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Birchley G, Bertram W, Moore AJ, Huxtable R, Howells N, Chivers Z, Johnson E, Wylde V, Jones L, Timlin T, Gooberman-Hill R. In risk we trust? Making decisions about knee replacement. Soc Sci Med 2024; 355:117112. [PMID: 39029443 DOI: 10.1016/j.socscimed.2024.117112] [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: 01/22/2024] [Revised: 07/03/2024] [Accepted: 07/06/2024] [Indexed: 07/21/2024]
Abstract
Risk communication is a key legal and ethical component of shared decision-making. Decisions about total knee replacement, a common surgery, must contend with the fact that a minority of cases result in unintended outcomes, some of which have devastating effects. To understand how risks are communicated during decision-making, we audio-recorded and analysed 62 consultations between surgeons and patients. Various communication methods were evident, including listing risks without elaboration, discussing them in a conversational manner, abrogating discussion of risk, or using decision-tools. Discussion of risks was often brief in nature, and risk communication was sometimes curtailed or deferred by both patients and surgeons. Risks could also be observed to play a part in reinforcing policy norms of the doctor-patient relationship that highlighted patient responsibility. Nevertheless, patients and surgeons in the observed consultations appeared more interested in developing trusting relationships than in discussing risks. Because patients had sometimes experienced considerable deterioration in their knee function before their consultation, were in pain and struggled with mobility, the realities of clinical practice clashed with the policy norms of choice and patient responsibility. Rather, decisions could appear coerced by the disease process rather than being clear-cut examples of self-determination. While policy norms putatively use risk disclosure to frame communication between patients and clinicians as a transaction between customer and technician, the lack of conformity to these norms in the consultations may indicate resistance to this framing. A greater emphasis on determining positive roles for trust and care would help policy to present a nuanced understanding of decision-making. Risk communication could be seen as a factor in the formation of trusting relationships, improving its role in decision-making processes while recognising its inherent tensions with practice.
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Affiliation(s)
| | - Wendy Bertram
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | | | - Richard Huxtable
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Nicholas Howells
- North Bristol NHS Trust, Southmead Hospital Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Zoe Chivers
- Versus Arthritis, Copeman House, Chesterfield, S41 7TD, UK
| | - Emma Johnson
- Bristol Medical School, University of Bristol, UK
| | - Vikki Wylde
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Leah Jones
- Bristol Medical School, University of Bristol, UK
| | - Tony Timlin
- North Bristol NHS Trust, Southmead Hospital Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
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Sensky T. The Person-Centred Clinical Interview. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:237-243. [PMID: 38830341 DOI: 10.1159/000539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Tom Sensky
- Centre for Mental Health, Department of Brain Sciences, Imperial College London, London, UK
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3
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Footman K. The illusion of treatment choice in abortion care: A qualitative study of comparative care experiences in England and Wales. Soc Sci Med 2024; 348:116873. [PMID: 38615614 DOI: 10.1016/j.socscimed.2024.116873] [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: 11/22/2023] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
Treatment choice is a key component of quality, person-centred care, but policies promoting choice often ignore how capacity to choose is unequally distributed and influenced by social structures. In abortion care, the choice of either medication or a procedure is limited in many countries, but the structuring of treatment choice from the perspective of people accessing abortion care is poorly understood. This qualitative study explored comparative experiences of abortion treatment choice in England and Wales, using in-depth interviews with 32 people who recently accessed abortion care and had one or more prior abortions. A codebook approach was used to analyse the data, informed by a multidisciplinary framework for understanding the relationship between choice and equity. Abortion treatment choice was structured by multiple intersecting mechanisms: limitations on the supply of abortion care, incomplete or unbalanced information from providers, and participants' socio-economic environments. Long waiting times or travel distances could reduce choice of both treatment options. In interactions with providers, participants described not being offered procedural abortions or receiving information that favoured medication abortion. Participants' socio-economic environments impacted the way they navigated decision-making and their ability to manage the experience of either treatment option. Individual preferences for care were shaped in part by the interplay between these structural barriers, creating an illusion of choice, as the health system bias towards medication abortion reinforced some participants' negative perceptions of procedural abortion. The erosion of choice, to the point it is rendered illusory, has unequal impacts on quality of care. People's needs for their abortion care are complex and diverse, and access to varied service models is required to meet these needs. Treatment choice could be expanded by integrating public and private non-profit sector provision, aligning time limits and workforce requirements for abortion care with international standards, addressing financial pressures on service delivery, and revising the language used to depict each treatment option.
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Affiliation(s)
- Katy Footman
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE, UK.
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Clapp JT, Kruser JM, Schwarze ML, Hadler RA. Language in Bioethics: Beyond the Representational View. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-13. [PMID: 38626326 DOI: 10.1080/15265161.2024.2337394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
Though assumptions about language underlie all bioethical work, the field has rarely partaken of theories of language. This article encourages a more linguistically engaged bioethics. We describe the tacit conception of language that is frequently upheld in bioethics-what we call the representational view, which sees language essentially as a means of description. We examine how this view has routed the field's theories and interventions down certain paths. We present an alternative model of language-the pragmatic view-and explore how it expands and clarifies traditional bioethical concerns. To lend concreteness, we apply the pragmatic view to a pervasive concept in bioethics and adjacent fields: decision making. We suggest that problems of the decision-making approach to bioethical issues are grounded in adherence to the representational view. Drawing on empirical work in surgery and critical care, we show how the pragmatic view productively reframes bioethical questions about how medical treatments are pursued.
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de Veer MR, Hermus M, van der Zijden CJ, van der Wilk BJ, Wijnhoven BPL, Stiggelbout AM, Dekker JWT, Coene PPLO, Busschbach JJ, van Lanschot JJB, Lagarde SM, Kranenburg LW. Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106935. [PMID: 37210275 DOI: 10.1016/j.ejso.2023.05.010] [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: 08/23/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial). MATERIALS AND METHODS A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy. RESULTS Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options. CONCLUSION Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.
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Affiliation(s)
- Mathijs R de Veer
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Merel Hermus
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Berend J van der Wilk
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Karnieli-Miller O, Palombo M, Laor N. The hidden curriculum of breaking bad news: Identification of three dimensions and four communication patterns. PATIENT EDUCATION AND COUNSELING 2023; 114:107807. [PMID: 37236123 DOI: 10.1016/j.pec.2023.107807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To explore students' observations in the hidden curriculum of physicians' breaking bad news interactions and identify dimensions and patterns within them. METHODS We qualitatively analyzed 156 written narrative descriptions of bad news encounters in the clinics written by senior medical students. RESULTS The analysis identified three dimensions within the encounters: providing information, dealing with emotions, and discussing treatment plans. These dimensions were observed in different proportions, identifying four communication patterns. Half of the encounters focused solely on presenting a treatment plan. Within them, the news was communicated abruptly while neglecting to share information or address emotions. CONCLUSIONS Compared to the main literature on breaking bad news that focuses on two dimensions-the present study identified a third, prominent dimension-discussing the treatment plan. Half of the hidden curriculum experiences contradict the taught protocol, paying little/no attention to emotion and information. PRACTICE IMPLICATIONS When teaching breaking bad news, it is essential to address the day-to-day practices students' observe. Students exposed to these encounters might misinterpret the physician's reliance on a single dimension as best practice. To mitigate this and help recognize their and others' tendency to focus primarily or solely on one dimension, we suggest a simple reflective prompt.
