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Kurpershoek E, Visser LNC, Malekzadeh A, de Bie RMA, Dijk JM, Hillen MA. How Information Affects Patients with Parkinson's Disease: A Scoping Review of the Literature. JOURNAL OF PARKINSON'S DISEASE 2024:JPD240073. [PMID: 38995802 DOI: 10.3233/jpd-240073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Patients with Parkinson's disease (PD) need to receive adequate information to manage their disease. However, little is known about how information provision affects patients. Objective To conduct a scoping review of the literature on the relationship between content, timing, manner of delivery, and source of PD-specific information on the one hand, and patient outcomes on the other. Methods All literature reporting about original data and published until April 2024 in peer-reviewed journals was searched in MEDLINE (Ovid), Embase (Ovid) and PsychInfo (Ovid). Subsequently, data were extracted and synthesized. Results 40 publications describing the effects of information provision or patients' evaluation thereof were retrieved. Four categories of patient outcomes were described, namely 1) evaluation and experience of information provision; 2) physical functioning; 3) psychosocial well-being; and 4) quality of life. In intervention studies, patients generally valued the provided information. Findings from cross-sectional and qualitative studies showed the importance of tailoring information to individuals' needs and capabilities. Due to variation in study designs and outcomes, no unambiguous conclusions could be drawn regarding the relationship between information and outcomes. Conclusions This scoping review identified how PD patients acquire information and revealed a lack of systematic research into the effect of information on patient outcomes. Future studies should assess 1) what information is currently provided by clinicians; 2) what additional information might be beneficial to provide; and 3) how information can be effectively aligned to benefit patients. This will eventually yield insight into how information might optimally empower PD patients.
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Affiliation(s)
- Elisabeth Kurpershoek
- Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Personalized Medicine, Amsterdam, The Netherlands
| | - Leonie N C Visser
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Personalized Medicine, Amsterdam, The Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Joke M Dijk
- Amsterdam UMC, University of Amsterdam, Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Marij A Hillen
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Personalized Medicine, Amsterdam, The Netherlands
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2
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MacRae H. Older Men, The Patient-Physician Relationship, and Patient Involvement. Can J Aging 2024; 43:142-152. [PMID: 37737232 DOI: 10.1017/s0714980823000478] [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] [Indexed: 09/23/2023] Open
Abstract
Despite the fact that older adults interact frequently with physicians, there is little research examining their preferences, and perceptions of the patient-physician relationship. Research on this topic is particularly sparse when it comes to older men. This study investigates older men's experiences with physicians, their perceptions of the patient-physician relationship, and the extent to which they wished to be involved in their health care. In-depth, face-to-face interviews were conducted with 23 men 55-96 years of age. Findings reveal that older men want to participate in the medical encounter and be involved in their care, contradicting earlier work suggesting that older adults prefer to be passive patients. Preferred involvement, however, varied along a continuum ranging from "quasi-involvement" to "taking charge", with most participants being in the middle, preferring a "partnership" patient-physician relationship. Factors influencing patient involvement and potential to negotiate the patient-physician relationship are discussed.
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Affiliation(s)
- Hazel MacRae
- Department of Sociology and Anthropology, Mount Saint Vincent University, Halifax, NS, Canada
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Rumintang Marito D, Widianto S. Link of Infection Prevention Climate to Patient-Centered Care: Role of Workplace Safety and Risk Mitigation. Risk Manag Healthc Policy 2024; 17:329-340. [PMID: 38352960 PMCID: PMC10863469 DOI: 10.2147/rmhp.s439907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Background Healthcare-associated infections pose a substantial threat to the quality of healthcare services. Consequently, it is imperative for hospital organizations to actively support an infection prevention climate, fostering workplace safety and risk mitigation, thereby promoting patient-centered care. Purpose This study aims to explore the interconnectedness between the infection prevention climate, workplace safety, risk mitigation, and patient-centered care. Methods A cross-sectional study design was employed, utilizing a questionnaire administered to 235 healthcare professionals in intensive care and inpatient units at Bandung Kiwari Regional General Hospital. Data analysis was conducted using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 4 and SPSS 25. Results The study revealed several significant relationships, including (1) between infection prevention climate and patient-centered care; (2) infection prevention climate and workplace safety; (3) workplace safety and patient-centered care; (4) infection prevention climate and patient-centered care mediated by workplace safety; (5) infection prevention climate and risk mitigation; (6) risk mitigation and patient-centered care; (7) and the relationship between infection prevention climate and patient-centered care mediated by risk mitigation. Conclusion Infection prevention climate emerges as a crucial intangible value that hospital organizations can cultivate to shape workplace safety. This, in turn, encourages healthcare workers' compliance in implementing infection prevention controls as a form of risk mitigation, ultimately contributing to the provision of patient-centered care.
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Affiliation(s)
| | - Sunu Widianto
- Department of Management and Business, Universitas Padjadjaran, Bandung, Indonesia
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Auffret M, Weiss D, Stocchi F, Vérin M, Jost WH. Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty. J Neural Transm (Vienna) 2023; 130:1411-1432. [PMID: 37436446 PMCID: PMC10645670 DOI: 10.1007/s00702-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.
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Affiliation(s)
- Manon Auffret
- France Développement Electronique (FDE), Monswiller, France.
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France.
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute of Research and Medical Care IRCCS San Raffaele Roma, Rome, Italy
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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Le TD, Lin SC, Huang MC, Fan SY, Kao CY. Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis. Nurs Ethics 2023:9697330231200570. [PMID: 37818823 DOI: 10.1177/09697330231200570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. OBJECTIVE The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. METHODS A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. RESULTS 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. CONCLUSIONS Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.
