying characteristics of a skilled communicator in the clinical encounter. MEDICAL EDUCATION 2023; 57:418-429. [PMID: 36223270 DOI: 10.1111/medu.14953] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. METHOD In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. RESULTS Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. CONCLUSIONS We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.
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Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marscha Luijkx
- Department of Family Medicine, School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anique de Bruin
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Dwyer LA, Epstein RM, Feeney BC, Blair IV, Bolger N, Ferrer RA. Responsive social support serves important functions in clinical communication: Translating perspectives from relationship science to improve cancer clinical interactions. Soc Sci Med 2022; 315:115521. [PMID: 36384086 PMCID: PMC9722606 DOI: 10.1016/j.socscimed.2022.115521] [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: 03/02/2022] [Revised: 07/26/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Patient-clinician interactions are critical to patient-centered care, including in cancer care contexts which are often defined by multiple patient-clinician interactions over an extended period. Research on these dyadic interactions has been guided by perspectives in clinical communication science, but the study of clinical communication has not been fully integrated with perspectives on interpersonal interactions from relationship science research. An overlapping concept in both fields is the concept of responsive socialsupport. In this article, we discuss responsiveness as a concept that offers opportunities for connections between these two disciplines. Next, we focus on how relationship science can be applied to research in clinical settings. We discuss how three areas of relationship science define responsiveness and have potential for extension to clinical communication: (1) (in)visibility of social support, (2) attachment orientations, and (3) shared meaning systems. We also discuss how social biases can impede responsiveness and suggest research avenues to develop ideas and understand potential challenges in connecting these two fields. Many opportunities exist for interdisciplinary theory development that can generate momentum in understanding interpersonal processes in cancer care.
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Affiliation(s)
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brooke C Feeney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Lynch JM, van Driel M, Meredith P, Stange KC, Getz L, Reeve J, Miller WL, Dowrick C. The Craft of Generalism clinical skills and attitudes for whole person care. J Eval Clin Pract 2022; 28:1187-1194. [PMID: 34652051 DOI: 10.1111/jep.13624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to describe the practical and philosophically robust ways that understanding about the whole person is formed. In this paper we describe first principles of generalist approaches to knowledge formation in clinical practice. We name the Craft of Generalism. METHODS The newly described methodology of Transdisciplinary Generalism is examined by skilled generalist clinicians and translated into skills and attitudes useful for everyday generalist person-centred practice and research. RESULTS The Craft of Generalism defines the required scope, process, priorities, and knowledge management skills of all generalists seeking to care for the whole person. These principles are Whole Person Scope, Relational Process, Healing Orientation, and Integrative Wisdom. These skills and attitudes are required for whole person care. If any element of these first principles is left out, the resultant knowledge is incomplete and philosophically incoherent. CONCLUSIONS Naming the Craft of Generalism defines the generalist gaze and protects generalism from the colonization of a narrowed medical gaze that excludes all but reductionist evidence or constructivist experience. Defining the Craft of Generalism enables clear teaching of the sophisticated skills and attitudes of the generalist clinician. These philosophically robust principles encourage and defend the use of generalist approaches to knowledge in settings across the community - including health policy, education, and research.
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Affiliation(s)
- Johanna M Lynch
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia.,Integrate Place at Zest Infusion, Birkdale, Queensland, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
| | - Pamela Meredith
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Linn Getz
- Department of Public Health and Nursing, NTNU: Norwegian University of Science and Technology, Trondheim, Norway
| | - Joanne Reeve
- Primary Care Research, Hull York Medical School, Hull, UK
| | - William L Miller
- Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.,Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Christopher Dowrick
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Hayer N, Wassif HS. General dental practitioners' perceptions of shared decision making: a qualitative study. Br Dent J 2022; 232:227-231. [PMID: 35217743 PMCID: PMC8881214 DOI: 10.1038/s41415-022-3980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/07/2021] [Indexed: 11/21/2022]
Abstract
Introduction As patient-centred care becomes more of the focus in healthcare, informed consent is receiving more attention in dental practice as the pinnacle principle in patient care. Shared decision making or person-centred care appears to be taking a back foot in dentistry. Aim This study aims to gain insight into the current views and perceptions of shared decision making by general dental practitioners and how it can be utilised in daily practice. Method Empirical qualitative data were collected using semi-structured interviews of nine dentists working in general practice, with an average of 30 minutes for each interview. The data were analysed using thematic analysis. Results Overall, there was a misunderstanding of what constitutes shared decision making among dental practitioners, with communication focused more on information provision rather than collaborative discussion. There were barriers which prevented full discussions with patients from occurring, some of which directly conflicted with the focus of shared decision making. Conclusion There is a need to provide more clarity of what shared decision making is and how it can facilitate person-centred care in dental practice. Dental practitioners felt that standards and guidelines were not clear; therefore, they were confused as to what was expected of them with regards to communication. More support, in the form of standardised decision-making aids, is needed to assist dental practitioners to streamline the delivery of shared decision making in primary care. Explores the subject of shared decision making in dental practice. Presents an insight into the current views and perceptions of shared decision making by general dental practitioners. Discusses some of the barriers to using shared decision making in dental practice with some suggestions about how to better support dental practitioners.
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Affiliation(s)
- Natasha Hayer
- Dental Surgery, 180 Northridge Way, Hemel Hempstead, HP1 2AL, UK
| | - Hoda S Wassif
- University of Bedfordshire, Healthcare Practice, Putteridge Bury Campus, Hitchin Road, Luton, LU2 8LE, UK.
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Steen R, Pollock K. Effect of stress on safety‐critical behaviour: An examination of combined resilience engineering and naturalistic decision‐making approaches. JOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT 2022. [DOI: 10.1111/1468-5973.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Riana Steen
- Department of Accounting and Operations Management BI Norwegian Business School Stavanger Norway
| | - Kevin Pollock
- UK Cabinet Office Emergency Planning College York UK
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Epstein RM. Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind. PATIENT EDUCATION AND COUNSELING 2021; 104:2635-2642. [PMID: 34334265 DOI: 10.1016/j.pec.2021.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epistemic uncertainty refers to situations in which available evidence is insufficient or unreliable, often accompanied by complexity due to novel contexts, multifactorial causation, and emerging options (the "unknowable unknown"). It stands in contrast to aleatory uncertainty where probabilities are known, and potential benefits and harms can be calculated and presented graphically (the "knowable unknown"). DISCUSSION Epistemic uncertainty is common, and encompasses uncertainty about the nature of the illness, whom to entrust with one's care, and one's ability to adapt and cope. Communication about the "unknowable unknown" occurs infrequently and ineffectively, and there is little research on improving communication in the face of epistemic and complex uncertainty. Terror Management Theory (TMT) predicts that in encountering serious illness, people engage in "worldview defense" - suppressing death-related thoughts, affiliating with like-minded others, and developing cognitive rigidity and intolerance of information that challenges their worldview. Mindfulness is associated with diminished defensive worldview reactions and cognitive rigidity, and greater tolerance of ambiguity. Shared mind encompasses shared understanding and affective attunement. CONCLUSION For clinicians and seriously ill patients facing epistemic uncertainty, psychologically-informed interventions that promote mindfulness and shared mind offer promise in promoting open discussions regarding prognostic uncertainty, advance care planning, and treatment decision-making.