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Affiliation(s)
| | - Michal Palombo
- Department of Medical Education, Tel Aviv University, Tel-Aviv, Israel; Department of Family Medicine, Clalit Heath Services, Petach Tikva, Israel
| | - Nathaniel Laor
- Department of Medical Education, Tel Aviv University, Tel-Aviv, Israel; Departments of Psychiatry and Philosophy, Tel Aviv University, Tel Aviv, Israel
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Zhou Y, Acevedo Callejas ML, Li Y, MacGeorge EL. What Does Patient-Centered Communication Look Like?: Linguistic Markers of Provider Compassionate Care and Shared Decision-Making and Their Impacts on Patient Outcomes. HEALTH COMMUNICATION 2023; 38:1003-1013. [PMID: 34657522 DOI: 10.1080/10410236.2021.1989139] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Patient-centered communication promotes positive patient outcomes. This study examines the linguistic markers of two key dimensions of patient-centered communication (i.e., provider compassionate care and shared decision-making) and their mediating effects on patient perceived quality of and affective responses to the provider's treatment recommendations. Transcripts (N = 343) of provider talk from provider-patient interactions in medical visits for upper respiratory infection symptoms where patients were not prescribed with antibiotics were analyzed with the Linguistic Inquiry and Word Count (LIWC) dictionary. Results showed that providers' use of affiliation words positively predicted patients' perceptions of their providers' compassionate care. Providers' use of insight words negatively predicted patients' perceptions of provider shared decision-making. Meanwhile, providers' use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making. Patient perceived compassionate care and shared decision-making further increased patients' positive affect toward and perceived quality of non-antibiotic treatment recommendations. These perceptions also reduced their negative affect toward the recommendations. Implications of the findings are discussed with regard to patient-centered communication in relation to the promotion of antibiotic stewardship.
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Affiliation(s)
- Yanmengqian Zhou
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | | | - Yuwei Li
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | - Erina L MacGeorge
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
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8
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Muhammad T, Sekher TV, Srivastava S. Association of objective and subjective socioeconomic markers with cognitive impairment among older adults: cross-sectional evidence from a developing country. BMJ Open 2022; 12:e052501. [PMID: 35981779 PMCID: PMC9394209 DOI: 10.1136/bmjopen-2021-052501] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/07/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study explored how various markers of objective and subjective socioeconomic status (SES) are associated with cognitive impairment among older Indian adults. DESIGN A cross-sectional study was conducted using large nationally representative survey data. SETTING AND PARTICIPANT This study used data from the Longitudinal Ageing Study in India (2017-2018). The sample included 31 464 older adults aged 60 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES Outcome variable was cognitive impairment, measured through broad domains of memory, orientation, arithmetic function, and visuo-spatial and constructive skills. We estimated descriptive statistics and presented cross-tabulations of the outcome. Χ2 test was used to evaluate the significance level of differences in cognitive impairment by subjective (ladder) and objective SES measures (monthly per-capita consumption expenditure (MPCE) quintile, education and caste status). Multivariable linear and logistic regression analyses were conducted to fulfil the objectives. RESULTS A proportion of 41.7% and 43.4% of older adults belonged to low subjective (ladder) and objective (MPCE) SES, respectively. Older adults with low subjective (adjusted OR (aOR): 2.04; p<0.05) and objective SES (aOR: 1.32; p<0.05) had higher odds of having cognitive impairment in comparison with their counterparts, with a stronger subjective SES-cognitive impairment association. Older adults with lower education or belonged to lower caste had higher odds of cognitive impairment than their counterparts. Interaction analyses revealed that older adults who belonged to lower subjective and objective (poorest MPCE quintile, Scheduled Castes and lowest education) SES had 2.45 (CI: 1.77 to 3.39), 4.56 (CI: 2.97 to 6.98) and 54.41 (CI: 7.61 to 388.93) higher odds of cognitive impairment than those from higher subjective and objective SES, respectively. CONCLUSION Subjective measures of SES were linked to cognitive outcomes, even more strongly than objective measures of SES; considering the relative ease of obtaining such measures, subjective SES measures are a promising target for future study on socioeconomic indicators of cognitive impairment.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - T V Sekher
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, India
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9
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Eliacin J, Carter J, Bass E, Flanagan M, Salyers MP, McGuire A. Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation. BMJ Open 2022; 12:e057300. [PMID: 35636799 PMCID: PMC9152945 DOI: 10.1136/bmjopen-2021-057300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units. DESIGN VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data. SETTING 34 VHA inpatient mental health units located in every geographical region of the USA. PARTICIPANTS 55 treatment team members. RESULTS Our results identified an overarching theme of 'power-sharing' that describes participants' conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1) No power sharing: patients are excluded from treatment decisions; (2) Limited power sharing: patients are informed of treatment decisions but have limited influence on the decision-making process; and (3) Shared-power: patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy. CONCLUSIONS Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients' self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica Carter
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Emily Bass
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Mindy Flanagan
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
| | - Alan McGuire
- Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychology, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, USA
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10
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Geurts EMA, Pittens CACM, Boland G, van Dulmen S, Noordman J. Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care. PATIENT EDUCATION AND COUNSELING 2022; 105:1130-1137. [PMID: 34456095 DOI: 10.1016/j.pec.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Both patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations. METHODS An exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings. RESULTS 24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings. CONCLUSIONS Persuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact. PRACTICE IMPLICATIONS Awareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.
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Affiliation(s)
- Esther M A Geurts
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands; Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
| | | | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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11
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Thorpe D, Fouyaxis J, Lipschitz JM, Nielson A, Li W, Murphy SA, Bidargaddi N. Cost and Effort Considerations for the Development of Intervention Studies Using Mobile Health Platforms: Pragmatic Case Study. JMIR Form Res 2022; 6:e29988. [PMID: 35357313 PMCID: PMC9015742 DOI: 10.2196/29988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 12/02/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The research marketplace has seen a flood of open-source or commercial mobile health (mHealth) platforms that can collect and use user data in real time. However, there is a lack of practical literature on how these platforms are developed, integrated into study designs, and adopted, including important information around cost and effort considerations. OBJECTIVE We intend to build critical literacy in the clinician-researcher readership into the cost, effort, and processes involved in developing and operationalizing an mHealth platform, focusing on Intui, an mHealth platform that we developed. METHODS We describe the development of the Intui mHealth platform and general principles of its operationalization across sites. RESULTS We provide a worked example in the form of a case study. Intui was operationalized in the design of a behavioral activation intervention in collaboration with a mental health service provider. We describe the design specifications of the study site, the developed software, and the cost and effort required to build the final product. CONCLUSIONS Study designs, researcher needs, and technical considerations can impact effort and costs associated with the use of mHealth platforms. Greater transparency from platform developers about the impact of these factors on practical considerations relevant to end users such as clinician-researchers is crucial to increasing critical literacy around mHealth, thereby aiding in the widespread use of these potentially beneficial technologies and building clinician confidence in these tools.
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Affiliation(s)
- Dan Thorpe
- Flinders Digital Health Research Lab, College of Medicine and Public Health, Flinders University, Clovelly Park, Australia
| | - John Fouyaxis
- Flinders Digital Health Research Lab, College of Medicine and Public Health, Flinders University, Clovelly Park, Australia
| | | | - Amy Nielson
- Flinders Digital Health Research Lab, College of Medicine and Public Health, Flinders University, Clovelly Park, Australia
| | - Wenhao Li
- Flinders Digital Health Research Lab, College of Medicine and Public Health, Flinders University, Clovelly Park, Australia
| | - Susan A Murphy
- Radcliffe Institute, Harvard University, Boston, MA, United States
| | - Niranjan Bidargaddi
- Flinders Digital Health Research Lab, College of Medicine and Public Health, Flinders University, Clovelly Park, Australia
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12
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Popejoy E, Almack K, Manning JC, Johnston B, Pollock K. Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study. Palliat Med 2022; 36:519-528. [PMID: 34965779 DOI: 10.1177/02692163211068997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes. AIM To explore the communication strategies used in shared decision-making for children with life-limiting conditions. DESIGN A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11. SETTING/PARTICIPANTS Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed. FINDINGS Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child's best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child's psychosocial wellbeing. CONCLUSIONS Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals' moral reasoning may assist the process of shared decision-making.