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Affiliation(s)
| | | | - Mei-Chih Huang
- National Cheng Kung University, Taiwan
- National Tainan Junior College of Nursing, Taiwan
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Danoudis M, Soh SE, Iansek R. Health care experiences of people with Parkinson's disease in Australia. BMC Geriatr 2023; 23:430. [PMID: 37438688 DOI: 10.1186/s12877-023-04142-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Little is known about the health care experiences of people with Parkinson's disease (PwP) living in Australia. Exploring health care experiences can provide insight into service gaps which can then help direct quality improvement, such as improving communication between patients and health professionals. METHODS This study aimed to examine the health care experiences of a sample of PwP living in Australia using the Patient-Centered Questionnaire for Parkinson's disease (PCQ-PD). Participants were recruited from four sources located in Victoria, Australia: (1) a metropolitan Movement Disorders Program (Group 1); (2) metropolitan based movement disorder neurologists working as sole practitioners and not within multidisciplinary teams (Group 2); (3) a regional based multidisciplinary PD program (Group 3); and (4) PD support groups in regional and rural Victorian towns without PD specialist programs (Group 4). Scores derived from the PCQ-PD included the overall patient-centered score (OPS), six sub-scale experience scores (SES) and the quality improvement scores (QIS). Health care experiences were compared between Groups 1, 2, 3 and 4 and multivariate linear regression models were used to explore factors contributing to patient-centeredness. RESULTS 227 participants reported a mean (SD) OPS score of 1.8 (SD 0.5) with no significant differences between groups. The rating for the Tailored Information subscale was low, (mean 1.3, SD 0.5), with Group 2 having a significantly lower score, 1.1 (SD 0.5), compared to Group 1, 1.4 (SD 0.5) (p = 0.048). Experiences of Continuity of Care and Collaboration of Professionals were rated significantly lower by Group 2, 1.3 (SD 1.0) compared to Groups 1, 1.8 (SD 0.9) (p = 0.018) and 3, 2.1 (SD 0.8) (p = 0.002). Care aspects related to the Tailored Information subscale were prioritised for improvement by all groups. The main predictors of positive health care experiences were disease duration (coeff 0.02; 95% CI 0.00, 0.04) and living with another person (coeff 0.27: 95% CI 0.03, 0.51). CONCLUSION This sample of participants with PD had poor experiences of several aspects of care known to be important in the provision of quality PD care. They prioritised the improvement of personalised health care information and better continuity of care and collaboration between health professionals.
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Affiliation(s)
- Mary Danoudis
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, Parkinson's Foundation Centre of Excellence, Monash Health, Cheltenham, VIC, Australia.
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
| | - Sze-Ee Soh
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, Parkinson's Foundation Centre of Excellence, Monash Health, Cheltenham, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
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7
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Bartkeviciute B, Riklikiene O, Kregzdyte R, Lesauskaite V. Individualized care for older adults with diabetes and its relationship with communication, psychosocial self-efficacy, resources and support for self-management and socio-demographics. Nurs Open 2023; 10:2560-2571. [PMID: 36479931 PMCID: PMC10006652 DOI: 10.1002/nop2.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/04/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022] Open
Abstract
AIM To examine the relationship between patient-provider communication, psychosocial patient self-efficacy, resources and support for self-management and socio-demographics within individualized care of older adults with diabetes. DESIGN A quantitative study with a cross-sectional survey design. METHODS Data were collected from September 2019 to January 2021 using: Individualized Care Scale, The Communication Assessment Tool, The Diabetes Empowerment Scale and The Resources and Support for Self-Management Scale. Patients with either Type 1 or Type 2 diabetes mellitus that were 65 years old and over (N = 145) participated in the study. RESULTS The most positive aspects of patient-provider communication were respect and creating a comfortable environment for the patient. A significant relationship was observed between patients' perceptions and support of individualized care and diabetes-related measures. Effective communication was the main factor associated with support for individualizing care, and together with education level, empowerment and access to resources, explained 23% of the variance.
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Affiliation(s)
- Birute Bartkeviciute
- Clinical Department of Geriatrics, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olga Riklikiene
- Department of Nursing, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rima Kregzdyte
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vita Lesauskaite
- Clinical Department of Geriatrics, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Loft MI. Caring from a distance: how a COVID-19 visitor ban affects
relatives when a loved one is admitted to a neurological or
neurosurgical ward. J Res Nurs 2022; 27:532-542. [PMID: 36338927 PMCID: PMC9630925 DOI: 10.1177/17449871221116440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Neurological patients often suffer physical, cognitive,
communicative, behavioural or psychosocial limitations. This may
weaken the preconditions for participating in decisions about
their treatment, rehabilitation and future. These impairments
often cause relatives to care and advocate for the patient. This
practice was gravely interrupted by the COVID-19 visitor
ban. Aims This study aims to investigate how relatives of neurological
patients experienced the visitor ban and to identify potential
areas for improvement. Methods Twelve semi-structured interviews with relatives of neurological
patients were conducted. Data were analysed by performing a
thematic analysis inspired by Braun and Clark. Results The following six themes emerged: Visitor ban as a necessary evil,
Losing control and feeling checkmate, Mending the information
gap, Waiting by the phone, Empathy and compassion as the core of
a good relationship and Caring for a loved one from a
distance. Conclusions Having a loved one admitted to a neurological ward during the
COVID-19 visitor ban greatly restrains relatives and affects the
relationship with their loved one and the hospital healthcare
staff. Healthcare staff need to take responsibility and reach
out, while simultaneously exploring new ways of
communicating.
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Affiliation(s)
- Mia I Loft
- Mia I Loft, Department of
Neurology, Rigshospitalet, Neurologisk Klinik N39, Valdemar Hansens
Vej 13, Copenhagen 2100. Denmark.