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Affiliation(s)
- Ronald M Epstein
- Center for Communication and Disparities Research, Department of Family Medicine, and Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Kiker WA, Rutz Voumard R, Andrews LIB, Holloway RG, Brumback LC, Engelberg RA, Curtis JR, Creutzfeldt CJ. Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury. JAMA Netw Open 2021; 4:e2128991. [PMID: 34673964 PMCID: PMC8531991 DOI: 10.1001/jamanetworkopen.2021.28991] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Shared decision-making requires key stakeholders to align in perceptions of prognosis and likely treatment outcomes. OBJECTIVE For patients with severe acute brain injury, the objective of this study was to better understand prognosis discordance between physicians and families by determining prevalence and associated factors. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods cross-sectional study analyzed a cohort collected from January 4, 2018, to July 22, 2020. This study was conducted in the medical and cardiac intensive care units of a single neuroscience center. Participants included families, physicians, and nurses of patients admitted with severe acute brain injury. EXPOSURES Severe acute brain injury was defined as stroke, traumatic brain injury, or hypoxic ischemic encephalopathy with a Glasgow Coma Scale score less than or equal to 12 points after hospital day 2. MAIN OUTCOMES AND MEASURES Prognosis discordance was defined as a 20% or greater difference between family and physician prognosis predictions; misunderstanding was defined as a 20% or greater difference between physician prediction and the family's estimate of physician prediction; and optimistic belief difference was defined as any difference (>0%) between family prediction and their estimate of physician prediction. Logistic regression was used to identify associations with discordance. Optimistic belief differences were analyzed as a subgroup of prognosis discordance. RESULTS Among 222 enrolled patients, prognostic predictions were available for 193 patients (mean [SD] age, 57 [19] years; 106 men [55%]). Prognosis discordance occurred for 118 patients (61%) and was significantly more common among families who identified with minoritized racial groups compared with White families (odds ratio [OR], 3.14; CI, 1.40-7.07, P = .006); among siblings (OR, 4.93; 95% CI, 1.35-17.93, P = .02) and adult children (OR, 2.43; 95% CI, 1.10-5.37; P = .03) compared with spouses; and when nurses perceived family understanding as poor compared with good (OR, 3.73; 95% CI, 1.88-7.40; P < .001). Misunderstanding was present for 80 of 173 patients (46%) evaluated for this type of prognosis discordance, and optimistic belief difference was present for 94 of 173 patients (54%). In qualitative analysis, faith and uncertainty emerged as themes underlying belief differences. Nurse perception of poor family understanding was significantly associated with misunderstanding (OR, 2.06; 95% CI, 1.07-3.94; P = .03), and physician perception with optimistic belief differences (OR, 2.32; 95% CI, 1.10-4.88; P = .03). CONCLUSIONS AND RELEVANCE Results of this cross-sectional study suggest that for patients with severe acute brain injury, prognosis discordance between physicians and families was common. Efforts to improve communication and decision-making should aim to reduce this discordance and find ways to target both misunderstanding and optimistic belief differences.
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Affiliation(s)
- Whitney A. Kiker
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Rachel Rutz Voumard
- Harborview Medical Center, Department of Neurology, University of Washington, Seattle
- Palliative and Supportive Care Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Leah I. B. Andrews
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Robert G. Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Lyndia C. Brumback
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Ruth A. Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - J. Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Claire J. Creutzfeldt
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
- Harborview Medical Center, Department of Neurology, University of Washington, Seattle
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Dencker A, Tjørnhøj-Thomsen T, Pedersen PV. A qualitative study of mechanisms influencing social inequality in cancer communication. Psychooncology 2021; 30:1965-1972. [PMID: 34278655 DOI: 10.1002/pon.5767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To understand and describe mechanisms influencing social inequality in cancer communication between patients, companions and healthcare professionals. METHODS The study was based on observations of 104 encounters and 30 semi-structured interviews with nurses and medical doctors on three Danish oncology wards. Observations, interviews and subsequent analysis were guided by the theoretical framework of cultural health capital developed by Shim to investigate mechanisms that may generate social inequality in cancer communication. The analysis addressed both interactive processes and interpretative meanings. RESULTS Information exchange was affected by (1) patient insight and preparation, (2) the presence of companions, and (3) communicating on patients' "home ground." Patients who, on the basis of language and hygiene, were assessed to have low capacity, received less information. Lack of mutual exchange of information left healthcare professionals and patients with fewer opportunities to provide-or receive-the best treatment. CONCLUSION Exchange of information between patients, companions and healthcare professionals is co-constructed in a mutual dynamic. To avoid social inequality in cancer communication, it is crucial that questions and answers allow proportionate insight into disease and treatment both for patients and for healthcare professionals.
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Affiliation(s)
- Annemarie Dencker
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark.,Department for Research, The Danish National Center for Grief, København, Denmark
| | - Tine Tjørnhøj-Thomsen
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark
| | - Pia Vivian Pedersen
- Research Department for Health and Social Context, National Institute of Public Health, University of Southern Denmark, København, Denmark
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Valentine N, Durning S, Shanahan EM, Schuwirth L. Fairness in human judgement in assessment: a hermeneutic literature review and conceptual framework. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:713-738. [PMID: 33123837 DOI: 10.1007/s10459-020-10002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Human judgement is widely used in workplace-based assessment despite criticism that it does not meet standards of objectivity. There is an ongoing push within the literature to better embrace subjective human judgement in assessment not as a 'problem' to be corrected psychometrically but as legitimate perceptions of performance. Taking a step back and changing perspectives to focus on the fundamental underlying value of fairness in assessment may help re-set the traditional objective approach and provide a more relevant way to determine the appropriateness of subjective human judgements. Changing focus to look at what is 'fair' human judgement in assessment, rather than what is 'objective' human judgement in assessment allows for the embracing of many different perspectives, and the legitimising of human judgement in assessment. However, this requires addressing the question: what makes human judgements fair in health professions assessment? This is not a straightforward question with a single unambiguously 'correct' answer. In this hermeneutic literature review we aimed to produce a scholarly knowledge synthesis and understanding of the factors, definitions and key questions associated with fairness in human judgement in assessment and a resulting conceptual framework, with a view to informing ongoing further research. The complex construct of fair human judgement could be conceptualised through values (credibility, fitness for purpose, transparency and defensibility) which are upheld at an individual level by characteristics of fair human judgement (narrative, boundaries, expertise, agility and evidence) and at a systems level by procedures (procedural fairness, documentation, multiple opportunities, multiple assessors, validity evidence) which help translate fairness in human judgement from concepts into practical components.
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Affiliation(s)
- Nyoli Valentine
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia.
| | - Steven Durning
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ernst Michael Shanahan
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
| | - Lambert Schuwirth
- Prideaux Health Professions Education, Flinders University, Bedford Park 5042, SA, Australia
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15
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Saban M, Drach-Zahavy A, Dagan E. A novel reflective practice intervention improves quality of care in the emergency department. Int Emerg Nurs 2021; 56:100977. [PMID: 33819845 DOI: 10.1016/j.ienj.2021.100977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/08/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Most interventions to improve clinical outcomes in the emergency department (ED) are based on structural changes. This study embraced a different strategy and examined the impact of a reflective practice intervention (RPI) on ED quality of care. METHODS A pre-post-intervention quasi-experimental nested design was conducted between January 2017 and June 2018 in an Israeli public tertiary academic ED. Nighty-six ED teams (triage and staff nurses and a physician) were included pre and post RPI. Data were collected pre and post RPI at patient-triage nurse encounters using triage-accuracy questionnaires. Time to decision, length-of-stay, and hospitalization and mortality rates were retrieved from the medical charts of 1920 patients (20 per team). RESULTS Accurate triage was significantly higher post than pre intervention (4.84 ± 1.45 vs. 3.87 ± 1.48; range 1-7; p < .001), whereas time to decision (253.30 ± 246.75 vs. 304.64 ± 249.14 min), hospitalization rates (n = 291, 30.3% vs. n = 374, 39.0%; p < .001), and hospital length-of-stay (5.73 ± 6.72 vs. 6.69 ± 6.20; p = .04) significantly decreased. CONCLUSIONS By adapting organizational reflective practice principles to the ED dynamic environment, the RPI was associated with a significant improvement in ED quality-of-care measures.