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Affiliation(s)
- Emma Popejoy
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing Glasgow, University of Glasgow, Glasgow, UK.,NHS Greater Glasgow and Clyde, Scotland, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
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13
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Pieterse AH, Brandes K, de Graaf J, de Boer JE, Labrie NHM, Knops A, Allaart CF, Portielje JEA, Bos WJW, Stiggelbout AM. Fostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making. Med Decis Making 2021; 42:375-386. [PMID: 34727753 PMCID: PMC8918871 DOI: 10.1177/0272989x211056334] [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] [Indexed: 11/18/2022]
Abstract
Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment. Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance. Results A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (Mpresent = 5.2 v. Mabsent = 5.0, P = 0.042, η2partial = 0.006) and physician preference communication had no (Mpresent = 5.0 v. Mabsent = 5.1, P = 0.144, η2partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (Mpresent = 4.7 v. Mabsent = 5.3, P = 0.006, η2partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust. Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Kim Brandes
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Jessica de Graaf
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Knops
- Dutch Federation of Patients' Organizations, Quality of Care Department, BM, Utrecht, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
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Kirsch V, Matthes J. A simulation-based module in pharmacology education reveals and addresses medical students' deficits in leading prescription talks. Naunyn Schmiedebergs Arch Pharmacol 2021; 394:2333-2341. [PMID: 34522985 PMCID: PMC8514349 DOI: 10.1007/s00210-021-02151-w] [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: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Although doctor-patient communication is essential for drug prescription, the literature reveals deficits in this area. An educational approach at the Cologne medical faculty aims at identifying and addressing those deficits in medical students.Fifth-year medical students first conducted a simulated prescription talk spontaneously. Subsequently, the conversation was discussed with peer students. A pharmacist moderated the discussion based upon a previously developed conversation guide. Afterwards, the same student had the conversation again, but as if for the first time. Conversations were video-recorded, transcribed and subjected to quantitative content analysis. Four days after the simulation, the students who conducted the talk, those who observed and discussed it, and students who did neither, completed a written test that focused on the content of an effective prescription talk.Content analysis revealed clear deficits in spontaneously led prescription talks. Even essential information as on adverse drug reactions were often lacking. Prescription talks became clearly more informative and comprehensive after the short, guided peer discussion. With regard to a comprehensive, informative prescription talk, the written test showed that both the students who conducted the talk and those who only observed it performed clearly better than the students who did not participate in the educational approach.Deficits regarding prescription talks are present in 5th year medical students. We provide an approach to both identify and address these deficits. It thus may be an example for training medical students in simulated and clinical environments like the EACPT recommended to improve pharmacology education.
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Affiliation(s)
- Verena Kirsch
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany
| | - Jan Matthes
- Center of Pharmacology, Institute II, University of Cologne, Gleueler Strasse 24, 50931, Cologne, Germany.
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15
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Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty. Anesthesiology 2021; 135:111-121. [PMID: 33891695 DOI: 10.1097/aln.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Calls to better involve patients in decisions about anesthesia-e.g., through shared decision-making-are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. METHODS This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. RESULTS The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. CONCLUSIONS Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists' attention away from important humanistic aspects of communication such as decreasing patients' anxiety. EDITOR’S PERSPECTIVE
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16
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van Dulmen S, Peereboom E, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld BC, Abrahams AC, Roodbeen R. The use of implicit persuasion in decision-making about treatment for end-stage kidney disease. Perit Dial Int 2021; 42:377-386. [PMID: 34212786 DOI: 10.1177/08968608211027019] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are various options for managing end-stage kidney disease. Each option impacts the lives of patients differently. When weighing the pros and cons of the different options, patients' values, needs and preferences should, therefore, be taken into account. However, despite the best intentions, nephrologists may, more or less deliberately, convey a treatment preference and thereby steer the decision-making process. Being aware of such implicit persuasion could help to further optimise shared decision-making (SDM). This study explores verbal acts of implicit persuasion during outpatient consultations scheduled to make a final treatment decision. These consultations mark the end of a multi-consultation, educational process and summarise treatment aspects discussed previously. METHODS Observations of video-recorded outpatient consultations in nephrology (n = 20) were used to capture different forms of implicit persuasion. To this purpose, a coding scheme was developed. RESULTS In nearly every consultation nephrologists used some form of implicit persuasion. Frequently observed behaviours included selectively presenting treatment options, benefits and harms, and giving the impression that undergoing or foregoing treatment is unusual. The extent to which nephrologists used these behaviours differed. CONCLUSION The use of implicit persuasion while discussing different kidney replacement modalities appears diverse and quite common. Nephrologists should be made aware of these behaviours as implicit persuasion might prevent patients to become knowledgeable in each treatment option, thereby affecting SDM and causing decisional regret. The developed coding scheme for observing implicit persuasion elicits useful and clinically relevant examples which could be used when providing feedback to nephrologists.
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Affiliation(s)
- Sandra van Dulmen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud institute for health sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Emma Peereboom
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Lotte Schulze
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, The Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, VU Amsterdam, The Netherlands.,Diapriva Dialysis Center, Amsterdam, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Ruud Roodbeen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, The Netherlands
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17
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Jacklin S, Maskrey N, Chapman S. Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study. JMIR MEDICAL EDUCATION 2021; 7:e22745. [PMID: 34110299 PMCID: PMC8235293 DOI: 10.2196/22745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient's informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. OBJECTIVE This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. METHODS Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants' views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants' experience of using the VP. RESULTS The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. CONCLUSIONS The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.
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Affiliation(s)
- Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Neal Maskrey
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom
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18
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Huang C, Lam L, Zhong Y, Plummer V, Cross W. Chinese mental health professionals' perceptions of shared decision-making regarding people diagnosed with schizophrenia: A qualitative study. Int J Ment Health Nurs 2021; 30:189-199. [PMID: 33300252 DOI: 10.1111/inm.12771_1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 10/22/2022]
Abstract
The implementation of shared decision-making regarding people diagnosed with schizophrenia is limited, although it is reported to have a positive impact on improving treatment adherence, therapeutic relationships and saving medical costs. The successful implementation of it is mainly dependent on the active engagement of mental health professionals. This study aims to identify mental health professionals' perceptions of shared decision-making regarding people diagnosed with schizophrenia in collectivist cultures such as Chinese culture. A qualitative descriptive approach was used, involving ten individual interviews with psychiatrists and four focus groups with twenty-three mental health nurses from the psychiatry department of a tertiary hospital in mainland China. An inductive thematic approach was used to analyze the data. Two main themes with five subthemes generated: willingness to engage in shared decision-making and perceiving shared decision-making as unachievable. The last theme included five subthemes: (i) deference to authority, (ii) tension between family decision-making and patient autonomy, (iii) uncertainty of trusting therapeutic relationships, (iv) implicit persuasion and (v) insufficient consultation time. Patients often lack opportunity and support to engage in decision-making. Mental health nurses in other countries need to be aware that Chinese patients and patients with a similar background are not knowledgeable about or value shared decision-making to the extent that other countries might. They need to evaluate and support them, including encouraging them to engage in decision-making as well as providing appropriate information. Mental health nurses need to collaborate with patients and their families to achieve patient-centred care when family involvement is expected.