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9
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Peters JB, Antons JC, Koolen EH, van Helvoort HAC, van Hees HWH, van den Borst B, Spruit MA, Vercoulen JH, van ’t Hul AJ. Patient activation is a treatable trait in patients with chronic airway diseases: An observational study. Front Psychol 2022; 13:947402. [PMID: 36275228 PMCID: PMC9581203 DOI: 10.3389/fpsyg.2022.947402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-management is key for reducing the burden of disease in chronical illness. However, applying self-management presupposes behavioral change. Sufficient knowledge, skills, confidence and motivation to make the needed behavior changes are important prerequisites. During the past years the Integral Diagnostic Trajectory was developed for patients with asthma or COPD which aims to identify treatable traits and activating patients for self-management. Objective In the present study the effects of the Integral Diagnostic Trajectory on the Patient Activation Measure (PAM®) were examined. In addition, predictive variables for PAM baseline scores and change scores were sought. Materials and methods A total of 241 patients with asthma or COPD referred to the pulmonologist at the Radboud university medical center, location Dekkerswald, Nijmegen were included. Patient activation was measured before the first visit and after the intervention with the 13-item PAM®. Additional, patient characteristics and health status were measured with the Nijmegen Clinical Screening Instrument (NCSI), modified Medical Research Council (mMRC), Asthma Control Questionnaire (ACQ), and COPD Clinical Questionnaire (CCQ). Results Fifty percent of the patients with asthma and seventy percent of the patients with COPD had low levels of activation at baseline (PAM level 1-2). Baseline PAM scores could be explained in patients with asthma for 7% by number of severe problems in health status. And for 18% in patients with COPD by number of severe problems, age and employment status. After the intervention both groups significantly improved on the PAM (T0: 56.0 ± 13.1 vs. T1:63.3 ± 14.0 in asthma, and T0: 50.0 ± 8.8 vs. 58.4 ± 11.1 in COPD). Multivariate stepwise regression analysis showed that only 24% of the change in score could be explained by baseline PAM score and being employed in patients with asthma, and 18% of the variance in change score could be predicted by baseline PAM score in COPD. Conclusion The present study showed that low level of activation is a common feature in patients with asthma and COPD. With a relatively short and seemingly simple intervention patients can reach higher levels of patient activation, which is a prerequisite for adopting self-management techniques in daily life.
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Affiliation(s)
- Jeannette B. Peters
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeanine C. Antons
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eleonore H. Koolen
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hanneke A. C. van Helvoort
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hieronymus W. H. van Hees
- Department of Pulmonary Diseases, Donders Institute for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Jan H. Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alex J. van ’t Hul
- Department of Pulmonary Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Damiaens A, Maes E, Van Roosbroek H, Van Hecke A, Foulon V. Methods to elicit and evaluate the attainment of patient goals in older adults: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3051-3061. [PMID: 35691792 DOI: 10.1016/j.pec.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs). METHODS The Arksey and O'Malley framework guided the review. A search was launched in PubMed, Embase, CINAHL, and Web of Science. Reference selection and data extraction were performed by three independent reviewers, followed by team discussions to solve discrepancies. Inductive thematic analysis was applied to synthesize the data. Included papers were reconsidered to identify methods for medication optimization interventions for NHRs. RESULTS Ninety-six references, encompassing 38 elicitation and 12 evaluation methods, were included. Elicitation methods differed in structure, content, and patient involvement levels. Qualitative and quantitative methods were found to assess goal attainment. Five elicitation and three evaluation methods were developed for NHRs, but none of these contained a medication-related assessment. CONCLUSION A variety of goal elicitation and evaluation methods for older adults was found, but none for medication optimization interventions in NHRs. PRACTICE IMPLICATIONS A holistic approach seems important to integrate patient goals into medication optimization interventions, not limiting goal elicitation to a medication-related assessment. Also, the choice of assessor seems important to obtain patient goals.
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Affiliation(s)
- Amber Damiaens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Evelien Maes
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Hanne Van Roosbroek
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, UGent, Department of Nursing Director, Ghent University Hospital Ghent, Belgium.
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
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Deep Brain Stimulation for Parkinson’s Disease: Why Earlier Use Makes Shared Decision Making Important. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09496-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Introduction
As deep brain stimulation (DBS) has shifted to being used earlier during Parkinson’s disease (PD), data is lacking regarding patient specific attitudes, preferences, and factors which may influence the timing of and decision to proceed with DBS in the United States. This study aims to identify and compare attitudes and preferences regarding the earlier use of DBS in Parkinson’s patients who have and have not undergone DBS.
Methods
We developed an online survey concerning attitudes about DBS and its timing in PD. The survey was distributed nationally in the United States via the Michael J. Fox Foundation Trial Finder, the American Parkinson Disease Association flyers, and as a link on the Parkinson Alliance website. Differences in responses between PD DBS and non-DBS patients were assessed.
Results
A total of 445 patients with PD met eligibility criteria for the survey of which 160 self-identified as having undergone DBS. Fifty-five percent (n = 124) of non-DBS patients believed that DBS for PD should only be considered after all medication options have been tried. Patients favoring early DBS had fewer concerns regarding the surgery than those favoring later DBS.
Conclusion
Our findings highlight a variety of important considerations and concerns patients have regarding DBS and its timing. These viewpoints are important aspects of shared decision-making, as they help to identify patients’ preferences, values, and goals, which should enable providers to better navigate, with their patients, the decision path for therapeutic options to consider.