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Affiliation(s)
- Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.
| | - Anat Drach-Zahavy
- The Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Efrat Dagan
- The Cheryl Spencer Department of Nursing, The Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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16
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Bartholdson C, Sandeberg MA, Molewijk B, Pergert P. Does participation in ethics discussions have an impact on ethics decision-making? A cross-sectional study among healthcare professionals in paediatric oncology. Eur J Oncol Nurs 2021; 52:101950. [PMID: 33862416 DOI: 10.1016/j.ejon.2021.101950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The overall aim of this study was to describe perceptions of the decision-making process in relation to participation/non-participation in ethics discussions among healthcare professionals in paediatric oncology. METHODS Healthcare professionals, working at three paediatric units where ethics discussions where performed answered a study-specific questionnaire focusing on perceptions of involvement, influence, responsibility and understanding of ethics decision-making. Statistical analyses included descriptive statistics, non-parametric paired t-tests and correlation tests. RESULTS Participation in ethics discussions was related to perceptions of greater involvement and the possibility of influencing decisions, as well as formal/shared responsibility for the ethics decisions related to patient care. Medical doctors and registered nurses perception of involvement in decisions, possibility to influence and responsibility decreased when they were not present during the ethics discussion or when no ethics discussion was conducted at all. Healthcare professionals had a generally good understanding of the ethical issues and the ethics decisions. The whole group considered medical doctors to be the most important participants in the ethics discussions, followed by patients/family. Healthcare professionals wanted more teamwork and viewed ethics discussions as very helpful for teamwork when dealing with ethical issues in paediatric oncology. CONCLUSIONS Ethics discussions in paediatric oncology practice increases the involvement within and the understanding of the decision-making process about ethical decisions. The understanding is not always dependent on participation, indicating a great trust in team members. Based on these findings the implementation of a structure for ethics support in paediatric oncology where patients/families are integrated is recommended.
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Affiliation(s)
- Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Neurology and Musculokeletal Disorders and Homecare, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Margareta Af Sandeberg
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Bert Molewijk
- Dep. Ethics, Law & Humanities, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Centre for Medical Ethics, University of Oslo, Norway
| | - Pernilla Pergert
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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17
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Saban M, Dagan E, Drach-Zahavy A. The Effects of a Novel Mindfulness-based Intervention on Nurses' State Mindfulness and Patient Satisfaction in the Emergency Department. J Emerg Nurs 2020; 47:412-425. [PMID: 33272560 DOI: 10.1016/j.jen.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction. METHODS A pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses' sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients' sociodemographic and satisfaction, nurses' state mindfulness, and ED workload. RESULTS An increase in nurses' state mindfulness and patients' satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients' satisfaction and nurses' state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation. DISCUSSION By adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.
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18
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Buchanan F, Cohen E, Milo-Manson G, Shachak A. What makes difficult decisions so difficult?: An activity theory analysis of decision making for physicians treating children with medical complexity. PATIENT EDUCATION AND COUNSELING 2020; 103:2260-2268. [PMID: 32409096 DOI: 10.1016/j.pec.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared Decision-Making (SDM) has been advocated as an ideal model of decision-making in the medical encounter. Much of the research into SDM has focused on measuring if SDM is happening, or facilitating SDM by developing specific models and tools. Understanding SDM as an activity in context, has remained mostly absent from the research. This study sought to garner details on the actions, judgements and motives that comprise the activity of making a decision, in the context of a shared process between physicians and families of Children with Medical Complexity (CMC). METHODS 11 physicians who treat CMC were interviewed. Activity Theory framework was employed to understand the complexity of the decision-making process in context. RESULTS Ambiguous information, conflicting rules, and beliefs on roles all contribute to the difficulty of decision-making. A decision is achieved by allocating the decision to one party. CONCLUSION Lack of tools, rules or beliefs that would assist sharing the decision between the physician and patient/family, contributes to the need to allocate the decision to one party. PRACTICE IMPLICATION In developing SDM policies and tools, one must consider all aspects of the SDM activity system, and how they influence each other and the activity as a whole.
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Affiliation(s)
- Francine Buchanan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Eyal Cohen
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Golda Milo-Manson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Division of Developmental Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Aviv Shachak
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Faculty of Information, University of Toronto, Toronto, Ontario, Canada
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Laryionava K, Hauke D, Heußner P, Hiddemann W, Winkler EC. "Often Relatives are the Key […]" -Family Involvement in Treatment Decision Making in Patients with Advanced Cancer Near the End of Life. Oncologist 2020; 26:e831-e837. [PMID: 33037846 PMCID: PMC8100569 DOI: 10.1002/onco.13557] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Family communication has been increasingly recognized as an important factor in decision making near the end of life. However, the role of the family in decision making is less studied in oncology settings, where most patients are conscious and able to communicate almost until dying. The aim of this study was to explore oncologists’ and nurses’ perceptions of family involvement in decision making about forgoing cancer‐specific treatment in patients with advanced cancer. Materials and Methods Qualitative semistructured interviews with 22 oncologists and 7 oncology nurses were analyzed according to the grounded theory approach. The results were discussed against the background of the clinical and ethical debate on family role near the end of life. Results We could identify two approaches shared by both oncologists and nurses toward family involvement. These approaches could be partly explained by different perception and definition of the concept of patients' autonomy: (a) a patient‐focused approach in which a patient's independence in decision making was the highest priority for oncologists and (b) a mediator approach with a family focus in which oncologists and nurses assigned an active role to patients' family in decision making and strived for building consensus and resolving conflicts. Conclusion The main challenge was to involve family, increasing their positive influences on the patient and avoiding a negative one. Thereby, the task of both oncologists and oncology nurses is to support a patient's family in understanding of a patient's incurable condition and to identify a patient's preference for therapy. Implications for Practice This study focused on oncologists’ and oncology nurses’ perceptions of family involvement in decision making about treatment limitation in patients with advanced cancer who are able to communicate in a hospital setting. Oncologists and oncology nurses should be aware of both positive aspects and challenges of family involvement. Positive aspects are patients’ emotional support and support in understanding and managing the information regarding treatment decisions. Challenges are diverging family preferences with regard to treatment goals that might become a barrier to advanced care planning, a possible increased psychological burden for the family. Especially challenging is involving the family of a young patient because increased attention, more time investment, and detailed discussions are needed. The role of family communication is recognized as an important factor in decision making for cancer patients near the end of life. This article discusses the value and role of family in end‐of‐life discussions and the challenges encountered by oncologist and oncology nurses when involving family in decision making.