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Affiliation(s)
- Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.,Xiangya School of Nursing, Central South University China, Changsha, China
| | - Louisa Lam
- School of Health, Federation University, Berwick, VIC, Australia
| | - Yaping Zhong
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Virginia Plummer
- School of Health, Federation University, Berwick, VIC, Australia
| | - Wendy Cross
- School of Health, Federation University, Berwick, VIC, Australia
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19
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Kumar G, Jaremko KM, Kou A, Howard SK, Harrison TK, Mariano ER. Quality of Patient Education Materials on Safe Opioid Management in the Acute Perioperative Period: What Do Patients Find Online? PAIN MEDICINE 2021; 21:171-175. [PMID: 30657963 DOI: 10.1093/pm/pny296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Guidelines on postoperative pain management recommend inclusion of patient and caregiver education on opioid safety. Patient education materials (PEMs) should be written at or below a sixth grade reading level. We designed this study to compare the readability of online PEMs related to postoperative opioid management produced by institutions with and without a regional anesthesiology and acute pain medicine (RAAPM) fellowship. METHODS With institutional review board exemption, we constructed our cohort of PEMs by searching RAAPM fellowship websites from North American academic medical centers and identified additional websites using structured Internet searches. Readability metrics were calculated from PEMs using the TextStat 0.4.1 textual analysis package for Python 2.7. The primary outcome was the Flesch-Kincaid Grade Level (FKGL), a score based on words per sentence and syllables per word. We also compared fellowship-based and nonfellowship PEMs on the presence or absence of specific content-related items. RESULTS PEMs from 15 fellowship and 23 nonfellowship institutions were included. The mean (SD) FKGL for PEMs was grade 7.84 (1.98) compared with the recommended sixth grade level (P < 0.001) and was not different between groups. Less than half of online PEMs contained explicit discussion of opioid tapering or cessation. Disposal and overdose risk were addressed more often by nonfellowship PEMs. CONCLUSIONS Available online PEMs related to opioid management are beyond the recommended reading level, but readability metrics for online PEMs do not differ between fellowship and nonfellowship groups. More than two-thirds of RAAPM fellowship programs in North America are lacking readable online PEMs on safe postoperative opioid management.
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Affiliation(s)
- Gunjan Kumar
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Kellie M Jaremko
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Steven K Howard
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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20
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De Sabbata K. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Front Psychiatry 2020; 11:571722. [PMID: 33240127 PMCID: PMC7680726 DOI: 10.3389/fpsyt.2020.571722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.
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Affiliation(s)
- Kevin De Sabbata
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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21
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Spierings J, van Rhijn-Brouwer FCC, de Bresser CJM, Mosterman PTM, Pieterse AH, Vonk MC, Voskuyl AE, de Vries-Bouwstra JK, Kars MC, van Laar JM. Treatment decision-making in diffuse cutaneous systemic sclerosis: a patient's perspective. Rheumatology (Oxford) 2020; 59:2052-2061. [PMID: 31808528 PMCID: PMC7382600 DOI: 10.1093/rheumatology/kez579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine the treatment decision-making process of patients with dcSSc in the context of haematopoietic stem cell transplantation (HSCT). METHODS A qualitative semi-structured interview study was done in patients before or after HSCT, or patients who chose another treatment than HSCT. Thematic analysis was used. Shared decision-making (SDM) was assessed with the 9-item Shared Decision Making Questionnaire (SDM-Q-9). RESULTS Twenty-five patients [16 male/nine female, median age 47 (range 27-68) years] were interviewed: five pre-HSCT, 16 post-HSCT and four following other treatment. Whereas the SDM-Q-9 showed the decision-making process was perceived as shared [median score 81/100 (range 49-100)], we learned from the interviews that the decision was predominantly made by the rheumatologist, and patients were often steered towards a treatment option. Strong guidance of the rheumatologist was appreciated because of a lack of accessible, reliable and SSc-specific information, due to the approach of the decision-making process of the rheumatologist, the large consequence of the decision and the trust in their doctor. Expectations of outcomes and risks also differed between patients. Furthermore, more than half of patients felt they had no choice but to go for HSCT, due to rapid deterioration of health and the perception of HSCT as 'the holy grail'. CONCLUSION This is the first study that provides insight into the decision-making process in dcSSc. This process is negatively impacted by a lack of disease-specific education about treatment options. Additionally, we recommend exploring patients' preferences and understanding of the illness to optimally guide decision-making and to provide tailor-made information.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht
| | - Femke C C van Rhijn-Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht
- Department of Nephrology and Hypertension, Regenerative Medicine Centre Utrecht, University Medical Centre Utrecht
| | | | - Petra T M Mosterman
- Patient Sounding Board of the Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden
| | | | - Alexandre E Voskuyl
- Department of Rheumatology, Rheumatology and Immunology Centre, Amsterdam UMC, Vrije Universiteit, Amsterdam
| | | | - Marijke C Kars
- Centre of Expertise Palliative Care, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht
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22
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Damman OC, Jani A, de Jong BA, Becker A, Metz MJ, de Bruijne MC, Timmermans DR, Cornel MC, Ubbink DT, van der Steen M, Gray M, van El C. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract 2020; 26:524-540. [PMID: 31840346 PMCID: PMC7155090 DOI: 10.1111/jep.13321] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The recent emphasis on value-based health care (VBHC) is thought to provide new opportunities for shared decision-making (SDM) in the Netherlands, especially when using patient-reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. AIM To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. APPROACH Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. RESULTS The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. CONCLUSION Successful implementation of SDM within VBHC initiatives may not be self-evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time-consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.
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Affiliation(s)
- Olga C. Damman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anant Jani
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Brigit A. de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center AmsterdamAmsterdam Neuroscience Research InstituteAmsterdamThe Netherlands
| | - Annemarie Becker
- Department of Pulmonary Diseases, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversiteit van AmsterdamAmsterdamThe Netherlands
| | - Margot J. Metz
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral SciencesGGz Breburg and Tilburg UniversityTilburgThe Netherlands
| | - Martine C. de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Danielle R. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Martina C. Cornel
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Dirk T. Ubbink
- Department of SurgeryAmsterdam UMC, Universiteit van AmsterdamAmsterdamThe Netherlands
| | - Marije van der Steen
- Department of Strategy and PolicyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Muir Gray
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Carla van El
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Dreesens D, Veul L, Westermann J, Wijnands N, Kremer L, van der Weijden T, Verhagen E. The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians' critical reflections. BMC Pediatr 2019; 19:467. [PMID: 31783822 PMCID: PMC6883587 DOI: 10.1186/s12887-019-1849-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of practice variation and new developments in palliative pediatric care, the Dutch Association of Pediatrics decided to develop the clinical practice guideline (CPG) palliative care for children. With this guideline, the association also wanted to precipitate an attitude shift towards shared decision-making (SDM) and therefore integrated SDM in the CPG Palliative care for children. The aim was to gain insight if integrating SDM in CPGs can potentially encourage pediatricians to practice SDM. Its objectives were to explore pediatricians' attitudes and thoughts regarding (1) recommendations on SDM in CPGs in general and the guideline Palliative care for children specifically; (2) other SDM enhancing strategies or tools linked to CPGs. METHODS Semi-structured face-to-face interviews. Pediatricians (15) were recruited through purposive sampling in three university-based pediatric centers in the Netherlands. The interviews were audio-recorded and transcribed verbatim, coded by at least two authors and analyzed with NVivo. RESULTS Some pediatricians considered SDM a skill or attitude that cannot be addressed by clinical practice guidelines. According to others, however, clinical practice guidelines could enhance SDM. In case of the guideline Palliative care for children, the recommendations needed to focus more on how to practice SDM, and offer more detailed recommendations, preferring a recommendation stating multiple options. Most interviewed pediatricians felt that patient decisions aids were beneficial to patients, and could ensure that all topics relevant to the patient are covered, even topics the pediatrician might not consider him or herself, or deems less important. Regardless of the perceived benefit, some pediatricians preferred providing the information themselves instead of using a patient decision aid. CONCLUSIONS For clinical practice guidelines to potentially enhance SDM, guideline developers should avoid blanket recommendations in the case of preference sensitive choices, and SDM should not be limited to recommendations on non-treatment decisions. Furthermore, preference sensitive recommendations are preferably linked with patient decision aids.