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Heckemann B, Chaaya M, Jakobsson Ung E, Olsson DS, Jakobsson S. Finding the Person in Electronic Health Records. A Mixed-Methods Analysis of Person-Centered Content and Language. HEALTH COMMUNICATION 2022; 37:418-424. [PMID: 33213210 DOI: 10.1080/10410236.2020.1846275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The co-creation and sharing of documentation of person-centered care is important, but challenging in clinical practice. Online access to health records is considered essential to increase patient participation and empowerment in person-centered care provision. The aims of this study were (1) to identify the extent of person-centered content in medical inpatient records and discharge letters; (2) to describe the characteristics of the language and rhetoric used in discharge letters. This was a concurrent, mixed-methods study involving a deductive, quantitative analysis of person-centered content in 69 Patient Accessible Electronic Health Records from patients with pituitary tumors, and an iterative, qualitative language analysis of a nested sample of 57 discharge letters. Both the content and language of inpatient records were mostly patient-centered. Records were concerned with the documentation of symptoms and medical and care interventions. There was little person-centered documentation of patients' preferences, wishes and needs, and shared decision-making. In the discharge letters, written for the patients, some physicians had attempted to write in a person-centered way, using plain language and a narrative. However, most wrote in a style that was reflective of their discourse community, using abbreviations and medical terms. Established norms for documentation in healthcare are a barrier to person-centered documentation. Patients' needs and preferences about documentation should be explored to increase understanding of how person-centered documentation can be achieved in clinical practice.
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Affiliation(s)
- Birgit Heckemann
- Institute of Health and Care Sciences, Sahlgrenska Academy, Centre for Person-Centered Care, University of Gothenburg
| | - Maryam Chaaya
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg
| | - Eva Jakobsson Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy, Centre for Person-Centered Care, University of Gothenburg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg
| | - Daniel S Olsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg
- Department of Endocrinology, Sahlgrenska University Hospital
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg
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Connor KI, Siebens HC, Mittman BS, Ganz DA, Barry F, McNeese-Smith DK, Cheng EM, Vickrey BG. Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS) in meeting challenges in care management. BMC Neurol 2022; 22:36. [PMID: 35073865 PMCID: PMC8785022 DOI: 10.1186/s12883-021-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) complexity poses challenges for individuals with Parkinson's, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature. METHODS These analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model's six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson's modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson's care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges. RESULTS All Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson's moderator types. Through card sorting, four Parkinson's care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson's care management. CHAPS activities and stakeholder perceptions addressed all these themes. CONCLUSIONS CHAPS, a supportive nurse-led proactive Parkinson's care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson's care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I Connor
- Veterans Affairs Parkinson's Disease Research, Education and Clinical Center, Los Angeles, CA, USA. .,UCLA David Geffen School of Medicine, Los Angeles, CA, USA. .,, Novato, CA, 94945, USA.
| | | | - Brian S Mittman
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - David A Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Eric M Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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LoBuono DL, Shea KS, Tovar A, Leedahl SN, Mahler L, Xu F, Lofgren IE. Diet Quality and Nutrition Concerns of People with Parkinson's Disease and Their Informal Caregivers: A Mixed Methods Study. J Nutr Gerontol Geriatr 2022; 41:1-21. [PMID: 35048783 DOI: 10.1080/21551197.2021.2024478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research exists regarding the diet quality and nutritional concerns of people with Parkinson's disease (PwPD) and their informal caregivers. The study's purpose was to assess diet quality via the Healthy Eating Index-2015 (HEI-2015) and self-reported nutrition concerns via semi-structured, dyadic interviews of 20 PwPD (69.7 ± 9.2 yrs) and their caregivers (66.7 ± 13.0 yrs). HEI-2015 scores were 58.3 ± 12.4 and 58.1 ± 10.6 for PwPD and caregivers, respectively. Reported dietary concerns related to PD included: change in appetite or amount eaten, gastrointestinal issues, food-medication management, chewing/swallowing issues, and change in taste/smell. The poor diet quality and nutrition concerns identified suggest nutrition professionals and caregivers are critical on the healthcare team to promote optimal health among PwPD. Future research should address overall and specific aspects of diet quality, and nutritional concerns identified by dyads in this study, such as gastrointestinal issues and food-medication management.
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Affiliation(s)
- Dara L LoBuono
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kyla S Shea
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Skye N Leedahl
- Department of Human Development and Family Science, University of Rhode Island, Kingston, RI, USA
| | - Leslie Mahler
- Department of Communicative Disorders, University of Rhode Island, Kingston, RI, USA
| | - Furong Xu
- School of Education, University of Rhode Island, Kingston, RI, USA
| | - Ingrid E Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
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15
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LoBuono DL, Shea KS, Tovar A, Leedahl SN, Mahler L, Xu F, Lofgren IE. Acceptance and perception of digital health for managing nutrition in people with Parkinson's disease and their caregivers and their digital competence in the United States: A mixed-methods study. Health Sci Rep 2021; 4:e412. [PMID: 34796282 PMCID: PMC8581626 DOI: 10.1002/hsr2.412] [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: 11/02/2020] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND AND AIMS This mixed-methods study examined participants' acceptance and perception of using digital health for managing nutrition and participants' digital competence. The results will be formative for making digital nutrition education more effective and acceptable for people with Parkinson's disease (PwPD) and their informal caregivers. METHODS Qualitative data were collected through in-person semi-structured, dyadic interviews, and questionnaires from 20 dyads (20 PwPD and their caregivers) in the Northeastern United States and analyzed throughout the 2018 to 2019 academic year. Interview transcripts were deductively coded using the framework analysis method. Phrases related to acceptance of digital health were sub-coded into accept, neutral, or reject and those related to perceptions of digital health were sub-coded into perceived usefulness, perceived ease of use, and awareness of digital health. Quantitative data were analyzed using independent samples t tests and Fisher's exact tests. Qualitative codes were transformed into variables and compared to digital competence scores to integrate the data. An average acceptance rate for digital health was calculated through examining the mean percent of phrases coded as accept from interview transcripts. RESULTS Twenty-five of 40 (62.5%) participants used the internet for at least 5 health-related purposes and the average acceptance rate was 54.4%. Dyads rejected digital health devices if they did not see the added benefit. The majority of participants reported digital health to be useful, but hard to use, and about half felt they needed education about existing digital health platforms. There was no difference in digital competence scores between PwPD and their caregivers (28.6 ± 12.6). CONCLUSION Findings suggest that dyads accept and use technology but not to its full potential as technology can be perceived as hard to use. This finding, combined with digital competence scores, revealed that education is warranted prior to providing a digital nutrition intervention.