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Affiliation(s)
- Katsiaryna Laryionava
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg (Saale), Germany
| | - Daniela Hauke
- Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich, Germany
| | - Pia Heußner
- Oncological Center Oberland, Hospital Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital Grosshadern; Ludwig-Maximilians University, Munich, Germany
| | - Eva C Winkler
- Department of Medical Oncology, National Center for Tumor Diseases, Programme for Ethics and Patient-Oriented Care in Oncology, Heidelberg University Hospital, Heidelberg, Germany
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20
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Jørgensen L, Kastrup Jensen S, Brogaard B. Situational awareness in the outpatient encounter between patients with breast cancer or malignant melanoma and healthcare professionals: Patients' perceptions. J Clin Nurs 2019; 29:1981-1990. [PMID: 31769553 DOI: 10.1111/jocn.15122] [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: 04/12/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To explore patients' experiences of situational awareness in the outpatient encounter when they are informed about the diagnosis of breast cancer or malignant melanoma. BACKGROUND Patients enter a stressful situation when receiving a diagnosis of breast cancer or malignant melanoma, and research indicates that needs are most prominent at this time. However, healthcare professionals often fail to address these needs adequately. It is unclear how patients experience situational awareness practised to meet their fundamental needs in the encounter when they are informed about the diagnosis of cancer. DESIGN This study used a phenomenological hermeneutical approach. METHODS Nine semi-structured interviews with patients being diagnosed with breast cancer or malignant melanoma were performed. The interpretation theory of Paul Ricoeur guided the analysis. The study is presented in line with the COREQ checklist. RESULTS The analysis resulted in three themes: 1) "Being accompanied" refers to how patients need information to be targeted to them as individuals. 2) "Being seen" points to HCPs' exploration of the patients' perspectives to get an understanding of their preferences. 3) "Being taken care of" indicates that patients feel supported if situational awareness is practised by the healthcare professionals. CONCLUSION Practicing situational awareness in the outpatient encounter is essential to patients' experience of feeling accommodated or rejected. Patients feel rejected when their fundamental needs are not met while experiencing situational awareness seems to accommodate fundamental needs and pre-empt an inappropriate patient outcome. RELEVANCE TO CLINICAL PRACTICE HCPs need to acknowledge the importance of using a structured approach to meeting patients' fundamental needs in a stressful situation. Each patient is different and may experience different needs in encounters where they are receiving the diagnosis of breast cancer or malignant melanoma. Therefore, treatment and care must be tailored to the individual patient based on a caring relationship.
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Affiliation(s)
- Lone Jørgensen
- Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Kastrup Jensen
- Department of Plastic Surgery, Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark
| | - Bettina Brogaard
- Department of Breast Surgery, Clinic for Surgery and Cancer Treatment, Aalborg University Hospital, Aalborg, Denmark
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21
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Erdman SA, Scherer RW, Sierra-Irizarry B, Formby C. The Tinnitus Retraining Therapy Trial's Standard of Care Control Condition: Rationale and Description of a Patient-Centered Protocol. Am J Audiol 2019; 28:534-547. [PMID: 31425658 PMCID: PMC6808311 DOI: 10.1044/2019_aja-18-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/24/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The selection and design of control conditions are critical factors in minimizing the influence of unwanted variables in randomized controlled trials (RCTs). This article describes the rationale, design, and content of a standard of care control condition in a Phase III RCT of tinnitus retraining therapy. Method Existing tinnitus practices at military hospitals were identified and aligned with the American Speech-Language-Hearing Association's (2006) preferred practice patterns for tinnitus management and counseling and embedded in a patient-centered protocol to ensure uniformity and treatment fidelity. Results For those involved in the design of behavioral RCTs, the article identifies options and methods to consider in the selection and design of control conditions. Conclusion For those who provide tinnitus services, the standard of care protocol developed for the tinnitus retraining therapy trial constitutes a patient-centered approach to intervention that can be implemented clinically. Supplemental Material https://doi.org/10.23641/asha.9342503.
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Affiliation(s)
- Sue Ann Erdman
- Audiologic Rehabilitation Consulting Services, Jensen Beach, FL
| | | | | | - Craig Formby
- Department of Communicative Disorders, University of Alabama, Tuscaloosa
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22
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Ronis SD, Kleinman LC, Stange KC. A Learning Loop Model of Collaborative Decision-Making in Chronic Illness. Acad Pediatr 2019; 19:497-503. [PMID: 31009759 PMCID: PMC8127066 DOI: 10.1016/j.acap.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 04/16/2019] [Indexed: 11/16/2022]
Abstract
Shared decision-making is a core attribute of quality health care that has proved challenging to implement and assess in pediatric practice. Current models of shared decision-making are limited, including their capacity to incorporate multiple stakeholders; to integrate downstream effects of subacute or minor decisions; and to account for the context(s) in which such decisions are being made and enacted. Based on a review of literature from organizational psychology, cognitive sciences, business, and medicine, we propose an iterative decision-making model of care planning and identify targets at several levels of influence warranting measurement in future studies. Our learning loop model posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians. We consider the model in light of the needs of children with special health care needs, for whom understanding the ongoing iterative effects of decision making and clinician-parent-child dynamics are likely to be particularly important in influencing outcomes.
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Affiliation(s)
- Sarah D Ronis
- Department of Pediatrics, Case Western Reserve University, and UH Rainbow Center for Child Health and Policy, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio (SD Ronis).
| | - Lawrence C Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (LC Kleinman)
| | - Kurt C Stange
- Center for Community Health Integration, Department of Family Medicine & Community Health, Department of Population & Quantitative Health Sciences, Department of Sociology, Case Western Reserve University, Cleveland, Ohio (KC Stange)
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23
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Trevino KM, Prigerson HG, Shen MJ, Tancredi DJ, Xing G, Hoerger M, Epstein RM, Duberstein PR. Association between advanced cancer patient-caregiver agreement regarding prognosis and hospice enrollment. Cancer 2019; 125:3259-3265. [PMID: 31145833 PMCID: PMC6717015 DOI: 10.1002/cncr.32188] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/12/2019] [Accepted: 04/23/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with advanced, incurable cancer who understand their illness is incurable are more likely to prefer hospice care at the end of life compared with patients who believe their illness is curable. To the authors' knowledge, it is unclear whether patient-caregiver agreement regarding perceived prognosis is associated with hospice enrollment. METHODS The current study examined the prospective relationship between patient-caregiver agreement concerning perceived prognosis and hospice enrollment in the last 30 days of life. Data were collected during a cluster randomized controlled trial examining a communication intervention for oncologists and patients with advanced cancer and their caregivers. At the time of study entry, patients and caregivers (141 dyads) were categorized as endorsing a "good" prognosis if they: 1) reported a >50% chance of surviving ≥2 years; or if they 2) predicted that the patient's quality of life 3 months into the future would be ≥7 on an 11-point scale. RESULTS Approximately one-fifth of dyads agreed on a poor prognosis whereas approximately one-half disagreed regarding prognosis. In approximately one-third of dyads, patients and caregivers both believed the patient's future quality of life would be good (34%) and that the patient would live for ≥2 years (30%). Patients in these dyads were less likely to enroll in hospice compared with patients in dyads who disagreed and those who agreed on a shorter life expectancy and poor future quality of life. CONCLUSIONS Dyadic understanding of patients' projected life expectancy and future quality of life appears to be predictive of care received at the end of life. Improving rates of hospice enrollment may be best achieved with dyadic interventions.