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Affiliation(s)
- Dunja Dreesens
- Department of Family Medicine, Maastricht University/School CAPHRI, P.O. Box 6166200, MD Maastricht, the Netherlands
- Knowledge Institute of the Federation of Medical Specialists, Utrecht, the Netherlands
| | - Lotte Veul
- GGD-regio Utrecht, Utrecht, the Netherlands
| | | | - Nicole Wijnands
- Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leontien Kremer
- Department of Pediatrics, Emma Children’s Hospital/Amsterdam UMC, Amsterdam, the Netherlands
- Princess Maxima Centre, Utrecht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University/School CAPHRI, P.O. Box 6166200, MD Maastricht, the Netherlands
| | - Eduard Verhagen
- University of Groningen, Groningen, the Netherlands
- Beatrix Children’s Hospital/University Medical Centre Groningen, Groningen, the Netherlands
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Medendorp NM, Hillen MA, van Maarschalkerweerd PEA, Aalfs CM, Ausems MGEM, Verhoef S, van der Kolk LE, Berger LPV, Wevers MR, Wagner A, Caanen BAH, Stiggelbout AM, Smets EMA. 'We don't know for sure': discussion of uncertainty concerning multigene panel testing during initial cancer genetic consultations. Fam Cancer 2019; 19:65-76. [PMID: 31773425 PMCID: PMC7026220 DOI: 10.1007/s10689-019-00154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 11/15/2019] [Indexed: 12/14/2022]
Abstract
Pre-test counseling about multigene panel testing involves many uncertainties. Ideally, counselees are informed about uncertainties in a way that enables them to make an informed decision about panel testing. It is presently unknown whether and how uncertainty is discussed during initial cancer genetic counseling. We therefore investigated whether and how counselors discuss and address uncertainty, and the extent of shared decision-making (SDM), and explored associations between counselors’ communication and their characteristics in consultations on panel testing for cancer. For this purpose, consultations of counselors discussing a multigene panel with a simulated patient were videotaped. Simulated patients represented a counselee who had had multiple cancer types, according to a script. Before and afterwards, counselors completed a survey. Counselors’ uncertainty expressions, initiating and the framing of expressions, and their verbal responses to scripted uncertainties of the simulated patient were coded by two researchers independently. Coding was done according to a pre-developed coding scheme using The Observer XT software for observational analysis. Additionally, the degree of SDM was assessed by two observers. Correlation and regression analyses were performed to assess associations of communicated uncertainties, responses and the extent of SDM, with counselors’ background characteristics. In total, twenty-nine counselors, including clinical geneticists, genetic counselors, physician assistants-in-training, residents and interns, participated of whom working experience varied between 0 and 25 years. Counselors expressed uncertainties mainly regarding scientific topics (94%) and on their own initiative (95%). Most expressions were framed directly (77%), e.g. We don’t know, and were emotionally neutral (59%; without a positive/negative value). Counselors mainly responded to uncertainties of the simulated patient by explicitly referring to the uncertainty (69%), without providing space for further disclosure (66%). More experienced counselors provided less space to further disclose uncertainty (p < 0.02), and clinical geneticists scored lower on SDM compared with other types of counselors (p < 0.03). Our findings that counselors mainly communicate scientific uncertainties and use space-reducing responses imply that the way counselors address counselees’ personal uncertainties and concerns during initial cancer genetic counseling is suboptimal.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Margreet G E M Ausems
- Division of Biomedical Genetics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Senno Verhoef
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lieke P V Berger
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijke R Wevers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara A H Caanen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology - Amsterdam UMC, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Genetics - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Yu CH, Ke C, Jovicic A, Hall S, Straus SE. Beyond pros and cons - developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development. BMC Med Inform Decis Mak 2019; 19:186. [PMID: 31533828 PMCID: PMC6749701 DOI: 10.1186/s12911-019-0898-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. METHODS This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. RESULTS Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. CONCLUSIONS A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Calvin Ke
- Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | | | - Susan Hall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Gruß I, McMullen CK. Barriers to eliciting patient goals and values in shared decision-making breast cancer surgery consultations: An ethnographic and interview study. Psychooncology 2019; 28:2233-2239. [PMID: 31461197 DOI: 10.1002/pon.5212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Previous research has demonstrated the importance of eliciting patients' goals and values during shared decision-making (SDM), but this does not occur in most SDM conversations. Understanding challenges to eliciting patients' goals and values is crucial. This study assessed how clinicians balanced sharing medical information and considering patients' goals and values during breast cancer surgery consultation in an integrated health care system. METHODS We conducted interviews with clinicians (n = 6) and patients (n = 11) and conducted naturalistic, ethnographic observations of eight surgical consultations in a multidisciplinary breast cancer clinic. We analyzed the data following the template method using the qualitative software NVivo 10. RESULTS Clinicians prioritized sharing medical information. We identified four patient factors necessary to integrate patients' values and goals into the conversation in addition to sharing medical information: ability to process large quantities of information quickly, willingness to embrace swift decision-making, ability to quickly formulate one's values, and prioritization of surgical choice as the goal of the conversation. CONCLUSIONS We found that SDM implementation results in practices that emphasize information and choice, with less focus on patient goals and values. More research is needed to explore factors that may encourage the elicitation of patients' goals and values.
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Affiliation(s)
- Inga Gruß
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, U.S
| | - Carmit K McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, U.S
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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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Fernandez HGC, Moreira MCN, Gomes R. Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature. CIENCIA & SAUDE COLETIVA 2019; 24:2279-2292. [PMID: 31269185 DOI: 10.1590/1413-81232018246.19202017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.
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Affiliation(s)
| | | | - Romeu Gomes
- Instituto Fernandes Figueira, Fiocruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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29
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Muscat DM, Shepherd HL, Hay L, Shivarev A, Patel B, McKinn S, Bonner C, McCaffery K, Jansen J. Discussions about evidence and preferences in real-life general practice consultations with older patients. PATIENT EDUCATION AND COUNSELING 2019; 102:879-887. [PMID: 30578105 DOI: 10.1016/j.pec.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/28/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore how decisions are made in real-life general practice consultations with older patients (65+ years), and examine how general practitioners (GPs) communicate risk and benefit information and evidence, and integrate patient preferences. METHODS Secondary analysis of 20 video-recorded consultations with older patients in Australian primary healthcare settings. Consultations were analysed qualitatively using the Framework method and quantitatively using the Observer OPTION5 scale and the Assessing Communication about Evidence and Patient Preferences (ACEPP) tool. RESULTS Overall, Observer OPTION5 and ACEPP scores were low, with mean total scores of 11.3 (out of 100) and 10.4 (out of 40) respectively. Together with qualitative findings, these results suggest that shared decision-making did not occur, and that healthcare options (including anticipated benefits and risks), evidence and patient preferences were rarely discussed in our sample of consultations with older people. GPs often unilaterally made treatment decisions (usually pharmacotherapy) while patients reverted to a passive decision-making role. CONCLUSION We observed a lack of shared decision-making in our primary care study, with little engagement of older patients in decisions about their health. PRACTICE IMPLICATIONS Training and support tools may be needed to enhance the capacity and self-efficacy of providers and older patients to share healthcare decisions.
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Affiliation(s)
- Danielle Marie Muscat
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Heather L Shepherd
- University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Louise Hay
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Alex Shivarev
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia
| | - Bindu Patel
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Australia; The George Institute for Global Health, University of New South Wales, Australia
| | - Shannon McKinn
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia
| | - Carissa Bonner
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Kirsten McCaffery
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia
| | - Jesse Jansen
- University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, Sydney, Australia.
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30
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Martin K, Morton L, Reid J, Feltham A, William Reid J, Jeremy G, McCulloch J. The Me first communication model. Nurs Child Young People 2019; 31:38-47. [PMID: 31468770 DOI: 10.7748/ncyp.2019.e1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 06/10/2023]
Abstract
This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.
