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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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O'Hara NN, Sciadini MF. Using Discrete Choice Experiments to Quantify Patient Preferences. J Am Acad Orthop Surg 2024; 32:e9-e16. [PMID: 37647520 DOI: 10.5435/jaaos-d-22-01125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Abstract
Discrete choice experiments are a robust technique for quantifying preferences. With this method, respondents are presented with a series of hypothetical comparisons described by attributes with varying levels. The aggregated choices from respondents can be used to infer the relative importance of the described attributes and acceptable trade-offs between attributes. The data generated from discrete choice experiments can aid surgeons in aligning patient values with treatment decisions and support the design of research that is responsive to patient preferences. This article summarizes the application of discrete choice experiments to orthopaedics. We share best practices for designing discrete choice experiments and options for reporting study results. Finally, we suggest opportunities for this method within our field.
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Affiliation(s)
- Nathan N O'Hara
- From the Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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Grytten J, Listl S, Skau I. Do Norwegian private dental practitioners with too few patients compensate for their loss of income by providing more services or by raising their fees? Community Dent Oral Epidemiol 2023; 51:778-785. [PMID: 35616472 DOI: 10.1111/cdoe.12750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE In Norway, supply of dental services exceeds demand, mainly because of the marked improvement in dental health during the last few decades. The aim of the study was to investigate whether private dental practitioners counteract a fall in demand for their services by providing more services or by raising their fees. METHODS The data were collected using a questionnaire that was sent to all private dental practitioners in Norway. Altogether 1237 practitioners responded, which gave a response rate of 56%. Our sample was representative of the population of practitioners in Norway. As a measure of patient supply, responses from the following questions were used: 'Based on an overall assessment of economy, workload and other personal factors, is the number of regular patients adequate? If not, do you wish to have more patients, or fewer patients?' The outcome variables were dental fees, length of recall interval and mean cost per visit. The data were analysed using ordinary least square regression and a linear probability model. The following characteristics of the private dental practitioners were included as control variables: age, gender, work experience in years and whether they worked in a solo practice. To test the robustness of the findings, a supplementary analysis with the patient as the unit of analysis was carried out, using survey data of Norwegians aged 20 years and older. Based on this survey, the relationship between population: dentist ratio and mean cost per dental visit were examined. RESULTS Nearly 40% of all practitioners reported that they had too few patients. They compensated for their loss of income by raising their fees, by recalling their patients more often and by increasing the cost per visit. The finding in the supplementary analysis using survey data from patients was similar to the findings in the main analyses using survey data from private dental practitioners. CONCLUSION The findings show that practitioners have market power. They were able to counteract a fall in demand for their services by providing more services and by raising their fees. The dental profession should be encouraged to provide appropriate services, in the present situation where supply exceeds demand.
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Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry, Dental Faculty University of Oslo, Oslo, Norway
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Stefan Listl
- Department of Dentistry - Quality and Safety of Oral Health Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irene Skau
- Department of Community Dentistry, Dental Faculty, University of Oslo, Oslo, Norway
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Ju I, Ohs J, Park T, Hinsley A. Harnessing an Integrated Health Communication (IHC) Framework for Campaigns: A Case of Prescription Drug Decision Making. HEALTH COMMUNICATION 2023; 38:981-992. [PMID: 34657528 DOI: 10.1080/10410236.2021.1986885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drawing on a multiplicity of mass media and health behavior theories, we propose an integrated health communication (IHC) framework to understand and leverage the ways in which mass mediated and interpersonal sources of health information influence the public's health behavior in the context of their prescription drug decisions. Building on the agenda setting theory, two-step flow theory, and the Health Belief Model, we dig into the interrelationships between mass media and interpersonal information sources and information seeking engagement. Employing survey methodology, our framework was tested using a sample of U.S. adults (N = 628). The major results include (a) information gained through interpersonal sources and perceived benefits of the prescription drugs positively and sequentially mediate the association between mass media exposure and intent to seek prescription drug information, (b) interpersonal health information positively moderate the mediation of mass media exposure - perceived benefits - intent to seek prescription drug information, and (c) the inexpert interpersonal information's positive interaction effect with mass media exposure on intent to seek prescription drug information mediated through perceived benefits was greater with high expert interpersonal communication. These results impart valuable theoretical contributions and have the potential to guide integrated health communication (IHC) campaigns.
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Affiliation(s)
- Ilwoo Ju
- Brian Lamb School of Communication, Purdue University
| | - Jennifer Ohs
- Department of Communication, Saint Louis University
| | - Taehwan Park
- Department of Pharmacy Administration and Public Health, St. John's University
| | - Amber Hinsley
- School of Journalism and Mass Communication, Texas State University
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Bujold M, Pluye P, Légaré F. Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis. BMC PRIMARY CARE 2022; 23:279. [PMID: 36352376 PMCID: PMC9644584 DOI: 10.1186/s12875-022-01879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes. METHODS We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor's explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes). RESULTS We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: 'prioritization' (n = 26), 'use of services' (n = 22), 'prescription' (n = 12), 'behavior change' (n = 4) and 'institutionalization' (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: 'well-managed' (n = 13), 'asymmetric encounters' (n = 21), 'self-management by default' (n = 8), and 'chaotic' (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making. CONCLUSION Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.
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Affiliation(s)
- Mathieu Bujold
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
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Waitzberg R, Gottlieb N, Quentin W, Busse R, Greenberg D. Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations? Int J Health Policy Manag 2022; 11:1823-1834. [PMID: 34634873 PMCID: PMC9808238 DOI: 10.34172/ijhpm.2021.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 07/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients' clinical needs and hospitals' financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems. METHODS We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning. RESULTS Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include 'reshaping management,' such as better planning of the entire course of treatment and improvement of the coding; and 'reframing decision-making,' which involves working with averages and developing tool-kits for decision-making. CONCLUSION Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.
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Affiliation(s)
- Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Berlin, Germany
| | - Nora Gottlieb
- Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Berlin, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wilm Quentin
- Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Reinhard Busse
- Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gurtner C, Schols JMGA, Lohrmann C, Halfens RJG, Hahn S. Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:531-548. [PMID: 33191536 DOI: 10.1111/jpm.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Shared decision-making is a concept originating in the medical field, and it is ideally based on a trustful relationship between the patient and the health professionals involved. Shared decision-making shows potential to strengthen patient autonomy and encourages patients to become involved in decisions regarding their treatment. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: A universal concept and understanding of shared decision-making with relevance specifically to psychiatric clinical practice could not be identified in the analysed literature. Shared decision-making refers to a process, and how and whether the patient wishes to participate in the decision-making process should be clarified from the very beginning. On the basis of this synthesizing review, a process model for psychiatric practice was specified and illustrated to help lead health professionals, patients and other supporters through the decision-making process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The process of shared decision-making should be made visible to all persons involved, and it should be stated at the beginning that a decision must be made. Decisions regarding treatment are usually not limited to a single consultation. A collaborative approach including multiple health professionals and other supporters, such as peer workers and family members, is required. Psychiatric nurses could support patients during the process of decision-making and provide additional information, if requested. ABSTRACT INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. AIM To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. METHOD An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. RESULTS Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. DISCUSSION SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. IMPLICATIONS FOR PRACTICE The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.