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Affiliation(s)
- Dara L. LoBuono
- Department of Health and Exercise ScienceRowan UniversityGlassboroNew JerseyUSA
| | - Kyla S. Shea
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
| | - Alison Tovar
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
| | - Skye N. Leedahl
- Department of Human Development and Family ScienceUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Leslie Mahler
- Department of Communicative DisordersUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Furong Xu
- School of EducationUniversity of Rhode IslandKingstonRhode IslandUSA
| | - Ingrid E. Lofgren
- Johnson and Wales University in the College of Food Innovation and Technology in Providence, RI
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Abstract
Parkinson’s disease is an incurable, progressive neurodegenerative disease. This condition is complicated by the varying symptoms in individuals who differ in age of onset, symptoms, progression of disease, response to treatment and prognosis. In this paper, we focus on quality of life achieved through a combination of comprehensive health care, continuous support, and self care. Determining what people with Parkinson’s disease want is like assembling multiple puzzles simultaneously. While we surmise that patient centered care, support programs, access to comprehensive health care, and relevant symptom control are pieces of this puzzle, more longitudinal studies— which are observational in nature and correlate the impact of symptoms with patients’ reported needs— are necessary.
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Affiliation(s)
- John Andrejack
- Queens College, Director of Student Advocacy; Parkinson's Foundation, Patient Advocate In Research, Flushing, NY, USA
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17
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Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2021; 46:103-117. [PMID: 34507339 DOI: 10.1097/npt.0000000000000376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).
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18
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Individualized Health Care for Older Diabetes Patients from the Perspective of Health Professionals and Service Consumers. J Pers Med 2021; 11:jpm11070608. [PMID: 34199022 PMCID: PMC8306441 DOI: 10.3390/jpm11070608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Individualized nursing care as a form of person-centered care delivery is a well-known approach in the health care context and is accepted as best practice by organizations and professionals, yet its implementation in everyday practice creates serious challenges. The aim was to assess and compare the perceptions of health professionals and older diabetes patients on their individual care in regard to the patient’s clinical situation, personal life situation, and decisional control. Methods: The quantitative study with a cross-sectional survey design was conducted from March 2019 until January 2021. The Individualized Care Scale was applied for the data collection. Health professionals (nurses and physicians, n = 70) and older diabetes patients (n = 145) participated in the study. The average duration of diabetes was 15.8 years (SD = 10.0) and type 2 diabetes was the most common (89.0%). The current glucose-lowering therapy for 51.0% of the patients was oral medications, 37.9% used injected insulin, and 11.1% were treated by combined therapy. Results: The highest-rated aspects of individualized care on both dimensions of the scale from the health professionals’ perspective related to the clinical situation, and the scores for provision were significantly higher than those for support. The highest means of patients’ ratings on the support dimension related to the clinical situation and the decisions over care sub-scale; for the care provision dimension, the highest individuality in care was assigned to the decisions over care sub-scale. The lowest ratings of individualized care, both in the health professionals’ and patients’ samples, related to the personal life situation sub-scale. Conclusions: Health professionals are more positive in regard to individualized care support and provisions for older diabetes patients than the patients themselves. Patient characteristics, such as the type of glucose-lowering therapy, education, and nutritional status, make a difference in patients’ understanding and experience of individuality in care.
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Sarabia-Tapia C, Corona T, Lopez-Alamillo S, Resendiz-Henriquez E, Cervantes-Arriaga A, Rodríguez-Violante M. Independence of Coping Styles With the Patient-Doctor Relationship and Shared Decision-Making in People With Parkinson's Disease. J Patient Exp 2021; 7:1271-1277. [PMID: 33457575 PMCID: PMC7786658 DOI: 10.1177/2374373520918725] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction: Coping styles have a mediating effect on several clinical outcomes. The patient–doctor relationship and the patient’s role in decision-making process might be influenced by the way the patient reacts to certain stressors or problems due to the evolution of their disease. Objective: To assess the role of coping strategies on the patient–doctor relationship and the patient’s role in decision-making in a group of people with Parkinson’s disease (PD). Methods: A cross-sectional study was carried out. The Coping Style Questionnaire (CSQ-40), the 9-item Patient–Doctor Relationship Questionnaire (PDRQ-9), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) were applied. Results: A total of 36 women and 64 men with PD were included. The predominant coping style in women was rational. In men, the detachment style was more frequent. The SDM-Q-9 mean score was 33.2 ± 11.2 (transformed median score of 80). The PDRQ-9 average score was 2.9 ± 1 (sum score of 26.1 ± 8.7). No association was found between the CSQ-40 with the PDRQ-9 or SDM-Q-9. On the other hand, the PDRQ-9 mean score and the transformed SDM-Q-9 score highly correlated (r = 0.62, P < .001). Conclusion: Patient–doctor relationship and shared decision-making are independent of the coping style in people with PD.