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Affiliation(s)
- Kelly M Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
| | - Megan Johnson Shen
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Department of Medicine, New York Presbyterian Hospital, New York, New York
| | - Daniel J Tancredi
- Department of Pediatrics, University of California at Davis, Davis, California
| | - Guibo Xing
- Department of Pediatrics, University of California at Davis, Davis, California
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Paul R Duberstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, New York.,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, New Brunswick, New Jersey
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24
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Palmer-Wackerly AL, Voorhees HL, D'Souza S, Weeks E. Infertility patient-provider communication and (dis)continuity of care: An exploration of illness identity transitions. PATIENT EDUCATION AND COUNSELING 2019; 102:804-809. [PMID: 30527731 DOI: 10.1016/j.pec.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/21/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify how and why infertility patients' communication with health care providers relates to their continuity of care within infertility treatment. METHOD A grounded theory analysis was conducted for 25 in-depth interviews across three coding phases, where we remained open to all themes present in the data, narrowed to most prominent themes, and found the connections between the themes. RESULTS Based on our identified themes, we created a conceptual model that explains why infertility patients (dis)continued care with one or more clinician. Through this model, we describe two infertility identity transitions for patients: Transition 1: "Infertility as Temporary" to "Infertility as Enduring"; and Transition 2: "Infertility as Enduring" to "Infertility as Integrated." CONCLUSION The study explains how and why patients' view of their infertility affects their communication, and thus their continuity of care, with clinicians. PRACTICE IMPLICATIONS To provide patient-centered care within infertility treatment, providers can recognize how patients' view of their infertility, and thus their needs, goals, and expectations, shift throughout their infertility experience.
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Affiliation(s)
| | - Heather L Voorhees
- Department of Communication Studies, The University of Nebraska-Lincoln, USA
| | - Sarah D'Souza
- Department of Biobehavioral Health, Pennsylvania State University, USA
| | - Edward Weeks
- School of Communication, The Ohio State University, USA
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25
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Dionne-Odom JN, Ejem D, Wells R, Barnato AE, Taylor RA, Rocque GB, Turkman YE, Kenny M, Ivankova NV, Bakitas MA, Martin MY. How family caregivers of persons with advanced cancer assist with upstream healthcare decision-making: A qualitative study. PLoS One 2019; 14:e0212967. [PMID: 30865681 PMCID: PMC6415885 DOI: 10.1371/journal.pone.0212967] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/12/2019] [Indexed: 12/27/2022] Open
Abstract
Aims Numerous healthcare decisions are faced by persons with advanced cancer from diagnosis to end-of-life. The family caregiver role in these decisions has focused on being a surrogate decision-maker, however, little is known about the caregiver’s role in supporting upstream patient decision-making. We aimed to describe the roles of family caregivers in assisting community-dwelling advanced cancer patients with healthcare decision-making across settings and contexts. Methods Qualitative study using one-on-one, semi-structured interviews with community-dwelling persons with metastatic cancer (n = 18) and their family caregivers (n = 20) recruited from outpatient oncology clinics of a large tertiary care academic medical center, between October 2016 and October 2017. Transcribed interviews were analyzed using a thematic analysis approach. Findings Caregivers averaged 56 years and were mostly female (95%), white (85%), and the patient’s partner/spouse (70%). Patients averaged 58 years and were mostly male (67%) in self-reported “fair” or “poor” health (50%) with genitourinary (33%), lung (17%), and hematologic (17%) cancers. Themes describing family member roles in supporting patients’ upstream healthcare decision-making were: 1) seeking information about the cancer, its trajectory, and treatments options; 2) ensuring family and healthcare clinicians have a common understanding of the patient’s treatment plan and condition; 3) facilitating discussions with patients about their values and the framing of their illness; 5) posing “what if” scenarios about current and potential future health states and treatments; 6) addressing collateral decisions (e.g., work arrangements) resulting from medical treatment choices; 6) originating healthcare-related decision points, including decisions about seeking emergency care; and 7) making healthcare decisions for patients who preferred to delegate healthcare decisions to their family caregivers. Conclusions These findings highlight a previously unreported and understudied set of critical decision partnering roles that cancer family caregivers play in patient healthcare decision-making. Optimizing these roles may represent novel targets for early decision support interventions for family caregivers.
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Affiliation(s)
- J. Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amber E. Barnato
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Richard A. Taylor
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Gabrielle B. Rocque
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yasemin E. Turkman
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Matthew Kenny
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Nataliya V. Ivankova
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michelle Y. Martin
- Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
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Hornik-Lurie T, Shalev A, Haknazar L, Garber Epstein P, Ziedenberg-Rehav L, Moran GS. Implementing recovery-oriented interventions with staff in a psychiatric hospital: A mixed-methods study. J Psychiatr Ment Health Nurs 2018; 25:569-581. [PMID: 30411432 DOI: 10.1111/jpm.12502] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study examines the influence of three different recovery-oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed-methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery-oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced. Mainly, the illness management and recovery training created a positive change in the work attitude and some work-related practices of mental health staff and the increased presence of a person-centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services. Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients. Psychiatric advance directives were reported as more challenging to implement and with limited impact. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Recovery-oriented trainings can be internalized and implemented by staff in medical model psychiatric settings. Despite recovery-oriented training, challenges do occur-notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses. Using multiple recovery-oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice. Ongoing comprehensive mental health staff training on recovery-oriented care programmes is essential in order to sustain change over time. Training is not enough in itself-hospital administrations need to be actively involved in promoting recovery-oriented policies. ABSTRACT: Introduction Developing person-centred recovery-oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim To assess the knowledge, attitudes and practices developed following recovery-oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery-oriented intervention in psychiatric wards. Method A mixed-methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery-oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person-centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice Our findings support the need for broader staff training in recovery-oriented interventions. Recruiting the support of the hospital administration for recovery-oriented intervention programmes is key, both ethically and structurally.
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Affiliation(s)
- Tzipi Hornik-Lurie
- The Falk Institute for Mental Health Studies, Kfar Shaul Hospital, Jerusalem, Israel
| | - Anat Shalev
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel.,Beer-Sheva Mental Health Center, Beer Sheva, Israel
| | - Lior Haknazar
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | - Galia S Moran
- Spitzer Department of Social Work, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Trevino KM, Maciejewski PK, Shen MJ, Prigerson HG, Mohile S, Kamen C, Epstein RM, Duberstein P. How much time is left? Associations between estimations of patient life expectancy and quality of life in patients and caregivers. Support Care Cancer 2018; 27:2487-2496. [PMID: 30387051 PMCID: PMC6494724 DOI: 10.1007/s00520-018-4533-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/26/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE It is unclear whether life-expectancy estimates of patients with advanced cancer and their caregivers are associated with patient existential, social, or emotional quality of life (QOL) or caregiver emotional QOL. METHODS Patients with advanced cancer and their caregivers (n = 162 dyads) reported estimates of the chance the patient would live for 2 years or more from 0% (most pessimistic) to 100% (most optimistic). They also completed self-report measures of QOL. RESULTS Adjusting for sociodemographic confounds and multiple comparisons, more pessimistic caregiver and patient life-expectancy estimates were associated with worse caregiver emotional QOL and worse patient existential QOL. Discrepancies between patient and caregiver estimates were not associated with patient or caregiver QOL. CONCLUSIONS Pessimistic life-expectancy estimates are associated with worse existential QOL in patients and worse emotional QOL in caregivers. Prospective research to establish causal relationships is needed, and interventions to address the relationship between beliefs about life expectancy and existential and emotional QOL should be considered. Providing these interventions to patients and caregivers receiving information on life expectancy may mitigate the negative impact of life-expectancy information on patient existential quality of life.