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Affiliation(s)
- Caroline Gurtner
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine & Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| | - Ruud J G Halfens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Borysowski J, Ehni HJ, Górski A. Ethics codes and medical decision making. PATIENT EDUCATION AND COUNSELING 2021; 104:1312-1316. [PMID: 33189489 DOI: 10.1016/j.pec.2020.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/24/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The objective of this study is to analyze guidance about medical decision making contained in ethics codes. The primary question we address is which of the main decision-making models - informed decision making (IDM), shared decision making (SDM), or paternalism - is promoted by these codes. METHODS We manually searched codes of medical ethics for guidance on medical decision making. Our analysis focused on the major international code, the World Medical Association International Code of Medical Ethics (ICME), and national codes of the US, Canada, Australia, New Zealand, the UK, Ireland, Germany, France and Norway. RESULTS The ICME does not promote any specific model of medical decision making. 10 of the 11 analyzed national codes contain guidance about IDM, while only four refer to SDM. Some codes contain articles which are imprecise with regard to the question of medical decision making. CONCLUSIONS All of the analyzed national codes should be updated or amended. In particular, given the great importance of SDM in medicine, codes which do not contain relevant guidance should be updated. PRACTICE IMPLICATIONS Relevant amendments introduced to ethics codes could contribute to promoting of adequate standards of medical decision making (especially those regarding SDM) among doctors.
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Affiliation(s)
- Jan Borysowski
- Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Nowy Świat 72, 05-077, Warsaw, Poland; Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.
| | - Hans-Jörg Ehni
- Institute of Ethics and History of Medicine, Eberhard Karls Universität, Gartenstrasse 47, 72074, Tübingen, Germany
| | - Andrzej Górski
- Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland; Laboratory of Bacteriophages, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114 Wrocław, Poland
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Spycher J, Dusheiko M, Beaupère P, Gravier B, Moschetti K. Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time. HEALTH & JUSTICE 2021; 9:11. [PMID: 33987749 PMCID: PMC8120814 DOI: 10.1186/s40352-021-00136-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. RESULTS In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. CONCLUSIONS The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners' penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.
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Affiliation(s)
- Jacques Spycher
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Pascale Beaupère
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Service of Correctional Medicine and Psychiatry (SMPP), University hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Karine Moschetti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Technology Assessment Unit (UET), University hospital of Lausanne (CHUV), Lausanne, Switzerland
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Brown A, Pain T, Preston R. Patient perceptions and preferences about prostate fiducial markers and ultrasound motion monitoring procedures in radiation therapy treatment. J Med Radiat Sci 2021; 68:37-43. [PMID: 32997897 PMCID: PMC7890917 DOI: 10.1002/jmrs.438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Patient experiences and preferences of image-guidance procedures in prostate cancer radiotherapy are largely unknown. This study explored experiences and preferences of patients undergoing both fiducial marker (FM) insertion and Clarity ultrasound (US) procedures. METHODS A sequential explanatory mixed method approach was used. A questionnaire (n = 40) ranked experiences from 0 to 10 (worst) in the domains of invasiveness; pain; physical discomfort; and psychological discomfort. Responses were analysed with descriptive and inferential statistics. Semi-structured interviews (n = 22) obtained further insights into their perspectives and preferences and were thematically analysed. RESULTS Perceptions of invasiveness varied with 46% reporting FMs more invasive than US and 49% the same for the two procedures. The mean score for FM was 3.6 and 2.1 for US. Mean scores for pain, physical and psychological discomfort were higher for FMs with 3.3, 3.2 and 2.9, respectively, and 1.1, 1.2 and 1.7 respectively for US, only pain achieved significance (P < 0.05). Three themes emerged from the interviews: Expectations versus Experience; Preferences linked to Priorities; and Motivations. Eleven patients (50%) preferred US; however, 10 (45%) could not illicit a preference. CONCLUSION Participants found both of the FM and US image-guidance procedures tolerable and acceptable. Men's preference was elusive, suggesting a more rigorous preference methodology is required to understand preferences in this population.
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Affiliation(s)
- Amy Brown
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Tilley Pain
- Townsville University HospitalTownsvilleQueenslandAustralia
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Robyn Preston
- James Cook UniversityTownsvilleQueenslandAustralia
- Central Queensland UniversityTownsvilleAustralia
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Physician-patient agreement on physicians’
communication skills and visit satisfaction
in dermatology clinics: a one-with-many design. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2021.110574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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The Quality, Readability, Completeness, and Accuracy of PTSD Websites for Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207629. [PMID: 33086772 PMCID: PMC7593916 DOI: 10.3390/ijerph17207629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022]
Abstract
Firefighters appear at an increased risk for post-traumatic stress disorder (PTSD). Because of PTSD-related stigma, firefighters may search for information online. The current study evaluated the quality, readability, and completeness of PTSD online resources, and to determine how the online treatment recommendations align with current evidence. Google.ca (Canada) searches were performed using four phrases: ‘firefighter PTSD’, ‘firefighter operational stress’, ‘PTSD symptoms’, and ‘PTSD treatment’. The 75 websites identified were assessed using quality criteria for consumer health information (DISCERN), readability and health literacy statistics, content analysis, and a comparison of treatments mentioned to the current best evidence. The average DISCERN score was 43.8 out of 75 (indicating ‘fair’ quality), with 9 ‘poor’ websites (16–30), 31 ‘fair’ websites (31–45), 26 “good” websites (46–60), and nine excellent websites (61–75). The average grade level required to understand the health-related content was 10.6. The most mentioned content was PTSD symptoms (48/75 websites) and PTSD treatments (60/75 websites). The most frequently mentioned treatments were medications (41/75 websites) and cognitive behavioural therapy (40/75 websites). Cognitive behavioural therapy is supported by strong evidence, but evidence for medications appears inconsistent in current systematic reviews. Online PTSD resources exist for firefighters, but the information is challenging to read and lacks evidence-based treatment recommendations.
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Jackson JL, Storch D, Jackson W, Becher D, O'Malley PG. Direct-Observation Cohort Study of Shared Decision Making in a Primary Care Clinic. Med Decis Making 2020; 40:756-765. [PMID: 32639863 DOI: 10.1177/0272989x20936272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background. Observational studies suggest that shared medical decision making (SMDM) is suboptimal. Our objective was to assess patient preferences, ratings, and objective measurements of decision making and their impact on patient outcomes. Methods. Hypertensive adults presenting for routine care with their primary care physician completed previsit surveys assessing SMDM preferences. Postvisit surveys assessed the degree of SMDM during the encounter, patient satisfaction, and trust. Encounters were audiotaped and transcripts were coded for type of decisions made as well as SMDM quality using OPTION-5. Adherence and blood pressure were measured at baseline and at 4 weeks. Results. Among 105 encounters, there were 7.4 decisions per visit; most were basic, such as refills and routine testing. Objective measures of decision making indicated that the degree of SMDM was lower than reported by patients or physicians, although physician ratings were more accurate. Previsit, 54% of patients expressed a desire for equally shared medical decision making, 24% preferred physician dominated decision making, and 18% preferred that they make the decisions. Postvisit, patients reported experiencing SMDM in 57% of encounters, with high concordance between desired and perceived decision making. Discordance between the patient's desired and experienced SMDM reduced trust and satisfaction. The quality of shared decisions had no impact on adherence or blood pressure at 4 weeks. Limitations. Single site, small sample. Conclusions. Decisions are common during internal medicine primary care visits, and most are basic. Most patients preferred SMDM, and their perceptions of the visit decision-making style were concordant with their preferences although higher than objective measures suggested. Physician ratings of the quality of SMDM were more accurate than patient ratings. Discordance between patients' expected and experienced SMDM lowered satisfaction and trust.