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Affiliation(s)
| | - Louise Morton
- Healthcare education, Health Education England, England
| | - Joanna Reid
- Non-medical education, Great Ormond Street Hospital for Children NHS Foundation Trust, London, England
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Boland L, Graham ID, Légaré F, Lewis K, Jull J, Shephard A, Lawson ML, Davis A, Yameogo A, Stacey D. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement Sci 2019; 14:7. [PMID: 30658670 PMCID: PMC6339273 DOI: 10.1186/s13012-018-0851-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved). METHODS We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality. RESULTS Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings. CONCLUSIONS Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice. TRIAL REGISTRATION PROSPERO CRD42015020527.
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Affiliation(s)
- Laura Boland
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON, K1G 5Z3, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec City, Quebec, G1L 3L5, Canada
| | - Krystina Lewis
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street Kingston, Ottawa, ON, K7L 3N6, Canada
| | - Allyson Shephard
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Alexandra Davis
- Learning Services, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Audrey Yameogo
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Brown SL, Salmon P. Reconciling the theory and reality of shared decision-making: A "matching" approach to practitioner leadership. Health Expect 2018; 22:275-283. [PMID: 30478979 PMCID: PMC6543140 DOI: 10.1111/hex.12853] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 12/12/2022] Open
Abstract
Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.
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Affiliation(s)
- Stephen L Brown
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Hollin G, Pilnick A. The categorisation of resistance: interpreting failure to follow a proposed line of action in the diagnosis of autism amongst young adults. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1215-1232. [PMID: 29797473 DOI: 10.1111/1467-9566.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many characteristics typical of autism, a neurodevelopmental condition characterised by socio-communicative impairments, are most evident during social interaction. Accordingly, procedures such as the Autism Diagnosis Observation Schedule (ADOS) are interactive and intended to elicit interactional impairments: a diagnosis of autism is given if interactional difficulties are attributed as a persistent quality of the individual undergoing diagnosis. This task is difficult, first, because behaviours can be interpreted in various ways and, second, because conversation breakdown may indicate a disengagement with, or resistance to, a line of conversation. Drawing upon conversation analysis, we examine seven ADOS diagnosis sessions and ask how diagnosticians distinguish between interactional resistance as, on the one hand, a diagnostic indicator and, on the other, as a reasonable choice from a range of possible responses. We find evidence of various forms of resistance during ADOS sessions, but it is a resistance to a line of conversational action that is often determined to be indicative of autism. However, and as we show, this attribution of resistance can be ambiguous. We conclude by arguing for reflexive practice during any diagnosis where talk is the problem, and for a commitment to acknowledge the potential impact of diagnostic procedures themselves upon results.
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Affiliation(s)
- Gregory Hollin
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
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Reuber M, Chappell P, Jackson C, Toerien M. Evaluating nuanced practices for initiating decision-making in neurology clinics: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BackgroundWe report follow-on research from our previous qualitative analysis of how neurologists offer patients choice in practice. This focus reflects the NHS’s emphasis on ‘patient choice’ and the lack of evidence-based guidance on how to enact it. Our primary study identified practices for offering choice, which we called ‘patient view elicitors’ (PVEs) and ‘option-listing’. However, that study was not designed to compare these with recommendations or to analyse the consequences of selecting one practice over another.ObjectivesTo (1) map out (a) the three decision-making practices – recommending, PVEs and option-listing – together with (b) their interactional consequences; (2) identify, qualitatively and quantitatively, interactional patterns across our data set; (3) statistically examine the relationship between interactional practices and self-report data; and (4) use the findings from 1–3 to compare the three practices as methods for initiating decision-making.DesignA mixed-methods secondary analysis of recorded neurology consultations and associated questionnaire responses. We coded every recommendation, PVE and option-list together with a range of variables internal (e.g. patients’ responses) and external to the consultation (e.g. self-reported patient satisfaction). The resulting matrix captured the qualitative and quantitative data for every decision.Setting and participantsThe primary study was conducted in two neurology outpatient centres. A total of 14 neurologists, 223 patients and 114 accompanying others participated.ResultsDistribution of practices – recommending was the most common approach to decision-making. Patient demographics did not appear to play a key role in patterning decisional practices. Several clinical factors did show associations with practice, including (1) that neurologists were more likely to use option-lists or PVEs when making treatment rather than investigation decisions, (2) they were more certain about a diagnosis and (3) symptoms were medically explained. Consequences of practices – option-lists and PVEs (compared with recommendations) – were strongly associated with choice by neurologists and patients. However, there was no significant difference in overall patient satisfaction relating to practices employed. Recommendations were strongly associated with a course of action being agreed. Decisions containing PVEs were more likely to end in rejection. Option-lists often ended in the decision being deferred. There was no relationship between length of consultation and the practice employed.LimitationsA main limitation is that we judged only outcomes based on the recorded consultations and the self-report data collected immediately thereafter. We do not know what happened beyond the consultation.ConclusionsPatient choice is harder to enact than policy directives acknowledge. Although there is good evidence that neurologists are seeking to enact patient choice, they are still more likely to make recommendations. This appears to be partly due to concerns that ‘choice’ might conflict with doctors’ duty of care. Future guidance needs to draw on evidence regarding choice in practice to support doctors and patients to achieve the wider goal of shared decision-making.Future researchTo advance understanding of how interactional practices might have effects beyond the clinic, a priority is to investigate associations between decision-making practices and external outcomes (such as adherence).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul Chappell
- Department of Sociology, University of York, York, UK
| | - Clare Jackson
- Department of Sociology, University of York, York, UK
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Rodenburg-Vandenbussche S, Carlier IVE, van Vliet IM, van Hemert AM, Stiggelbout AM, Zitman FG. Clinical and sociodemographic associations with treatment selection in major depression. Gen Hosp Psychiatry 2018; 54:18-24. [PMID: 30048764 DOI: 10.1016/j.genhosppsych.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate treatment selection in a naturalistic sample of MDD outpatients and the factors influencing treatment selection in specialized psychiatric care. METHOD Multinomial Logistic Regression analysis investigated associations between treatment selection and patients' sociodemographic and clinical characteristics, using retrospective chart review data and Routine Outcome Monitoring (ROM) data of MDD outpatients. RESULTS Of the patients included for analyses (N = 263), 34% received psychotherapy, 32% received an antidepressant (AD) and 35% received a combination. Men were more likely than women to receive AD with reference to psychotherapy (ORAD = 5.57, 95% CI 2.38-13.00). Patients with severe depression and patients with AD use upon referral, prescribed by their general practitioner, were more likely to receive AD (ORsevere depression = 5.34, 95% CI 1.70-16.78/ORAD GP = 9.26, 95% CI 2.53-33.90) or combined treatment (ORsevere depression = 6.32, 95% CI 1.86-21.49/ORAD GP = 22.36, 95% CI 5.89-83.59) with respect to psychotherapy. More severe patients with AD upon referral received combined treatment less often compared to psychotherapy (OR = 0.14, 95% CI 0.03-0.68). CONCLUSION AD prescriptions in primary care, severity and gender influenced treatment selection for depressive disorders in secondary psychiatric care. Other factors such as the accessibility of treatment and patient preferences may have played a role in treatment selection in this setting and need further investigation.