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Affiliation(s)
- Kelly M Trevino
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA.
| | - Paul K Maciejewski
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Megan Johnson Shen
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Holly G Prigerson
- Weill Cornell Medicine, 525 E. 68th St., Box 39, New York, NY, 10065, USA
| | - Supriya Mohile
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Charles Kamen
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Ronald M Epstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Paul Duberstein
- University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Subramani S. The moral significance of capturing micro-inequities in hospital settings. Soc Sci Med 2018; 209:136-144. [DOI: 10.1016/j.socscimed.2018.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/24/2022]
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Ejem D, Dionne-Odom JN, Turkman Y, Knight SJ, Willis D, Kaufman PA, Bakitas M. Incongruence between women's survey- and interview-determined decision control preferences: A mixed methods study of decision-making in metastatic breast cancer. Psychooncology 2018; 27:1950-1957. [DOI: 10.1002/pon.4747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Deborah Ejem
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | | | - Yasemin Turkman
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | - Sara J. Knight
- Department of Preventive Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Dan Willis
- School of Nursing; University of Wisconsin-Madison; Madison WI USA
| | - Peter A. Kaufman
- Section of Hematology Oncology; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
| | - Marie Bakitas
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
- Department of Medicine; Division of Geriatrics, Gerontology, and Palliative Medicine; Birmingham AL USA
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Woolf SH, Krist AH, Lafata JE, Jones RM, Lehman RR, Hochheimer CJ, Sabo RT, Frosch DL, Zikmund-Fisher BJ, Longo DR. Engaging Patients in Decisions About Cancer Screening: Exploring the Decision Journey Through the Use of a Patient Portal. Am J Prev Med 2018; 54:237-247. [PMID: 29241715 PMCID: PMC7144024 DOI: 10.1016/j.amepre.2017.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Engaging patients to make informed choices is paramount but difficult in busy practices. This study sought to engage patients outside the clinical setting to better understand how they approach cancer screening decisions, including their primary concerns and their preferences for finalizing their decision. METHODS Twelve primary care practices offering patients an online personal health record invited eligible patients to complete a 17-item online interactive module. Among 11,458 registered users, invitations to complete the module were sent to adults aged 50-74 years who were overdue for colorectal cancer screening and to women aged 40-49 years and men aged 55-69 who had not undergone a recent mammogram or prostate-specific antigen test, respectively. RESULTS The module was started by 2,355 patients and completed by 903 patients. Most respondents (76.8%) knew they were eligible for screening. Preferred next steps were talking to the clinician (76.6%), reading/research (28.6%), and consulting trusted friends/family (16.4%). Priority topics included how much screening improves life expectancy, comparative test performance, and the prevalence/health risks of the cancer. Leading fears were getting cancer/delayed detection (79.2%), abnormal results (40.5%), and testing complications (39.1%), the last referring to false test results, medical complications, or unnecessary treatments. Men eligible for prostate-specific antigen screening were more likely than women eligible for mammography to express concerns about testing complications and to prioritize weighing pros and cons over gut feelings (p<0.05). CONCLUSIONS Although this sample was predisposed to screening, most patients wanted help in finalizing their decision. Many wanted to weigh the pros and cons and expressed fears of potential harms from screening. Understanding how patients approach decisions may help design more effective engagement strategies.
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Affiliation(s)
- Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Elston Lafata
- Department of Health Behavior and Policy, Lineberger Comprehensive Cancer Center and Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania
| | | | - Camille J Hochheimer
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Daniel R Longo
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
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Årestedt L, Persson C, Rämgård M, Benzein E. Experiences of encounters with healthcare professionals through the lenses of families living with chronic illness. J Clin Nurs 2017; 27:836-847. [PMID: 29076223 DOI: 10.1111/jocn.14126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES To describe and explore the experience of healthcare encounters in families living with chronic illness. BACKGROUND Living with chronic illness is a family concern and often includes frequent encounters with healthcare professionals. These encounters affect how persons with illness and family members handle everyday life. Disease-related explanations are perceived by healthcare professionals as being of higher importance than the actual experience of illness, even though patients are concerned with issues involving their everyday life. DESIGN A descriptive design with a qualitative approach. METHODS Narrative family interviews were conducted with twelve families, using a qualitative content analysis. RESULTS One main category was indicated following analysis, specifically "The impact of an accompanying family member." Additionally, three subcategories were revealed; "The importance of collaboration," "Mutual understanding," "A desire to be confirmed in one's illness". CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE Having a participating family member increased the sense of power in families during encounters with healthcare professionals. This participation constitutes a level of support, making it easier for families to handle everyday life due to illness. Family members are, in most cases, included in discussions and decisions, both before and after encounters, and it should be a natural for healthcare professionals to invite them to the encounter too. This is an offer that may not fit every family, but the person with illness or the family should at least have the opportunity to choose.
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Affiliation(s)
- Liselott Årestedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Carina Persson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Centre for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Eva Benzein
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Centre for Collaborative Palliative Care, Linnaeus University, Kalmar, Sweden
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Giroldi E, Veldhuijzen W, Geelen K, Muris J, Bareman F, Bueving H, van der Weijden T, van der Vleuten C. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1263-1278. [PMID: 28220333 PMCID: PMC5663797 DOI: 10.1007/s10459-017-9765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/14/2017] [Indexed: 05/16/2023]
Abstract
To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.
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Affiliation(s)
- Esther Giroldi
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Wemke Veldhuijzen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Kristel Geelen
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jean Muris
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Frits Bareman
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Herman Bueving
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
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Groen-van de Ven L, Smits C, de Graaff F, Span M, Eefsting J, Jukema J, Vernooij-Dassen M. Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare. BMJ Open 2017; 7:e018337. [PMID: 29133329 PMCID: PMC5695519 DOI: 10.1136/bmjopen-2017-018337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. DESIGN A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. SETTING Community settings and nursing homes in the Netherlands. PARTICIPANTS 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). RESULTS The participants' responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. CONCLUSION Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.
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Affiliation(s)
- Leontine Groen-van de Ven
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Carolien Smits
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Fuusje de Graaff
- MUTANT Agency for Diversity and Change, The Hague, The Netherlands
| | - Marijke Span
- ProMemo Expertise Centre for Professionals in Dementia Care, WindesheimUniversity of Applied Sciences, Zwolle, The Netherlands
| | - Jan Eefsting
- Department of Nursing Home Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jan Jukema
- Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Myrra Vernooij-Dassen
- Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare and Nijmegen Alzheimer Centre, Nijmegen, The Netherlands
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Dencker A, Kristiansen M, Rix BA, Bøge P, Tjørnhøj-Thomsen T. Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children. Eur J Cancer Care (Engl) 2017; 27. [PMID: 29114990 DOI: 10.1111/ecc.12792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Abstract
Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication.
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Affiliation(s)
- A Dencker
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - M Kristiansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B A Rix
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - P Bøge
- Patient Support & Community Activities, The Danish Cancer Society, Copenhagen, Denmark
| | - T Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Laidsaar-Powell R, Butow P, Charles C, Gafni A, Entwistle V, Epstein R, Juraskova I. The TRIO Framework: Conceptual insights into family caregiver involvement and influence throughout cancer treatment decision-making. PATIENT EDUCATION AND COUNSELING 2017; 100:2035-2046. [PMID: 28552193 DOI: 10.1016/j.pec.2017.05.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Family caregivers are regularly involved in cancer consultations and treatment decision-making (DM). Yet there is limited conceptual description of caregiver influence/involvement in DM. To address this, an empirically-grounded conceptual framework of triadic DM (TRIO Framework) and corresponding graphical aid (TRIO Triangle) were developed. METHODS Jabareen's model for conceptual framework development informed multiple phases of development/validation, incorporation of empirical research and theory, and iterative revisions by an expert advisory group. RESULTS Findings coalesced into six empirically-grounded conceptual insights: i) Caregiver influence over a decision is variable amongst different groups; ii) Caregiver influence is variable within the one triad over time; iii) Caregivers are involved in various ways in the wider DM process; iv) DM is not only amongst three, but can occur among wider social networks; v) Many factors may affect the form and extent of caregiver involvement in DM; vi) Caregiver influence over, and involvement in, DM is linked to their everyday involvement in illness care/management. CONCLUSION The TRIO Framework/Triangle may serve as a useful guide for future empirical, ethical and/or theoretical work. PRACTICE IMPLICATIONS This Framework can deepen clinicians's and researcher's understanding of the diverse and varying scope of caregiver involvement and influence in DM.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia.