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Affiliation(s)
- Jeffrey L Jackson
- General Internal Medicine Section, Zablocki VAMC, Milwaukee, WI, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Derek Storch
- General Internal Medicine Section, Zablocki VAMC, Milwaukee, WI, USA
| | - Wilkins Jackson
- General Internal Medicine Section, Zablocki VAMC, Milwaukee, WI, USA
| | - Dorothy Becher
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Patrick G O'Malley
- Division of General Internal Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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14
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Sorscher S. To treat or not to treat, that is the question . Health Psychol Open 2020; 7:2055102920943025. [PMID: 32742714 PMCID: PMC7375721 DOI: 10.1177/2055102920943025] [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: 11/15/2022] Open
Abstract
Following a diagnosis and surgical treatment for localized breast cancer, medical oncologists present patients with adjuvant systemic therapeutic options that have been shown to reduce the risk of subsequent cancer recurrence. In this commentary, I present the challenge that resulted from my discussions with a patient and family who asked that I not only discuss options and make recommendations but also decide the choice of therapy on her behalf.
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Holdsworth LM, Zionts D, Asch SM, Winget M. "Along for the Ride": A Qualitative Study Exploring Patient and Caregiver Perceptions of Decision Making in Cancer Care. MDM Policy Pract 2020; 5:2381468320933576. [PMID: 32587894 PMCID: PMC7294494 DOI: 10.1177/2381468320933576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 05/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background. Shared decision making is a cornerstone of an informed consent process for cancer treatment, yet there are often many physician and patient-related barriers to participation in the process. Decisions in cancer care are often perceived as relating to a discrete, treatment decision event, yet there is evidence that decisions are longitudinal in nature and reflect a multifactorial experience. Objective. To explore patient and caregiver perceptions of the choices and decision-making opportunities within cancer care. Design. Qualitative in-depth interviews with 37 cancer patients and 7 caregivers carried out as part of an evaluation of a cancer center’s effort to improve patient experience. Results. Participants described decision making related to four distinct phases in complex cancer care, with physicians leading, and often limiting, decisions related to disease assessment and treatment options and access, and patients leading decisions related to physician selection. Though physicians led many decisions, patients had a moderating influence on treatment, such that if patients did not like options presented, they would reconsider their options and sometimes switch physicians. Patients had various strategies for dealing with uncertainty when faced with decisions, such as seeking additional information to make an informed choice or making a conscious choice to defer decision making to the physician. Limitations. Patients were sampled from one academic cancer center that serves a predominantly Caucasian, Asian, and Hispanic/Latino population and received complex treatment. Conclusion. Because of the complexity of cancer treatment, many patients felt as though they were a “passenger” in decision making about care and did not lead many of the decisions, though many patients trusted their doctors to make the best decisions and were comforted by their expertise.
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Affiliation(s)
- Laura M Holdsworth
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Dani Zionts
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Marcy Winget
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
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Ju I, Park T, Ohs JE. Consumer Engagement with Prescription Medicine Decisions: Influences of Health Beliefs and Health Communication Sources. HEALTH COMMUNICATION 2020; 35:135-147. [PMID: 30460872 DOI: 10.1080/10410236.2018.1545336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Consumers' prescription drug decisions are affected by a number of structural, psychological, and health communication source variables. To provide a theoretically sound and comprehensive prescription medication decision engagement framework, this study integrated Andersen's Health Service Use Model to address contextual and structural factors, the Health Belief Model (HBM) to examine psychological factors, and extant research on the influence of various health communication sources to explain the prescription drug decision engagement mechanisms of health information-seeking intention, prescription drug-seeking intent, and prescription-seeking behavior. Employing survey methodology, the framework was tested using a sample of U.S. adult consumers (N = 370). Results demonstrated the utility of the integrated model for explaining consumers' participation in their prescription decisions. Specifically, consumers' assessment of target health behaviors and the use of various health communication sources significantly improved the explanatory power of the decision engagement model beyond structural factors. The results impart valuable theoretical contributions and have the potential to guide public health interventions related to consumers' prescription drug decisions.
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Affiliation(s)
- Ilwoo Ju
- Department of Communication, College of Arts and Sciences, Saint Louis University
| | - Taehwan Park
- Department of Pharmaceutical and Administrative Sciences, Saint Louis College of Pharmacy
| | - Jennifer E Ohs
- Department of Communication, College of Arts and Sciences, Saint Louis University
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17
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Person-Centred Care Including Deprescribing for Older People. PHARMACY 2019; 7:pharmacy7030101. [PMID: 31349584 PMCID: PMC6789714 DOI: 10.3390/pharmacy7030101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022] Open
Abstract
There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.
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Abstract
Decision aids, sometimes known as decision-support tools, are increasingly used to help patients to understand treatment options and to reach an informed decision consistent with their own values, yet methods for their economic evaluation have received limited attention. This is at odds with the increasingly rigorous methods being applied to assess the cost effectiveness of other health technologies. This paper reviews current approaches to evaluating decision aids and proposes a new method for assessing their benefits relative to other interventions in a resource-constrained health system that seeks to improve health, equity and patient satisfaction. Current evaluation frameworks are found to be unsuitable for the economic evaluation of decision aids since their objectives are broader than health maximisation. Decision aids may generate significant non-health benefits such as improved patient knowledge and satisfaction, which cannot be assessed using cost-utility analysis. A stated-preference consultation time trade-off (CTTO) is proposed in which a proportion of hypothetical physician consultation is traded for use of the decision aid. A decision aid provides information for a patient to make an informed choice and therefore may be considered to be a substitute for physician time. The CTTO can be reported in consultation minutes or converted to monetary units using the cost of physician time. These values may be used, alongside the implementation cost, for economic evaluation.
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Affiliation(s)
- Thomas Butt
- National School of Development, Peking University, Beijing, China.
- Institute of Ophthalmology, University College London, London, UK.