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Affiliation(s)
| | - I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - I M van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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Sidani S, Reeves S, Hurlock-Chorostecki C, van Soeren M, Fox M, Collins L. Exploring Differences in Patient-Centered Practices among Healthcare Professionals in Acute Care Settings. HEALTH COMMUNICATION 2018; 33:716-723. [PMID: 28402138 DOI: 10.1080/10410236.2017.1306476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals' characteristics (gender, work experience) and a contextual factor (caseload), with the professionals' PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada. Consenting professionals (n = 382) completed a self-report instrument assessing the three PCC components and responded to standard questions inquiring about their characteristics and workload. Small differences were found in the PCC practices across professional groups: (1) physicians reported higher levels of enacting the holistic care component; (2) physicians, other healthcare providers, and social workers reported implementing higher levels of the collaborative care component; and (3) physicians, nurses, and other healthcare providers reported higher levels of providing responsive care. Caseload influenced holistic care practices. Interprofessional education and training strategies are needed to clarify and address professional differences in valuing and practicing PCC components. Clinical guidelines can be revised to enable professionals to engage patients in care-related decisions, customize patient care, and promote interprofessional collaboration in planning and implementing PCC. Additional research is warranted to determine the influence of professional, patient, and other contextual factors on professionals' PCC practices in acute care hospitals.
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Affiliation(s)
- Souraya Sidani
- a Daphne Cockwell School of Nursing , Ryerson University
| | - Scott Reeves
- b Centre for Health & Social Care Research , Kingston University & St George's, University of London
| | | | - Mary van Soeren
- c Labatt Family School of Nursing , University of Western Ontario
| | - Mary Fox
- d School of Nursing , York University
| | - Laura Collins
- a Daphne Cockwell School of Nursing , Ryerson University
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Zisman-Ilani Y, Shern D, Deegan P, Kreyenbuhl J, Dixon L, Drake R, Torrey W, Mishra M, Gorbenko K, Elwyn G. Continue, adjust, or stop antipsychotic medication: developing and user testing an encounter decision aid for people with first-episode and long-term psychosis. BMC Psychiatry 2018; 18:142. [PMID: 29788933 PMCID: PMC5963160 DOI: 10.1186/s12888-018-1707-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. METHODS A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation. RESULTS An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents. CONCLUSIONS The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Rehabilitation Sciences, College of Public Health, Temple University, 1700 North Broad St., Philadelphia, PA 19122 USA
| | - David Shern
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | | | - Julie Kreyenbuhl
- The Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD USA
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD USA
| | - Lisa Dixon
- Columbia University Medical Center, New York, NY USA
- New York State Psychiatric Institute, New York, USA
| | - Robert Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
| | - William Torrey
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Manish Mishra
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
| | - Ksenia Gorbenko
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
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Diamond-Brown L. “It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making. Soc Sci Med 2018; 205:48-54. [DOI: 10.1016/j.socscimed.2018.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/31/2023]
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Gibson B, Butler J, Doyon K, Ellington L, Bray BE, Zeng Q. Veterans Like Me: Formative evaluation of a patient decision aid design. J Biomed Inform 2017; 71S:S46-S52. [PMID: 27623534 PMCID: PMC5513765 DOI: 10.1016/j.jbi.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/29/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
Abstract
Patient decision aids are tools intended to facilitate shared decision-making. Currently development of a patient decision aid is resource intensive: it requires a decision-specific review of the scientific literature by experts to ascertain the potential outcomes under different treatments. The goal of this project was to conduct a formative evaluation of a generalizable, scalable decision aid component we call Veterans Like Me (VLme). VLme mines EHR data to present the outcomes of individuals "like you" on different treatments to the user. These outcome are presented through a combination of an icon array and simulated narratives. Twenty-six patients participated in semi-structured interviews intended to elicit feedback on the tool's functional and interface design. The interview focused on the filters users desired with which to make cases similar to them, the kinds of outcomes they wanted presented, and their envisioned use of the tool. The interview also elicited participants information needs and salient factors related to the therapeutic decision. The interview transcripts were analyzed using an iteratively refined coding schema and content analysis. . Participants generally expressed enthusiasm for the tool's design and functionality. Our analysis identified desired filters for users to view patients like themselves, outcome types that should be included in future iterations of the tool (e.g. patient reported outcomes), and information needs that need to be addressed for patients to effectively participate in shared decision making. Implications for the integration of our findings into the design of patient decision aids are discussed.
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Affiliation(s)
- Bryan Gibson
- IDEAS 2.0 Center, George E Whalen VA Medical Center, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States.
| | - Jorie Butler
- IDEAS 2.0 Center, George E Whalen VA Medical Center, Salt Lake City, UT, United States; Geriatric Research Education and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, United States
| | - Katherine Doyon
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Bruce E Bray
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Qing Zeng
- Department of Biomedical Informatics, George Washington University, Washington DC, United States
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Boland L, Kryworuchko J, Saarimaki A, Lawson ML. Parental decision making involvement and decisional conflict: a descriptive study. BMC Pediatr 2017; 17:146. [PMID: 28610580 PMCID: PMC5470309 DOI: 10.1186/s12887-017-0899-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/05/2017] [Indexed: 01/03/2023] Open
Abstract
Background Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child’s health. However, little is known about parents’ experience of decisional conflict. We explored parents’ perceived decision making involvement and its association with parents’ decisional conflict. Method We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Results Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p < 0.001). Further, parents with options were more likely to: feel sure about the decision (RR 1.08, 95% CI 1.02–1.15); understand the information (RR 1.92, 95% CI 1.63–2.28); be clear about the risks and benefits (RR 1.12, 95% CI 1.05–1.20); and, have sufficient support and advice to make a choice (RR 1.07, 95% CI 1.03–1.11). Conclusion Many parents in our sample experienced decisional conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents’ decisional conflict. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0899-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Boland
- University of Ottawa, Faculty of Health Sciences, Population Health, 125 University Street, room 232, Ottawa, ON, K1N 6N5, Canada
| | - Jennifer Kryworuchko
- University of Saskatchewan College of Nursing Health Sciences, E-4220, 104 Clinic Place, Saskatoon, S7N 5E5, SK, Canada.,Present address: School of Nursing, University of British Columbia, Vancouver, Canada
| | - Anton Saarimaki
- Ottawa Hospital Research Institute & University of Ottawa, 501 Smyth Road, Box 711, Ottawa, ON, K2G 0Y1, Canada
| | - Margaret L Lawson
- Family Decision Services, CHEO Research Institute, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, K1H 8L1, ON, Canada.
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Abstract
Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non-maleficence. It is argued that SDM is "polyvalent", a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high-quality decision support tools; integrating SDM with other recovery-supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes - social marketing and the hospitality industry - are identified.
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Affiliation(s)
- Mike Slade
- Institute of Mental Health, School of Health Sciences, University of NottinghamNottinghamUK
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Hauser K, Koerfer A, Niehaus M, Albus C, Herzig S, Matthes J. The prescription talk - an approach to teach patient-physician conversation about drug prescription to medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc18. [PMID: 28584866 PMCID: PMC5450434 DOI: 10.3205/zma001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 01/31/2017] [Accepted: 02/15/2017] [Indexed: 06/07/2023]
Abstract
Background: Medication communication from physicians to patients often is poor, by this among others enhancing the risk of non-adherence. In this context, a neglect regarding the prescription talk has been complained. Aim of the project: In a newly developed elective medical students work on physician-patient conversations dealing with drug prescription. Essential aspects related to an effective and safe drug treatment are combined with steps of shared decision-making. Together with a tutor, students develop a (model) conversation guide that might be tailored according to individual needs and views. Description/Methods: In a one-week course 3rd-5th year medical students treat a paper case according to problem-based learning. This is accompanied by a one-hour lecture and literature provided on an online learning platform (ILIAS). During a workshop, aspects of drug treatment and patient participation are integrated into a guide for a prescription talk. At the end of the week the students are invited to apply the (if need be individualized) guide in a simulated physician-patient communication with an actor. The conversation is evaluated using a checklist based upon the (model) conversation guide. Results: Informal and formalized feedback indicate high acceptance and satisfaction of participants with this elective. The checklist turned out to be of acceptable to good reliability with mostly selective items. Portfolio entries and written evaluation suggest that participants' positions and attitudes are influenced.