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Cathy Charles
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
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Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, Kiatpongsan S, Lim Abdullah K, Tanaka M, Limpongsanurak S. Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries. Med Decis Making 2017; 38:14-25. [DOI: 10.1177/0272989x17715628] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Research suggests that desired family involvement (FI) in medical decision making may depend on cultural values. Unfortunately, the field lacks cross-cultural studies that test this assumption. As a result, providers may be guided by incomplete information or cultural biases rather than patient preferences. Methods. Researchers developed 6 culturally relevant disease scenarios varying from low to high medical seriousness. Quota samples of approximately 290 middle-aged urban residents in Australia, China, Malaysia, India, South Korea, Thailand, and the USA completed an online survey that examined desired levels of FI and identified individual difference predictors in each country. All reliability coefficients were acceptable. Regression models met standard assumptions. Results. The strongest finding across all 7 countries was that those who desired higher self-involvement (SI) in medical decision making also wanted lower FI. On the other hand, respondents who valued relational-interdependence tended to want their families involved – a key finding in 5 of 7 countries. In addition, in 4 of 7 countries, respondents who valued social hierarchy desired higher FI. Other antecedents were less consistent. Conclusion. These results suggest that it is important for health providers to avoid East–West cultural stereotypes. There are meaningful numbers of patients in all 7 countries who want to be individually involved and those individuals tend to prefer lower FI. On the other hand, more interdependent patients are likely to want families involved in many of the countries studied. Thus, individual differences within culture appear to be important in predicting whether a patient desires FI. For this reason, avoiding culture-based assumptions about desired FI during medical decision making is central to providing more effective patient centered care.
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Affiliation(s)
- Dana L. Alden
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - John Friend
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Ping Yein Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Yew Kong Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Lyndal Trevena
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Chirk Jenn Ng
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Sorapop Kiatpongsan
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Khatijah Lim Abdullah
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Miho Tanaka
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Supanida Limpongsanurak
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
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Groen van de Ven L, Smits C, Elwyn G, Span M, Jukema J, Eefsting J, Vernooij-Dassen M. Recognizing decision needs: first step for collaborative deliberation in dementia care networks. PATIENT EDUCATION AND COUNSELING 2017; 100:1329-1337. [PMID: 28238420 DOI: 10.1016/j.pec.2017.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/10/2017] [Accepted: 01/29/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study describes the process elements of decision-making for dementia, in order to enrich a model to facilitate shared decision-making for professionals working with people with dementia and their informal caregivers. METHODS We performed a qualitative study based on secondary analysis of 117 interviews from 23 care networks consisting of people with dementia, their informal caregivers and professionals. Findings were compared to an existing model of collaborative deliberation. RESULTS We made an enhancement to the existing collaborative deliberation model, to include: (1) constructive network engagement, (2) recognizing the need for a decision, (3) defining what to decide on, (4) developing alternatives, (5) constructing preferences through deliberation and trying out alternatives, (6) multiple preference integration, and (7) evaluating decision-making. CONCLUSION In describing the process elements of decision-making in dementia, this empirical study proposes a modification of the model of collaborative deliberation for the context of dementia care. The adaptation highlights the special attention needed to recognize and define what to decide on, try out alternatives, and handle conflicting interests and preferences. PRACTICE IMPLICATIONS Professionals should be attentive to mark the start of the decision-making process and work with participants towards a shared view on the pressing matters at hand.
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Affiliation(s)
- Leontine Groen van de Ven
- Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands.
| | - Carolien Smits
- Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA
| | - Marijke Span
- Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Jan Jukema
- Research Group Innovating with Older Adults, Centre of Expertise in Health Care and Social Work, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Jan Eefsting
- Care Organization IJssel-Vecht, Zwolle, The Netherlands; Department of Nursing Home Medicine and EMGO Institute for Health and Care Research, Free University Medical Centre Amsterdam, The Netherlands
| | - Myrra Vernooij-Dassen
- Scientific Institute for Quality of Healthcare (IQ healthcare) and Nijmegen Alzheimer Centre, Department of Primary Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Krieger JL, Krok-Schoen JL, Dailey PM, Palmer-Wackerly AL, Schoenberg N, Paskett ED, Dignan M. Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology. QUALITATIVE HEALTH RESEARCH 2017; 27:1146-1159. [PMID: 27179018 DOI: 10.1177/1049732316645321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Mark Dignan
- 4 University of Kentucky, Lexington, Kentucky, USA
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Malecki-Ketchell A, Marshall P, Maclean J. Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/1474515117715730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lippa KD, Feufel MA, Robinson FE, Shalin VL. Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition. QUALITATIVE HEALTH RESEARCH 2017; 27:1035-1048. [PMID: 27557927 DOI: 10.1177/1049732316665347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.
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Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study. Cancer Nurs 2017; 41:E40-E49. [PMID: 28426536 DOI: 10.1097/ncc.0000000000000490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses' working conditions. OBJECTIVE The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. METHODS Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. RESULTS Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses' decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called "dynamic decision-making adaptation." CONCLUSIONS The present study showed how the aims, contents, and degree of autonomy in the nurses' decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. IMPLICATIONS FOR PRACTICE Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients' problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership.
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Kazimierczak KA. Clinical encounter and the logic of relationality: Reconfiguring bodies and subjectivities in clinical relations. Health (London) 2017; 22:185-201. [DOI: 10.1177/1363459316688521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article critically examines the significance of relational approaches for sociological understandings of clinical interactions, relations and practices, by exploring the ways in which relational theories and concepts have been employed in the recent sociological accounts of clinical encounters to trouble the classical dyadic models of clinical interaction and the related atomistic conceptions of agency and accountability. Reading this work through the theoretical contributions from feminist science studies scholarship, and particularly the work of Donna Haraway and Karen Barad, the article proposes an alternative understanding of clinical interactions, relations and practices, where relations are conceived as constitutive of individuals (objects/bodies and their attributes/identities), rather than being constituted by encounters between individuals. Key for this understanding is the reconceptualisation of clinical encounter as an apparatus of bodily production through which different agents (patients, clinicians, diseases and healthcare services) are materialised and enacted.
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43
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Buiting HM, Brink M, Wijnhoven MN, Lokker ME, van der Geest LG, Terpstra WE, Sonke GS. Doctors' reports about palliative systemic treatment: A medical record study. Palliat Med 2017; 31:239-246. [PMID: 27492158 DOI: 10.1177/0269216316661685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Decisions about palliative systemic treatment are key elements of palliative and end-of-life care. Such decisions must often be made in complex, clinical situations. AIM To explore the content of medical records of patients with advanced non-small cell lung cancer and pancreatic cancer with specific emphasis on doctors' notes about decisions on palliative systemic treatment. DESIGN Medical record review (2009-2012) of 147 cancer patients containing 276 notes about palliative systemic treatment. We described the proportion of notes/medical records containing pre-specified items relevant to palliative systemic treatment. We selected patients using the nationwide Netherlands Cancer Registry. SETTING Hospital based. RESULTS About 75% of all notes reported doctors' considerations to start/continue palliative systemic treatment, including information about the prognosis (47%), possible survival gain (22%), patients' wish for palliative systemic treatment (33%), impact on quality of life (8%), and patient's age (3%). Comorbidity (82%), smoking status (78%) and drinking behaviour (63%) were more often documented than patients' performance status (16%). Conversations with the patient/family about palliative systemic treatment were reported in 49% of all notes. Response measurements and dose adaptations were documented in 75% and 71% of patients who received palliative systemic treatment respectively. CONCLUSION Medical records provide insight into the decision-making process about palliative systemic treatment. The content and detail of doctors' notes, however, widely varies especially concerning their palliative systemic treatment considerations. Registries that aim to measure the quality of (end-of-life) care must be aware of this outcome. Future research should further explore how medical records can best assist in evaluating the quality of the decision-making process in the patient's final stage of life.