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19
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Tetteh EK. Reducing avoidable medication-related harm: What will it take? Res Social Adm Pharm 2019; 15:827-840. [PMID: 30981449 DOI: 10.1016/j.sapharm.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
Consumption of quality-assured medicines is expected to maintain or improve population health. Yet in a number of situations, what is realized is lower health benefits or magnified safety risks. Recognizing the public health implications of safety risks or medication-related harm, and that some types of harm are avoidable, the World Health Organization has initiated the third Global Patient Safety challenge on Medication Safety. Under the term "Medication Without Harm", this Challenge aims to assess the scope and nature of avoidable medication-related harm, create a framework for intervention and develop national guidance and tools to support safer medication use. The global target under the Challenge is to reduce the level of severe avoidable medication-related harm by 50% over a five-year period or within the next five years. Given a higher morbidity and mortality due to medication-related harm in low-income countries, this paper evaluates what needs to be done in low-income countries in order to achieve the global target. The ideal solution advocated requires that health planners in each low-income country determine what fraction of safety risks or harm can be prevented; and the relationship between number or frequency of avoidable harm or safety risks and the resource costs of treatment or prevention. In the absence of such information, this paper discusses a number of prevention strategies that might help; arguing that the period over which avoidable medication-related harm can be reduced by 50% will depend on whether significant continuous investments in health-system strengthening are made prior to and within that period.
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Affiliation(s)
- Ebenezer Kwabena Tetteh
- Department of Pharmacy Practice & Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
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20
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Rotter J, Spencer JC, Wheeler SB. Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared. J Oncol Pract 2019; 15:e300-e307. [PMID: 30844331 DOI: 10.1200/jop.18.00518] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Patients with metastatic or advanced cancer are likely to be particularly susceptible to financial hardship for reasons related both to the characteristics of metastatic disease and to the characteristics of the population living with metastatic disease. First, metastatic cancer is a resource-intensive condition with expensive treatment and consistent, high-intensity monitoring. Second, patients diagnosed with metastatic disease are disproportionately uninsured and low income and from racial or ethnic minority groups. These vulnerable subpopulations have higher cancer related financial burden even in earlier stages of illness, potentially resulting from fewer asset reserves, nonexisting or less generous health insurance benefits, and employment in jobs with less flexibility and fewer employment protections. This combination of high financial need and high financial vulnerability makes those with advanced cancer an important population for additional study. In this article, we summarize why financial toxicity is burdensome for patients with advanced disease; review prior work in the metastatic or advanced settings specifically; and close with implications and recommendations for research, practice, and policy.
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Affiliation(s)
- Jason Rotter
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Stephanie B Wheeler
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC.,2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Souraya S, Hanlon C, Asher L. Involvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study. Global Health 2018; 14:85. [PMID: 30134989 PMCID: PMC6103856 DOI: 10.1186/s12992-018-0403-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The involvement of people with psychosocial disabilities in decision-making is a fundamental component of a person-centred and recovery-oriented model of care, but there has been little investigation of this approach in low- and middle-income countries. The aim of this study was to explore the involvement of people with schizophrenia in decision-making relating to their care in rural Ethiopia. METHODS A qualitative study was conducted in rural Ethiopia as part of the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) project, involving two focus group discussions (n = 10) with community-based rehabilitation workers, and 18 in-depth interviews with people with schizophrenia, caregivers, health officers, supervisors and a community-based rehabilitation worker. Thematic analysis was used to examine major themes related to involvement in decision-making in this specific setting. RESULTS Involvement of people with schizophrenia in decision-making in this rural Ethiopian setting was limited and coercive practices were evident. People with schizophrenia tended to be consulted about their care only when they were considered clinically 'recovered'. Caregivers typically had a prominent role in decision-making, but they also acquiesced to the views of health care professionals. People with schizophrenia and caregivers were often unable to execute their desired choice due to inaccessible and unaffordable treatment. CONCLUSIONS Community-based rehabilitation, as a model of care, may give opportunities for involvement of people with schizophrenia in decision-making. In order to increase involvement of people with schizophrenia in rural Ethiopia there needs to be greater empowerment of service users, wider availability of treatment choices and a facilitating policy environment. Further studies are needed to explore concepts of person-centred care and recovery across cultural settings.
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Affiliation(s)
- Sally Souraya
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. .,Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Charlotte Hanlon
- Health Services and Population Research Department, Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Laura Asher
- Department of Population Health, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Kovanur Sampath K, Roy DE. Barriers to identifying mood disorders in clients by New Zealand osteopaths: Findings of a thematic analysis. INT J OSTEOPATH MED 2018. [DOI: 10.1016/j.ijosm.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Coast J. A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967-2017. Soc Sci Med 2017; 196:227-232. [PMID: 29132835 DOI: 10.1016/j.socscimed.2017.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Joanna Coast
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
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24
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Heinrich P, Schwabe G. Facilitating Informed Decision-Making in Financial Service Encounters. BUSINESS & INFORMATION SYSTEMS ENGINEERING 2017. [DOI: 10.1007/s12599-017-0501-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Decisional control preferences of patients with advanced cancer receiving palliative care. Palliat Support Care 2017; 16:544-551. [DOI: 10.1017/s1478951517000803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Understanding patients' decisional control preferences (DCPs) is important to improving the quality of care and the satisfaction of patients who have advanced cancer with their care. In addition to passive decisional control (i.e., the patient prefers his/her doctor or family caregiver to make a decision on their behalf) and active decisional control (i.e., the patient decides alone), shared decisional control, where patients and caregivers decide together, could be more appropriate. The primary aim of our study was to describe the decision-making process and the DCPs of patients with advanced cancer receiving palliative care in France.Method:We conducted a prospective survey with advanced cancer patients referred to a palliative care team in an outpatient setting. We collected information about patients' demographic and clinical characteristics using the Decision Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and the Understanding of Illness questionnaire.Results:A total of 200 patients were evaluable. The median age was 63.5 years and 53.5% female. The cancers most commonly represented were gastrointestinal and breast. A total of 72 patients (36.2%) preferred active decisional control, 52 (26.1%) preferred shared decisional control, and 75 (37.7%) preferred passive decisional control. Younger age (p = 0.003), higher education (p < 0.001), and employment status (p = 0.046) were found to be associated with active or shared DCPs. Some 82% of patients were satisfied with the decision-making process, 35% of whom expressed wishes that did not match the actual decision-making process. Only 23% of patients thought they could be cured of their illness, and 47% thought that their treatment would “get rid of ” their disease.Significance of Results:The decision-making processes are shared in the three models of DCPs in our cohort of French patients with advanced cancer. Further prospective studies are needed.
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Vass CM, Payne K. Using Discrete Choice Experiments to Inform the Benefit-Risk Assessment of Medicines: Are We Ready Yet? PHARMACOECONOMICS 2017; 35:859-866. [PMID: 28536955 PMCID: PMC5563347 DOI: 10.1007/s40273-017-0518-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
There is emerging interest in the use of discrete choice experiments as a means of quantifying the perceived balance between benefits and risks (quantitative benefit-risk assessment) of new healthcare interventions, such as medicines, under assessment by regulatory agencies. For stated preference data on benefit-risk assessment to be used in regulatory decision making, the methods to generate these data must be valid, reliable and capable of producing meaningful estimates understood by decision makers. Some reporting guidelines exist for discrete choice experiments, and for related methods such as conjoint analysis. However, existing guidelines focus on reporting standards, are general in focus and do not consider the requirements for using discrete choice experiments specifically for quantifying benefit-risk assessments in the context of regulatory decision making. This opinion piece outlines the current state of play in using discrete choice experiments for benefit-risk assessment and proposes key areas needing to be addressed to demonstrate that discrete choice experiments are an appropriate and valid stated preference elicitation method in this context. Methodological research is required to establish: how robust the results of discrete choice experiments are to formats and methods of risk communication; how information in the discrete choice experiment can be presented effectually to respondents; whose preferences should be elicited; the correct underlying utility function and analytical model; the impact of heterogeneity in preferences; and the generalisability of the results. We believe these methodological issues should be addressed, alongside developing a 'reference case', before agencies can safely and confidently use discrete choice experiments for quantitative benefit-risk assessment in the context of regulatory decision making for new medicines and healthcare products.