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Affiliation(s)
- Cynthia Sarabia-Tapia
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Teresa Corona
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Susana Lopez-Alamillo
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Etienne Resendiz-Henriquez
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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20
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. How people living with motor neurone disease and their carers experience healthcare decision making: a qualitative exploration. Disabil Rehabil 2020; 44:3095-3103. [PMID: 33295820 DOI: 10.1080/09638288.2020.1855261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Healthcare decision making in motor neurone disease (MND) focuses on symptom management and quality of life. Decision making may be affected by personal approach to receiving information, decision making style, and disease symptoms. This study explored decision making from the perspectives of people living with motor neurone disease (plwMND). The issues impacting engagement and involvement in healthcare decisions were investigated. METHODS Semi-structured interviews were conducted with 19 plwMND and 15 carers. Interview data was inductively analysed to identify and describe patterns and themes. RESULTS Data analysis identified six overarching themes: Dimensions of decision making; Window of opportunity for choice; Intrinsic influences on decision making; Extrinsic influences impacting decision making; Planning in uncertainty; and, Communication is core. Many participants did not identify a process of "decision-making" except if considering early gastrostomy placement. Information provision requires a balance between ensuring patients are informed but not overwhelmed. Communication impairment impacts involvement. Healthcare professionals' communication style influences engagement in decision making. CONCLUSION PlwMND perceive a lack of clinical decisions to make because disease symptoms and clinical phenotypes dictate necessary interventions. PlwMND describe communication impairment as a barrier to involvement in decision making and extra support is required to ensure they maintain engagement.IMPLICATIONS FOR REHABILITATIONPeople living with MND (plwMND) perceive they have few clinical decisions to make and viewed this process as "accepting a recommendation", rather than "making a decision" although early gastrostomy placement is the exception with considerable deliberation evident.Specialist multidisciplinary clinic advice is especially helpful for plwMND without dysphagia (swallowing problems) when considering early gastrostomy placement.Communication impairment may be a barrier to involvement in healthcare decisions and extra support to remain engaged is required.Some plwMND choose not to involve others in their decisions, and patients/families with medical or scientific backgrounds are more likely to collaborate with each other outside the context of clinic appointments.
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Affiliation(s)
- C Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - S Mathers
- Calvary Health Care Bethlehem, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - H Gregory
- Calvary Health Care Bethlehem, Melbourne, Australia
| | - A P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Parkville, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Germany.,Redenlab, Australia
| | - M Cruice
- Division of Language and Communication Science, City, University of London, London, UK
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21
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De Panfilis L, Tanzi S, Perin M, Turola E, Artioli G. "Teach for ethics in palliative care": a mixed-method evaluation of a medical ethics training programme. BMC Palliat Care 2020; 19:149. [PMID: 32977796 PMCID: PMC7519533 DOI: 10.1186/s12904-020-00653-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Training in medical ethics aims to educate health care professionals in dealing with daily care ethical issues. To guarantee quality of life and spiritual and emotional support, palliative care professionals have to develop ethical and relational skills. We propose the implementation and evaluation of a specialized training programme in medical ethics dedicated to a hospital-based Palliative Care Unit. METHODS This study is a mixed-method before-after evaluation with data triangulation. RESULTS The results highlight that participants developed their ethical knowledge, and a deeper ethical awareness. They also felt more confident and motivated to widely apply ethical reflections and reasonings in their daily practice. CONCLUSION The participants appreciated the innovative structure of the training, especially regarding the integration of the theoretical-interactive and practical parts. However, they recommended increasing the number of concrete occasions for ethical supervision and practical application of what they learned during the programme. The training programme also has some potential practical implications: the development of advanced ethical skills within a hospital-based PC team may improve the quality of life of the patients and their families. In addition, health care professionals with advanced ethical competencies are able to educate patients and their families towards more active participation in the decision-making process.
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Affiliation(s)
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Perin
- Unit of Bioethics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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22
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Bogossian A, Majnemer A, Racine E. Contextualized Autonomy in Transitional Care for Youth With Neurologic Conditions: The Role of the Pediatric Neurologist. J Child Neurol 2020; 35:536-542. [PMID: 32338583 DOI: 10.1177/0883073820918454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with neurologic conditions experience multiple life transitions. The transfer from pediatric to adult health care systems exemplifies one such complex and multifaceted transition that occurs in parallel with developmental, legal, and social changes that may influence the roles and responsibilities of youth and their caregivers. As a result, ethical situations, questions, and challenges may surface in transition care to which pediatric neurologists may be confronted. In this article, we focus on the topic of autonomy and situations that may arise in transition care in the context of pediatric neurology. Building from a clinical case, we present the concept of contextualized autonomy to work through the questions that arise in the case and propose ways of thinking through those challenging situations in transition care.
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Affiliation(s)
- Aline Bogossian
- School of Social Work, Faculty of Arts and Science, Université de Montréal, Pavillon Lionel-Groulx, Montréal, Quebec, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montréal, Quebec, Canada.,Montreal Children's Hospital and RI-McGill University Health Centre & Centre for Interdisciplinary Research in Rehabilitation, Montréal, Quebec, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada.,Department of Neurology and Neurosurgery, Biomedical Ethics Unit and Division of Experimental Medicine, McGill University, Montréal, Quebec, Canada
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23
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Choo XY, Lim SY, Chinna K, Tan YJ, Yong VW, Lim JL, Lau KF, Chung JY, Em JM, Tan HT, Lim JH, Tan SB, Tan CT, Tan AH. Understanding patients’ and caregivers’ perspectives and educational needs in Parkinson’s disease: a multi-ethnic Asian study. Neurol Sci 2020; 41:2831-2842. [DOI: 10.1007/s10072-020-04396-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
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Leslie M, Gray RP, Khayatzadeh-Mahani A. What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives. Scand J Caring Sci 2020; 35:220-232. [PMID: 32168399 DOI: 10.1111/scs.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With governments worldwide reducing their involvement in the provision of institutional long-term elder care, community-based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals. METHODS We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis. RESULTS Quality of care - as delivered by both FCs themselves, and formal health and social care systems - was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas. CONCLUSIONS Our findings suggest that the formal care system providers could be more caregiver-oriented in their communications by engaging FCs in the decision-making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications.