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Affiliation(s)
- Hilde M Buiting
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,2 Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mirian Brink
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Marleen N Wijnhoven
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,3 Department of Clinical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine E Lokker
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Lydia Gm van der Geest
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Wim E Terpstra
- 4 Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Gabe S Sonke
- 1 Department of Registry and Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,5 Department of Medical Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Palmer-Wackerly AL, Krieger JL, Rhodes ND. The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction. JOURNAL OF HEALTH COMMUNICATION 2017; 22:10-19. [PMID: 27967332 DOI: 10.1080/10810730.2016.1245804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.
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Affiliation(s)
- Angela L Palmer-Wackerly
- a Department of Communication Studies , University of Nebraska-Lincoln , Lincoln , Nebraska , USA
| | - Janice L Krieger
- b Department of Advertising , College of Journalism and Communications, University of Florida , Gainesville , Florida , USA
| | - Nancy D Rhodes
- c Department of Advertising and Public Relations, College of Communication Arts and Sciences , Michigan State University , Lansing , Michigan , USA
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Dowrick C, Heath I, Hjörleifsson S, Misselbrook D, May C, Reeve J, Swinglehurst D, Toon P. Recovering the self: a manifesto for primary care. Br J Gen Pract 2016; 66:582-583. [PMID: 27789507 PMCID: PMC5072912 DOI: 10.3399/bjgp16x687901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool
| | | | - Stefan Hjörleifsson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Carl May
- University of Southampton, Southampton
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Hausmann D, Zulian C, Battegay E, Zimmerli L. Tracing the decision-making process of physicians with a Decision Process Matrix. BMC Med Inform Decis Mak 2016; 16:133. [PMID: 27756369 PMCID: PMC5070075 DOI: 10.1186/s12911-016-0369-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/04/2016] [Indexed: 12/02/2022] Open
Abstract
Background Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient’s condition. Objective The principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]). Methods The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings. Results The DPM comprised an average of 3.2 suspected diagnoses and 7.9 information units (cues). The following three-phase pattern could be observed: option generation, option verification, and final diagnosis determination. Residents strove for the highest possible level of confidence before making the final diagnoses (in two-thirds of the medical cases with a rating of practically certain) or excluding suspected diagnoses (with practically impossible in half of the cases). Discussion The following challenges have to be addressed in the future: real-time capturing of emerging suspected diagnoses in the memory of the physician, definition of meaningful information units, and a more contemporary measurement of confidence. Conclusions DPM is a useful tool for tracing real and individual diagnostic processes. The methodological approach with DPM allows further investigations into the underlying cognitive diagnostic processes on a theoretical level and improvement of individual clinical reasoning skills in practice.
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Affiliation(s)
- Daniel Hausmann
- Department of Psychology, Applied Social and Health Psychology, University of Zurich, Binzmuehlestrasse 14, Box 14, Zurich, 8050, Switzerland.
| | - Cristina Zulian
- Department of Psychology, Applied Social and Health Psychology, University of Zurich, Binzmuehlestrasse 14, Box 14, Zurich, 8050, Switzerland
| | - Edouard Battegay
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
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Bartels J, Rodenbach R, Ciesinski K, Gramling R, Fiscella K, Epstein R. Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients. PATIENT EDUCATION AND COUNSELING 2016; 99:1584-1594. [PMID: 27156659 PMCID: PMC6100772 DOI: 10.1016/j.pec.2016.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/17/2016] [Accepted: 04/17/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Silences in doctor-patient communication can be "connectional" and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients. METHODS Two medical students and a professor of voice screened all 1211 silences over 2s in length from 124 oncology office visits. We developed a "strength of connection" taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm. RESULTS We identified connectional silences with good reliability. Typical dialog rhythms surrounding connectional silences are characterized by relatively equal turn lengths and frequent short vocalizations. We found no pattern of volume and pitch variability around these silences. Connectional silences occurred in a wide variety of lexical contexts. CONCLUSION Particular patterns of dialog rhythm mark connectional silences. Exploring structures of connectional silence extends our understanding of the audio-linguistic conditions that mark patient-clinician connection. PRACTICE IMPLICATIONS Communicating with an awareness of pitch, rhythm, and silence - in addition to lexical content - can facilitate shared understanding and emotional connection.
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Affiliation(s)
- Josef Bartels
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Rachel Rodenbach
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | | | - Robert Gramling
- Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA.
| | - Kevin Fiscella
- Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA.
| | - Ronald Epstein
- Center for Communication and Disparities Research, University of Rochester Department of Family Medicine, 1381 South Avenue, Rochester, NY 14620, USA.
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Zdenkowski N, Butow P, Mann B, Fewster S, Douglas C, Boyle FM. Decisions about neoadjuvant systemic therapy for breast cancer: a survey of Australian and New Zealand specialists. ANZ J Surg 2016; 85:797-8. [PMID: 26798858 DOI: 10.1111/ans.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Laidsaar-Powell R, Butow P, Bu S, Charles C, Gafni A, Fisher A, Juraskova I. Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences. PATIENT EDUCATION AND COUNSELING 2016; 99:1146-1155. [PMID: 26873544 DOI: 10.1016/j.pec.2016.01.014] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. METHODS Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. RESULTS Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. CONCLUSION This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. PRACTICE IMPLICATIONS Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed.
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Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia.
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Stella Bu
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Cathy Charles
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics and Centre for Health and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Alana Fisher
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, New South Wales, Australia
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Lechner S, Herzog W, Boehlen F, Maatouk I, Saum KU, Brenner H, Wild B. Control preferences in treatment decisions among older adults - Results of a large population-based study. J Psychosom Res 2016; 86:28-33. [PMID: 27302543 DOI: 10.1016/j.jpsychores.2016.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Older adults appear to be a specifically vulnerable group that could benefit considerably from the assessment of their decision-making preferences. The aim of this study was to estimate prevalence rates and to explore characteristics of control preferences in a population-based sample of older adults. METHODS Data was derived from the 8-year follow-up of the ESTHER study - a German epidemiological study in the elderly population. n=3124 participants ages 57 to 84 were visited at home by trained medical doctors for a comprehensive assessment regarding various aspects of their life. The German version of the Control Preferences Scale (CPS) was used to assess decision-making. RESULTS Most of the participants reported a preference for an active role in the decision-making process (46%, 95% CI [44.3; 47.9]), while 30.0% [28.4; 31.5] preferred a collaborative role, and 23.9% [22.4; 25.5] a passive role. Participants aged ≤65years preferred a more passive role in decision-making compared to persons aged <65years. Participants with clinically significant depression symptoms (CSD) preferred significantly more often a passive role compared to those without CSD. Similarly, multimorbid patients preferred a passive role compared to people with none or one chronic disease. Conversely, in groups with active or collaborative control preferences the morbidity index was lower compared to the group with passive control preferences. CONCLUSION Results indicate that physical and mental health in the elderly are associated with the preference role. It should, however, be investigated whether multimorbidity or mental diseases influence the treatment preference of older adults.
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Affiliation(s)
- Sabine Lechner
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Friederike Boehlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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