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Affiliation(s)
- Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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Pedersen LB, Hess S, Kjær T. Asymmetric information and user orientation in general practice: Exploring the agency relationship in a best-worst scaling study. JOURNAL OF HEALTH ECONOMICS 2016; 50:115-130. [PMID: 27723469 DOI: 10.1016/j.jhealeco.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
This study uses a best-worst scaling experiment to test whether general practitioners (GPs) act as perfect agents for the patients in the consultation; and if not, whether this is due to asymmetric information and/or other motivations than user orientation. Survey data were collected from 775 GPs and 1379 Danish citizens eliciting preferences for a consultation. Sequential models allowing for within-person preference heterogeneity and heteroskedasticity between best and worst choices were estimated. We show that GPs do not always act as perfect agents and that this non-alignment stems from GPs being both unable and unwilling to do so. Unable since GPs have imperfect information about patients' preferences, and unwilling since they are also motivated by other factors than user orientation. Our findings highlight the need for multi-pronged strategies targeting different motivational factors to ensure that GPs act in correspondence with patients' preferences in areas where alignment is warranted.
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Affiliation(s)
- Line Bjørnskov Pedersen
- Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Research Unit for General Practice, University of Southern Denmark, J.B. Winsløwsvej 9A, 1, 5000 Odense C, Denmark.
| | - Stephane Hess
- Institute for Transport Studies & Choice Modelling Centre, University of Leeds, Lifton Villas, 1-3 Lifton Place, Leeds LS2 9JT, UK
| | - Trine Kjær
- Centre of Health Economics Research (COHERE), Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Arheiam A, Brown SL, Higham SM, Albadri S, Harris RV. The information filter: how dentists use diet diary information to give patients clear and simple advice. Community Dent Oral Epidemiol 2016; 44:592-601. [PMID: 27549896 DOI: 10.1111/cdoe.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diet diaries are recommended for dentists to monitor children's sugar consumption. Diaries provide multifaceted dietary information, but patients respond better to simpler advice. We explore how dentists integrate information from diet diaries to deliver useable advice to patients. METHODS As part of a questionnaire study of general dental practitioners (GDPs) in Northwest England, we asked dentists to specify the advice they would give a hypothetical patient based upon a diet diary case vignette. A sequential mixed method approach was used for data analysis: an initial inductive content analysis (ICA) to develop coding system to capture the complexity of dietary assessment and delivered advice. Using these codes, a quantitative analysis was conducted to examine correspondences between identified dietary problems and advice given. From these correspondences, we inferred how dentists reduced problems to give simple advice. RESULTS A total of 229 dentists' responses were analysed. ICA on 40 questionnaires identified two distinctive approaches of developing diet advice: a summative (summary of issues into an all-encompassing message) and a selective approach (selection of a main message approach). In the quantitative analysis of all responses, raw frequencies indicated that dentists saw more problems than they advised on and provided highly specific advice on a restricted number of problems (e.g. not eating sugars before bedtime 50.7% or harmful items 42.4%, rather than simply reducing the amount of sugar 9.2%). Binary logistic regression models indicate that dentists provided specific advice that was tailored to the key problems that they identified. CONCLUSION Dentists provided specific recommendations to address what they felt were key problems, whilst not intervening to address other problems that they may have felt less pressing.
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Affiliation(s)
- Arheiam Arheiam
- Department of Health Services Research/School of Dentistry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Stephen L Brown
- Department of Psychological Sciences/School of Dentistry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Susan M Higham
- Department of Health Services Research/School of Dentistry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Sondos Albadri
- Department of Health Services Research/School of Dentistry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Rebecca V Harris
- Department of Health Services Research/School of Dentistry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Affiliation(s)
| | - Helen Tottey
- Project Manager, at Mojo Consultancy, St Albans, UK
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30
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Astbury R, Shepherd A, Cheyne H. Working in partnership: the application of shared decision-making to health visitor practice. J Clin Nurs 2016; 26:215-224. [PMID: 27459947 DOI: 10.1111/jocn.13480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the processes that support shared decision-making when health visitors and parents are creating plans to improve the well-being of babies and children. BACKGROUND Worldwide, there is a focus on promoting children's well-being to enhance the population health. Within the United Kingdom, health visitors have a key responsibility for working in partnership with parents to support this agenda. Despite evidence that the application of 'shared decision-making' frameworks can increase patient participation, improve patient satisfaction and improve health outcomes, there is limited research linking shared decision-making with health visitor practice. DESIGN A qualitative, descriptive study. METHODS The study was undertaken in two phases: in Phase 1, data were collected by audio recording two health visitor-parent decision-making conversations, in the absence of the researcher, where decisions around planning for a baby or child were being made as part of usual care, and then the participants' experiences were sought through individual questionnaires. In Phase 2, semistructured interviews were conducted with nine health visitors and nine parents in relation to their recent experiences of planning care. RESULTS Evidence of supportive processes included having a shared understanding around the issue needing to be addressed; being able to identify interventions that were accessible for the family; engaging in decision-making through deep, meaningful conversations using sensitive and responsive approaches; and establishing positive relationships between health visitors and parents, significant others within the family and other professionals. CONCLUSION Despite evidence of strong, trusting relationships between parents and health visitors, there were times when shared decision-making was unable to take place due to the absence of supportive processes. RELEVANCE TO CLINICAL PRACTICE Health visitors are aware that planning interventions with parents can be complex. These findings indicate the value of using a shared decision-making framework to structure planning, as application of a framework identified the processes that support a collaborative approach in practice.
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Affiliation(s)
- Ruth Astbury
- Children and Families Teams, NW Sector - Glasgow City HSCP, Glasgow, UK
| | - Ashley Shepherd
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Helen Cheyne
- Nursing Midwifery and Allied Health Professions-Research Unit, University of Stirling, Stirling, UK
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Riise J, Hole AR, Gyrd-Hansen D, Skåtun D. GPs' implicit prioritization through clinical choices - evidence from three national health services. JOURNAL OF HEALTH ECONOMICS 2016; 49:169-83. [PMID: 27476007 DOI: 10.1016/j.jhealeco.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/27/2023]
Abstract
We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience. In general, there is a substantial amount of heterogeneity also within each country. We discuss the results from the DCE in the light of the GPs' two conflicting agency roles and what we know about the incentive structures and cultures in the different countries.