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Affiliation(s)
- Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,School of Public Policy, University of Calgary, Calgary, AB, Canada
| | | | - Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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25
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Hedlund Å, Nordström T, Kristofferzon M, Nilsson A. New insights and access to resources change the perspective on life among persons with long-term illness-An interview study. Nurs Open 2019; 6:1580-1588. [PMID: 31660186 PMCID: PMC6805306 DOI: 10.1002/nop2.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/05/2019] [Indexed: 11/10/2022] Open
Abstract
AIM The aim was to describe individuals' experiences of living with long-term illness. METHODS A qualitative approach with a descriptive design was used. Semi-structured interviews were conducted with 16 persons (50-80 years). They were also asked to self-rate their perceptions of their current health status and confidence in their ability to cope with everyday life. RESULTS One main theme was identified: new insights and access to resources change the perspective on life. Personal characteristics and support from others were advantageous in finding ways to deal with limitations related to the illness. Most of the persons experienced a changed approach to life, in that they now valued life more than they had before. However, some persons also experienced lost values and found it difficult to accept medications. The persons rated their current health status as slightly above average, but their confidence in their ability to cope with everyday life as high.
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Affiliation(s)
- Åsa Hedlund
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
| | - Tina Nordström
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
| | - Marja‐Leena Kristofferzon
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
- Department of Public Health and Caring Sciences,Section of Caring SciencesUppsala UniversityUppsalaSweden
| | - Annika Nilsson
- Department of Health and Caring SciencesUniversity of GävleGävleSweden
- Department of Public Health and Caring Sciences,Section of Caring SciencesUppsala UniversityUppsalaSweden
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26
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Rastgardani T, Armstrong MJ, Gagliardi AR, Grabovsky A, Marras C. Communication About OFF Periods in Parkinson's Disease: A Survey of Physicians, Patients, and Carepartners. Front Neurol 2019; 10:892. [PMID: 31481924 PMCID: PMC6709650 DOI: 10.3389/fneur.2019.00892] [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: 04/24/2019] [Accepted: 08/01/2019] [Indexed: 12/16/2022] Open
Abstract
Background: OFF periods impair quality of life in Parkinson's disease and are often amenable to treatment. Optimal treatment decisions rely on effective communication between physicians, patients and carepartners regarding this highly variable and complex phenomenon. Little is published in the literature about communication about OFF periods. Methods: Informed by interviews with physicians, patients and carepartners we designed questionnaires for each group. We surveyed these parties using an online platform to investigate the frequency, content and ease of communication about OFF periods and barriers and facilitators of communication with physicians. Results: Fifty movement disorder neurologists, 50 general neurologists, 442 patients and 97 carepartners participated. A free-flowing dialogue is the mainstay of communication according to all parties. Motor aspects of OFF periods are discussed more frequently than non-motor aspects (90 vs. <50% according to both general neurologists and movement disorder neurologists). The most common physician-reported barriers to communication are patient cognitive impairment, patient difficulty recognizing OFF periods and poor patient understanding of OFF periods' relationship to medication timing. The barriers most commonly cited as major by patients were that they perceived OFF periods to be part of the disease (i.e., not a clinical aspect that could be improved by a physician), variability of symptoms, and difficulty in describing symptoms. The most commonly described facilitator (by physicians) was the input of a caregiver. Positively viewed but less commonly used facilitators included pre-visit questionnaires or diaries, digital apps and wearable devices to monitor fluctuations. The majority of patients and carepartners identified a free-flowing dialogue with their physicians and having an agenda as helpful facilitators of communication about OFF periods which they already use. The majority of both groups felt that keeping a diary and pre-visit questionnaires were potentially helpful facilitators that were not currently in use. Conclusions: Perceived barriers and facilitators to communication about OFF periods are different between health care providers and receivers of health care. Modifiable barriers and facilitators that could be implemented were identified by both groups. Future research should develop and test strategies based on this input to optimize communication and thus clinical care for this common and debilitating problem.
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Affiliation(s)
- Tara Rastgardani
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Connie Marras
- The Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Research, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Nijhuis FAP, van den Heuvel L, Bloem BR, Post B, Meinders MJ. The Patient's Perspective on Shared Decision-Making in Advanced Parkinson's Disease: A Cross-Sectional Survey Study. Front Neurol 2019; 10:896. [PMID: 31474936 PMCID: PMC6706819 DOI: 10.3389/fneur.2019.00896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Choosing between deep brain stimulation (DBS), Levodopa-Carbidopa intestinal gel (LCIG), or continuous subcutaneous Apomorphine infusion (CSAI) in advanced Parkinson's disease is a complex decision. It is paramount to combine evidence with the professional's expertise and the patient's preferences. The patient's preferences can be elicited and integrated into the treatment choice through shared decision-making (SDM). Objective: In this cross-sectional survey study we explored patient's involvement in decision-making and identified facilitators and barriers for shared decision-making (SDM) in advanced Parkinson from the patient's perspective. Methods: We invited 180 Dutch persons with Parkinson who started DBS, LCIG, or CSAI in the previous 3 years to complete a questionnaire. Questions covered three topics; (1) preferred and experienced roles in the decision process for an advanced treatment, (2) information needs to make a decision and actually received information, and (3) factors that had positively or negatively influenced shared decision-making (SDM). Results: One hundred and twenty one participants completed the questionnaire. The large majority preferred to be involved in the decision-making (93%), and most respondents had experienced an active role (85%). In about half of the respondents (47%), their preferred role did not match their experienced role; 28% had a more active role than they would have preferred. Although 77% perceived to be fully informed at the time of decision, only 41% stated they knew all three therapeutic options. Participants identified the most important facilitators for shared decision-making (SDM) at the patient's level (i.e., perceiving the decision to be his own choice), at the neurologist's level (i.e., having expertise on all treatment options, and taking time for the decision), and within the professional-patient relationship (i.e., trust and having an open discussion). The main barriers for shared decision-making (SDM) existed at the patient's level (i.e., perceiving there is no choice), neurologist's level (own treatment preference), and organizational level (i.e., no research available that compares treatments, multiple professionals involved, and lack of consultation time). Conclusions: Patients want to be involved and feel involved when choosing an advanced treatment, but often do not know all treatment options. Implementation of true patient involvement needs personalized information provision on all treatment options and improvement on how this information is communicated.