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Affiliation(s)
- Katarina Hauser
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
| | - Armin Koerfer
- Uniklinik Köln, Klinik und Poliklinik für Psychosomatik und Psychotherapie, Köln, Deutschland
| | - Mathilde Niehaus
- Universität zu Köln, Humanwissenschaftliche Fakultät, Lehrstuhl für Arbeit und Berufliche Rehabilitation, Köln, Deutschland
| | - Christian Albus
- Uniklinik Köln, Klinik und Poliklinik für Psychosomatik und Psychotherapie, Köln, Deutschland
| | - Stefan Herzig
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
- Universität zu Köln, Rektorat, Köln, Deutschland
| | - Jan Matthes
- Universität zu Köln, Zentrum für Pharmakologie, Institut II, Köln, Deutschland
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Wood F, Phillips K, Edwards A, Elwyn G. Working with interpreters: The challenges of introducing Option Grid patient decision aids. PATIENT EDUCATION AND COUNSELING 2017; 100:456-464. [PMID: 27745941 DOI: 10.1016/j.pec.2016.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/15/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. METHODS Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. RESULTS Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. CONCLUSION Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. PRACTICE IMPLICATIONS Option Grid decision aids are not being used as intended in interpreted consultations.
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Affiliation(s)
- Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Katie Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover NH USA
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Reeve E, Denig P, Hilmer SN, Ter Meulen R. The Ethics of Deprescribing in Older Adults. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:581-590. [PMID: 27416980 DOI: 10.1007/s11673-016-9736-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 05/02/2016] [Indexed: 06/06/2023]
Abstract
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners' prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing. Respecting the autonomy of older adults is complex as they may not wish to be active in the decision-making process; they may also have reduced cognitive function and family members may therefore have to step in as surrogate decision-makers. Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time. However, people are rarely updated on the altered risks and benefits of their long-term medications as they age. Cessation of inappropriate medication use has a large financial benefit to the individual and the community. However, the principle of justice also dictates equal rights to treatment regardless of age.
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Affiliation(s)
- Emily Reeve
- Ageing and Pharmacology, Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Level 12 Kolling building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Petra Denig
- Faculty of Medical Sciences, Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands
| | - Sarah N Hilmer
- Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital and Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Level 12 Kolling building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ruud Ter Meulen
- Centre for Ethics in Medicine, School of Social and Community Medicine, University of Bristol, Office Room G.04b, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Abstract
OBJECTIVES The aim of the study was to understand the association between parents' perceptions of the decision process and the decision outcomes in decisions about the use of biologics in pediatric chronic conditions. METHODS We mailed surveys to parents of children with inflammatory bowel disease or juvenile idiopathic arthritis who had started treatment with biologics in the prior 2 years and were treated at either of 2 children's hospitals. The survey included measures of the decision process, including decision control and physician engagement, and decision outcomes, including conflict and regret. We used means and frequencies to assess the response distributions. General linear models were used to test the associations between decision process and decision outcomes. RESULTS We had 201 respondents (response rate 54.9%). Approximately 47.0% reported using shared decision making. Each physician engagement behavior was experienced by the majority of parents, with the highest percentage reporting that their child's physician used language they understood and listened to them. Approximately 48.5% of parents had decisional conflict scores of 25 or greater, indicating high levels of conflict. Approximately 28.2% had no regret, 31.8% had mild regret, and the remaining 40.0% had moderate to severe regret. Shared decision making was not associated with improved decisional conflict, but physician engagement behaviors were associated with both decisional conflict and regret. CONCLUSIONS Improving decision outcomes will require more than just focusing on who parents perceive as controlling the final decision. Developing interventions that facilitate specific physician engagement behaviors may decrease parents' distress around decision making and improve decision outcomes.
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Kienle GS, Mussler M, Fuchs D, Kiene H. Individualized Integrative Cancer Care in Anthroposophic Medicine: A Qualitative Study of the Concepts and Procedures of Expert Doctors. Integr Cancer Ther 2016; 15:478-494. [PMID: 27151589 PMCID: PMC5739166 DOI: 10.1177/1534735416640091] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient's wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care-related specialists. Conclusion Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.
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Affiliation(s)
- Gunver S Kienle
- University of Witten Herdecke, Freiburg, Germany
- University Medical Center Freiburg, Freiburg, Germany
| | | | | | - Helmut Kiene
- University of Witten Herdecke, Freiburg, Germany
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Müller-Engelmann M, Donner-Banzhoff N, Keller H, Rosinger L, Sauer C, Rehfeldt K, Krones T. When Decisions Should Be Shared. Med Decis Making 2016; 33:37-47. [DOI: 10.1177/0272989x12458159] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Shared decision making (SDM) is often advocated as an ideal for making medical decisions. Until now, however, opinions regarding which treatment situations warrant SDM have not been systematically investigated. The purpose of this study was to examine social norms regarding medical decision making, using a factorial survey design. Methods. The factorial survey applied in this study consisted of 7 situational factors (e.g., the reason for consultation), each with 2 to 3 levels (e.g., prevention and severe disease). These factors were turned into various descriptions of treatment situations. A total of 101 physicians, 115 patients, and 113 members of self-help groups participated in the study. Each participant assessed 10 vignettes using a 5-point scale to indicate who they thought should make the decision in each specific situation. Results. Most assessments across the 3 groups called for a shared decision (39%). Ordered logistic regression analysis demonstrated that, according to study participants, all 7 situational factors (reason for consultation, time frame of negative outcomes, time pressure, number of therapeutic options, side effects, scientific evidence of efficacy, and desire to participate) significantly affected how decisions regarding treatment should be made. The strongest factor was the patient’s desire to participate in decision making (odds ratio = 1.84; P ≤ 0.001), followed by the reason for consultation (odds ratio = 0.69; P ≤ 0.001). Conclusions. This study reveals that there is a general desire for SDM in a variety of treatment situations. Furthermore, based on the responses of our participants, our findings also lay the framework in determining which treatment situations warrant SDM.
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Affiliation(s)
- Meike Müller-Engelmann
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Norbert Donner-Banzhoff
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Heidi Keller
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Lydia Rosinger
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Carsten Sauer
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Kerstin Rehfeldt
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
| | - Tanja Krones
- University of Marburg, Marburg, Germany (MM-E, ND-B, HK, LR, KR, TK)
- Bielefeld University, Bielefeld, Germany (CS)
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Timor-Shlevin S, Krumer-Nevo M. Partnership-based practice with young people: relational dimensions of partnership in a therapeutic setting. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:576-586. [PMID: 25809498 DOI: 10.1111/hsc.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 06/04/2023]
Abstract
The recent literature concerning partnership between professionals and young people reveals important developments regarding the nature of partnership: from short-term partnerships with young people's parents intended to improve decision-making in the context of critical life decisions, to a growing interest in direct partnership between professionals and young people as a core principle of long-term relationships. Although it is widely acknowledged among health and social service professionals that partnerships can have positive outcomes for young people, the concept and implementation of partnership remain vague. This article examines the meanings of partnership for people involved in a community youth centre for marginalised youth. Data were collected during the year 2011 using multiple-methods including focus groups (with eight youth workers), participant observations (in assembly meetings and 'partnership meetings') and semi-structured interviews (with 10 principal stakeholders, including youth, youth workers and the Center's founders). Data were analysed using principles of grounded theory to articulate partnership as an ongoing experience, combining both structural-technical and content-experiential components. Our findings present partnership as existing simultaneously in the practice of decision-making and in the realm of self-experience and interpersonal relationships, and explore the relationship between both spheres. The findings also shed light on the importance of the specific characteristics of shared decision-making (atmosphere, content and duration) in the creation of partnership. We discuss our findings in the light of possibilities for partnership-based practice with marginalised youth.
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Affiliation(s)
- Shachar Timor-Shlevin
- Sociology and Anthropology, Bar Ilan University, Israel
- Social Work, Ben Gurion University of the Negev, Israel
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