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Affiliation(s)
- Julie Riise
- Department of Economics, University of Bergen, Postbox 7800, 5020 Beregen, Norway.
| | - Arne Risa Hole
- Department of Economics, The University of Sheffield, 9 Mappin Street, Sheffield S1 4DT, UK
| | - Dorte Gyrd-Hansen
- COHERE, Department of Business and Economics, University of Southern Denmark; COHERE, Department of Public Health, University of Southern Denmark; Department of Community Medicine, UiT, The Arctic University of Norway
| | - Diane Skåtun
- Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Reddock JR. Assessing the Right to Health in the Sixth Millennium Development Goal in the Eastern Caribbean. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Oncologists' Perceptions of Recurrent Ovarian Cancer Patients' Preference for Participation in Treatment Decision Making and Strategies for When and How to Involve Patients in This Process. Int J Gynecol Cancer 2016; 25:1717-23. [PMID: 26501437 DOI: 10.1097/igc.0000000000000548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The treatment decision-making (TDM) process in the medical encounter in ovarian cancer (OC) is directed by oncologists. There is little information on oncologists' perceptions of this process. Our objectives were to explore oncologists' perceptions concerning (1) patients' preference for involvement in TDM, (2) factors that affect when to introduce this discussion, and (3) strategies used for engaging women in TDM. METHODS We adopted a qualitative descriptive approach. Individual in-person interviews were used to collect data; themes were identified. RESULTS Fifteen gynecologic and 5 medical oncologists from Ontario, Canada, participated. We found that oncologists made the assumption that women with recurrent OC were interested in being involved in TDM but rarely reported attempting to validate this assumption. The oncologists timed the initiation of the TDM discussion based on their degree of certainty of recurrent OC and their perception of the patient's readiness to be involved in TDM. Oncologists reported using strategies to engage women such as getting the women to take ownership of the decision, verbalize their priorities, lead the discussions, and giving the opportunity to gather information. CONCLUSIONS Oncologists need to listen to each patient rather than make assumptions about the person based on her disease.
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Rot I, Wassersug RJ, Walker LM. What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product. Transl Androl Urol 2016; 5:235-47. [PMID: 27141453 PMCID: PMC4837317 DOI: 10.21037/tau.2016.03.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education. Methods International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product). Results No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists. Conclusions ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.
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Affiliation(s)
- Irena Rot
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Richard J Wassersug
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lauren M Walker
- 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Xiong M, Stone TE, Turale S, Petrini MA. Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study. Nurs Health Sci 2016; 18:314-20. [PMID: 26817836 DOI: 10.1111/nhs.12270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022]
Abstract
There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person-centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in-depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision-making by removing barriers and advocating on their behalf.
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Affiliation(s)
- Mo Xiong
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | - Teresa E Stone
- Faculty of Health Sciences, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Sue Turale
- Editor International Nursing Review, International Council of Nurses, Geneva, Switzerland
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Fischer S, Pelka S, Riedl R. Understanding patients’ decision-making strategies in hospital choice: Literature review and a call for experimental research. COGENT PSYCHOLOGY 2015. [DOI: 10.1080/23311908.2015.1116758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sophia Fischer
- Department of Business and Economics, Research Group InnoTech4Health, Technische Universität Dresden, 01062 Dresden, Germany
| | - Stefanie Pelka
- Department of Business Informatics - Information Engineering, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
| | - René Riedl
- Department of Business Informatics - Information Engineering, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040 Linz, Austria
- Digital Business Management, School of Management, University of Applied Sciences Upper Austria, Wehrgrabengasse 1-3, 4400 Steyr, Austria
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Bansback N, Harrison M, Marra C. Does Introducing Imprecision around Probabilities for Benefit and Harm Influence the Way People Value Treatments? Med Decis Making 2015; 36:490-502. [DOI: 10.1177/0272989x15600708] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/20/2015] [Indexed: 11/15/2022]
Abstract
Background. Imprecision in estimates of benefits and harms around treatment choices is rarely described to patients. Variation in sampling error between treatment alternatives (e.g., treatments have similar average risks, but one treatment has a larger confidence interval) can result in patients failing to choose the option that is best for them. The aim of this study is to use a discrete choice experiment to describe how 2 methods for conveying imprecision in risk influence people’s treatment decisions. Methods. We randomized a representative sample of the Canadian general population to 1 of 3 surveys that sought choices between hypothetical treatments for rheumatoid arthritis based on different levels of 7 attributes: route and frequency of administration, chance of benefit, serious and minor side effects and life expectancy, and imprecision in benefit and side-effect estimates. The surveys differed in the way imprecision was described: 1) no imprecision, 2) quantitative description based on a range with a visual graphic, and 3) qualitative description simply describing the confidence in the evidence. Results. The analyzed data were from 2663 respondents. Results suggested that more people understood imprecision when it was described qualitatively (88%) versus quantitatively (68%). Respondents who appeared to understand imprecision descriptions placed high value on increased precision regarding the actual benefits and harms of treatment, equivalent to the value placed on the information about the probability of serious side effects. Both qualitative and quantitative methods led to small but significant increases in decision uncertainty for choosing any treatment. Limitations included some issues in defining understanding of imprecision and the use of an internet survey of panel members. Conclusions. These findings provide insight into how conveying imprecision information influences patient treatment choices.
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Affiliation(s)
- Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada (NB)
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (NB)
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK (MH)
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada (MH)
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada (CM)
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada (NB)
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (NB)
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK (MH)
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada (MH)
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada (CM)
| | - Carlo Marra
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada (NB)
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (NB)
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK (MH)
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada (MH)
- School of Pharmacy, Memorial University, St. John’s, Newfoundland and Labrador, Canada (CM)
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Laugesen J, Hassanein K, Yuan Y. The Impact of Internet Health Information on Patient Compliance: A Research Model and an Empirical Study. J Med Internet Res 2015; 17:e143. [PMID: 26068214 PMCID: PMC4526934 DOI: 10.2196/jmir.4333] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/17/2015] [Accepted: 05/07/2015] [Indexed: 12/16/2022] Open
Abstract
Background Patients have been increasingly seeking and using Internet health information to become more active in managing their own health in a partnership with their physicians. This trend has both positive and negative effects on the interactions between patients and their physicians. Therefore, it is important to understand the impact that the increasing use of Internet health information has on the patient-physician relationship and patients’ compliance with their treatment regimens. Objective This study examines the impact of patients’ use of Internet health information on various elements that characterize the interactions between a patient and her/his physician through a theoretical model based on principal-agent theory and the information asymmetry perspective. Methods A survey-based study consisting of 225 participants was used to validate a model through various statistical techniques. A full assessment of the measurement model and structural model was completed in addition to relevant post hoc analyses. Results This research revealed that both patient-physician concordance and perceived information asymmetry have significant effects on patient compliance, with patient-physician concordance exhibiting a considerably stronger relationship. Additionally, both physician quality and Internet health information quality have significant effects on patient-physician concordance, with physician quality exhibiting a much stronger relationship. Finally, only physician quality was found to have a significant impact on perceived information asymmetry, whereas Internet health information quality had no impact on perceived information asymmetry. Conclusions Overall, this study found that physicians can relax regarding their fears concerning patient use of Internet health information because physician quality has the greatest impact on patients and their physician coming to an agreement on their medical situation and recommended treatment regimen as well as patient’s compliance with their physician’s advice when compared to the impact that Internet health information quality has on these same variables. The findings also indicate that agreement between the patient and physician on the medical situation and treatment is much more important to compliance than the perceived information gap between the patient and physician (ie, the physician having a higher level of information in comparison to the patient). In addition, the level of agreement between a patient and their physician regarding the medical situation is more reliant on the perceived quality of their physician than on the perceived quality of Internet health information used. This research found that only the perceived quality of the physician has a significant relationship with the perceived information gap between the patient and their physician and the quality of the Internet health information has no relationship with this perceived information gap.
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Affiliation(s)
- John Laugesen
- Pilon School of Business, Sheridan College, Mississauga, ON, Canada.
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Pattison N, O’Gara G, Wigmore T. Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making. Am J Crit Care 2015; 24:232-40. [PMID: 25934720 DOI: 10.4037/ajcc2015715] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Little research has examined the involvement of critical care outreach teams in end-of-life decision making. OBJECTIVE To establish how much time critical care outreach teams spend with patients who are subsequently subject to limitation of medical treatment and end-of-life decisions and how much influence the teams have on those decisions. METHODS A single-center retrospective review, with qualitative analysis, in a large cancer center. Data from all patients referred emergently for critical care outreach from October 2010 to October 2011 who later had limitation of medical treatment or end-of-life care were retrieved. Findings were analyzed by using SPSS 19 and qualitative free-text analysis. RESULTS Of 890 patients referred for critical care outreach from October 2010 to October 2011, 377 were referred as an emergency; 108 of those had limitation of medical treatment and were included in the review. Thirty-five patients (32.4%) died while hospitalized. As a result of outreach intervention and a decision to limit medical treatment, 56 (51.9%) of the 108 patients received a formal end-of-life care plan (including care pathways, referral to palliative care team, hospice). About a fifth (21.5%) of clinical contact time is being spent on patients who subsequently are subject to limitation of medical treatment. Qualitative document analysis showed 5 emerging themes: difficulty of discussions about not attempting cardiopulmonary resuscitation, complexities in coordinating multiple teams, delays in referral and decision making, decision reversals and opaque decision making, and technical versus ethical imperatives. CONCLUSION A considerable amount of time is being spent on these emergency referrals, and decisions to limit medical treatment are common. The appropriateness of escalation of levels of care is often not questioned until patients become critically or acutely unwell, and outreach teams subsequently intervene.
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Affiliation(s)
- Natalie Pattison
- Natalie Pattison is a senior clinical nursing research fellow, Geraldine O’Gara is a nurse researcher, and Timothy Wigmore is divisional medical director and consultant in critical care and anesthesia, The Royal Marsden NHS Foundation Trust, London, England
| | - Geraldine O’Gara
- Natalie Pattison is a senior clinical nursing research fellow, Geraldine O’Gara is a nurse researcher, and Timothy Wigmore is divisional medical director and consultant in critical care and anesthesia, The Royal Marsden NHS Foundation Trust, London, England
| | - Timothy Wigmore
- Natalie Pattison is a senior clinical nursing research fellow, Geraldine O’Gara is a nurse researcher, and Timothy Wigmore is divisional medical director and consultant in critical care and anesthesia, The Royal Marsden NHS Foundation Trust, London, England
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Fischer S, Soyez K, Gurtner S. Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice. Med Decis Making 2015; 35:525-32. [PMID: 25810267 DOI: 10.1177/0272989x15575518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 02/06/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. METHODS Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. RESULTS The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. CONCLUSIONS This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities.
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Affiliation(s)
- Sophia Fischer
- Research Group InnoTech4Health, Department of Business and Economics, Technische Universität Dresden, Germany (SF)
| | - Katja Soyez
- University of Cooperative Education Riesa, Germany (KS)
| | - Sebastian Gurtner
- Institute of Radiation Oncology, Helmholtz-Zentrum Dresden-Rossendorf, Germany (SG)
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Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction - Underlying mechanisms and treatment - Part II. J Bodyw Mov Ther 2015; 19:526-43. [PMID: 26118526 DOI: 10.1016/j.jbmt.2015.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
This paper offers an extensive review of the main fascia-mediated mechanisms underlying various therapeutic processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the several fascial influences that may come into play during and after manual treatment. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying neuro-fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of manual therapeutic effects as being partially, if not entirely, mediated by the fascia. By taking into consideration a wide spectrum of fascia-related factors - from cell-based mechanisms to cognitive and behavioural influences - a model emerges suggesting, amongst other results, a multidisciplinary-approach to the intervention of somatic dysfunction. Finally, it is proposed that a sixth osteopathic 'meta-model' - the connective tissue-fascial model - be added to the existing five models in osteopathic philosophy as the main interface between all body systems, thus providing a structural and functional framework for the body's homoeostatic potential and its inherent abilities to heal.
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Affiliation(s)
- Paolo Tozzi
- School of Osteopathy C.R.O.M.O.N., Rome, Italy; C.O.ME. Collaboration, Pescara, Italy.
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Lee D, Rutsohn P. Physician perceived market competition associated with barriers to delivery of quality care: Evidence from a national cross-sectional survey of physicians in the USA. Health Serv Manage Res 2015. [DOI: 10.1177/0951484815611146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While quality is of paramount concern in health care, there has been little research done examining physician attitudes towards quality of health care and their perceived competitiveness in the market place. Utilizing the national physician survey data ( n = 4720), we undertook a bivariate and multivariate regression analysis to explore the association between physician perceived competition and barriers to quality of care. After adjusting personal and organizational factors, two quality care measures were found to be related to increased physician perceived market competition: (1) inadequate mechanism (patient’s inability to pay for care); (2) variations in practice (medical errors and untimeliness of medical reports). Overall our findings suggest the association between perceived market competition and barriers to quality of care. In physicians’ views the current managed care market system appears to be competitive but this market competition may not benefit practicing physicians in improving quality of patient care.
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Affiliation(s)
- Doohee Lee
- Division of Management, Marketing, MIS, Lewis College of Business (LCOB), Marshall University, West Virginia, USA
| | - Phil Rutsohn
- Retired Professor of health care administration and consultant, Augusta, Georgia, USA
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Vernazza CR, Rousseau N, Steele JG, Ellis JS, Thomason JM, Eastham J, Exley C. Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment. Community Dent Oral Epidemiol 2015; 43:75-85. [PMID: 25265369 PMCID: PMC4312916 DOI: 10.1111/cdoe.12129] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/22/2014] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice.
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Affiliation(s)
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
| | - Jimmy G Steele
- Centre for Oral Health Research, Newcastle UniversityNewcastle upon Tyne, UK
| | - Janice S Ellis
- Centre for Oral Health Research, Newcastle UniversityNewcastle upon Tyne, UK
| | - John Mark Thomason
- Centre for Oral Health Research, Newcastle UniversityNewcastle upon Tyne, UK
| | - Jane Eastham
- Centre for Oral Health Research, Newcastle UniversityNewcastle upon Tyne, UK
| | - Catherine Exley
- Institute of Health and Society, Newcastle UniversityNewcastle upon Tyne, UK
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Medicine price awareness in chronic patients in Belgium. Health Policy 2014; 119:217-23. [PMID: 25533549 DOI: 10.1016/j.healthpol.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Under increasing pressure to contain health expenditures governments across Europe have implemented policies to increase responsible medicine use, e.g. by increasing co-insurance paid for by patients. In times of austerity, how do chronic disease patients perceive the medicine price they have to pay? METHOD We used a mixed methods research design. First, we distributed a close-ended questionnaire among 983 chronic disease patients in 30 Flemish pharmacies. Second, we performed semi-structured interviews with 15 of these patients. We surveyed for knowledge on the prescription medicine they bought, as well as for their needs for information and their therapeutic compliance. RESULTS Although patients express a lack (and a need) of information on prices during the consultation with the general practitioner (GP), (s)he hardly addresses medicine prices. Patients often only know the medicine price when they are at the pharmacy and patients need to decide to buy the medicine or not. This often results in patients taking the medicine when considered affordable within their social and financial context. CONCLUSION It seems essential that patients are better informed about medicine prices as well as the constraints on physicians to prescribe cost-effectively. Therefore, medicine prices should be discussed more often during physician consults.
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Charles C, Gafni A. The vexing problem of defining the meaning, role and measurement of values in treatment decision-making. J Comp Eff Res 2014; 3:197-209. [PMID: 24645693 DOI: 10.2217/cer.13.91] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision-making models such as EBM and SDM, and determining whose values ought to count are complex and difficult tasks that will not be resolved quickly. Additional conceptual thinking and research are needed to explore and clarify these issues. To date, the values component of these models remains elusive and underdeveloped.
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Affiliation(s)
- Cathy Charles
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main St West, 2nd Floor, CRL Building, Hamilton, ON, L8S4K1, Canada
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Durif-Bruckert C, Roux P, Morelle M, Mignotte H, Faure C, Moumjid-Ferdjaoui N. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation. Eur J Cancer Care (Engl) 2014; 24:461-72. [PMID: 25040308 DOI: 10.1111/ecc.12214] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.
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Affiliation(s)
- C Durif-Bruckert
- Groupe de Recherche en Psychologie Sociale, Institut de psychologie (GRePS), Université de Lyon (Lyon 2), Bron, France.,CIC-EC3, Inserm, Preducan, Institut de Cancérologie de la Loire, St-Priest-en-Jarez, France
| | - P Roux
- Groupe de Recherche en Psychologie Sociale, Institut de psychologie (GRePS), Université de Lyon (Lyon 2), Bron, France
| | - M Morelle
- Centre Léon Bérard, Lyon, France.,GATE Lyon St Etienne CNRS UMR 5824, Ecully, France
| | | | - C Faure
- Centre Léon Bérard, Lyon, France
| | - N Moumjid-Ferdjaoui
- Centre Léon Bérard, Lyon, France.,GATE Lyon St Etienne CNRS UMR 5824, Ecully, France.,Université Lyon 1, Villeurbanne, France
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Shepherd A, Shorthouse O, Gask L. Consultant psychiatrists' experiences of and attitudes towards shared decision making in antipsychotic prescribing, a qualitative study. BMC Psychiatry 2014; 14:127. [PMID: 24886121 PMCID: PMC4009071 DOI: 10.1186/1471-244x-14-127] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 03/24/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Shared decision making represents a clinical consultation model where both clinician and service user are conceptualised as experts; information is shared bilaterally and joint treatment decisions are reached. Little previous research has been conducted to assess experience of this model in psychiatric practice. The current project therefore sought to explore the attitudes and experiences of consultant psychiatrists relating to shared decision making in the prescribing of antipsychotic medications. METHODS A qualitative research design allowed the experiences and beliefs of participants in relation to shared decision making to be elicited. Purposive sampling was used to recruit participants from a range of clinical backgrounds and with varying length of clinical experience. A semi-structured interview schedule was utilised and was adapted in subsequent interviews to reflect emergent themes.Data analysis was completed in parallel with interviews in order to guide interview topics and to inform recruitment. A directed analysis method was utilised for interview analysis with themes identified being fitted to a framework identified from the research literature as applicable to the practice of shared decision making. Examples of themes contradictory to, or not adequately explained by, the framework were sought. RESULTS A total of 26 consultant psychiatrists were interviewed. Participants expressed support for the shared decision making model, but also acknowledged that it was necessary to be flexible as the clinical situation dictated. A number of potential barriers to the process were perceived however: The commonest barrier was the clinician's beliefs regarding the service users' insight into their mental disorder, presented in some cases as an absolute barrier to shared decision making. In addition factors external to the clinician - service user relationship were identified as impacting on the decision making process, including; environmental factors, financial constraints as well as societal perceptions of mental disorder in general and antipsychotic medication in particular. CONCLUSIONS This project has allowed identification of potential barriers to shared decision making in psychiatric practice. Further work is necessary to observe the decision making process in clinical practice and also to identify means in which the identified barriers, in particular 'lack of insight', may be more effectively managed.
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Affiliation(s)
| | | | - Linda Gask
- University of Manchester, Manchester, UK
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Thomson OP, Petty NJ, Moore AP. Clinical decision-making and therapeutic approaches in osteopathy – A qualitative grounded theory study. ACTA ACUST UNITED AC 2014; 19:44-51. [DOI: 10.1016/j.math.2013.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/05/2013] [Accepted: 07/12/2013] [Indexed: 11/25/2022]
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Abstract
It is often argued that biomedicine alienates patients from doctors, from ailments and from understanding treatment processes, while indigenous and alternative healing systems are portrayed as respectful of patients and their experience. Specifically, South Indian siddha medicine has been seen as diverging from biomedicine in empowering its patients. This approach not only assumes biomedicine to be a homogeneous practice, but also lumps together diverse therapeutic techniques under the labels of "traditional" or "alternative." Analysis of a manual subdiscipline of siddha medicine cautions against such analytic imprecision and active/passive binaries in physician-patient encounters. Practitioners of vital spot medicine claim to "heal the hidden." They rarely communicate diagnostic insights verbally and object to auxiliary devices. However, their physical engagement with patients' ailing bodies highlights the corporeal nature of manual medicine in particular and processual, situational, and reciprocal characteristics of curing in general.
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Affiliation(s)
- Roman Sieler
- Postdoctoral Researcher, MESH (Medicine Environment Societies Health), Institut Français de Pondichéry, Pondicherry, India
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Changing communication needs and preferences across the cancer care trajectory: insights from the patient perspective. Support Care Cancer 2013; 22:1009-15. [DOI: 10.1007/s00520-013-2056-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/12/2013] [Indexed: 01/12/2023]
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