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Affiliation(s)
- Frouke A P Nijhuis
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Lieneke van den Heuvel
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Bart Post
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
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Racine E, Cascio MA, Montreuil M, Bogossian A. Instrumentalist analyses of the functions of ethics concept-principles: a proposal for synergetic empirical and conceptual enrichment. THEORETICAL MEDICINE AND BIOETHICS 2019; 40:253-278. [PMID: 31587142 DOI: 10.1007/s11017-019-09502-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics-and the specific role(s) it can or should play-remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: (1) function identification, (2) function enrichment, and (3) function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing (eudaimonia). We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts.
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Affiliation(s)
- Eric Racine
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada.
- Université de Montréal, Montréal, QC, Canada.
- McGill University, Montréal, QC, Canada.
| | - M Ariel Cascio
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- Central Michigan University, Mount Pleasant, MI, USA
| | - Marjorie Montreuil
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Aline Bogossian
- Institut de recherches cliniques de Montréal, Montreal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
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Armstrong MJ, Rastgardani T, Gagliardi AR, Marras C. Barriers and facilitators of communication about off periods in Parkinson's disease: Qualitative analysis of patient, carepartner, and physician Interviews. PLoS One 2019; 14:e0215384. [PMID: 30998707 PMCID: PMC6472878 DOI: 10.1371/journal.pone.0215384] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Successful patient-physician communication is critical for improving health outcomes, but research regarding optimal communication practices in Parkinson’s disease is limited. The objective of the current study was to investigate barriers and facilitators of communication between persons with Parkinson’s disease, carepartners, and physicians, specifically in the setting of off periods, with the goal of identifying ways to improve patient-carepartner-physician communication. Method We interviewed persons with Parkinson’s, carepartners, and physicians (specialists and non-specialists) using a semi-structured questionnaire to identify and describe experiences, barriers, and facilitators relating to communication about off periods in Parkinson’s disease. We used a qualitative descriptive approach to analyze interview transcripts and compare themes between participating groups. Results Twenty persons with Parkinson’s and their carepartners and 20 physicians (10 specialists, 10 non-specialists) participated in interviews. Identified communication barriers included patient-level (e.g. cognitive impairment, reluctance to discuss symptoms), caregiver-level (e.g. caregiver absence), and physician-level (e.g. distraction by technology, lack of appreciation of the burden of off periods) factors. Other barriers included the challenging nature of off periods themselves. Positive physician characteristics such as empathy, respect, and taking time to listen were major facilitators of communication regarding off periods. Persons with Parkinson’s, carepartners, and physicians described using various tools (e.g. home diaries, questionnaires, mobile phone videos) to aid communication regarding off periods but participants identified a need for more formal educational materials. Conclusions Physicians caring for persons with Parkinson’s can improve communication through more patient-centered practice but there is a need for improved educational tools regarding off periods. Further research is needed to identify optimal strategies for communication about off periods and preferred approaches for off period education.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, United States of America
| | - Tara Rastgardani
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Toronto, Ontario, Canada
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Bracken-Roche D, Shevell M, Racine E. Understanding and addressing barriers to communication in the context of neonatal neurologic injury: Exploring the ouR-HOPE approach. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:511-528. [PMID: 31324327 DOI: 10.1016/b978-0-444-64029-1.00024-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Predicting neurologic outcomes for neonates with acute brain injury is essential for guiding the development of treatment goals and appropriate care plans in collaboration with parents and families. Prognostication helps parents imagine their child's possible future and helps them make ongoing treatment decisions in an informed way. However, great uncertainty surrounds neurologic prognostication for neonates, as well as biases and implicit attitudes that can impact clinicians' prognoses, all of which pose significant challenges to evidence-based prognostication in this context. In order to facilitate greater attention to these challenges and guide their navigation, this chapter explores the practice principles captured in the ouR-HOPE approach. This approach proposes the principles of Reflection, Humility, Open-mindedness, Partnership, and Engagement and related self-assessment questions to encourage clinicians to reflect on their practices and to engage with others in responding to challenges. We explore the meaning of each principle through five clinical cases involving neonatal neurologic injury, decision making, and parent-clinician communication. The ouR-HOPE approach should bring more cohesion to the sometimes disparate concerns reported in the literature and encourage clinicians and teams to consider its principles along with other guidelines and practices they find to be particularly helpful in guiding communication with parents and families.
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Affiliation(s)
- Dearbhail Bracken-Roche
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Michael Shevell
- Department of Pediatrics and Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
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Jordan A, Wood F, Edwards A, Shepherd V, Joseph-Williams N. What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences. PATIENT EDUCATION AND COUNSELING 2018; 101:1725-1735. [PMID: 29937112 DOI: 10.1016/j.pec.2018.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. METHODS A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six databases were searched from inception to March 2017. The quality of the articles was assessed, and relevant data were extracted and coded thematically. RESULTS The search yielded 27 articles which met the inclusion criteria. Decision-making involvement preferences and experiences were reported from the adolescents' perspectives. Adolescents often report that they do not have any choice of treatment options. Variability in preferences and experiences were found within and between individuals. Mismatches between preferences and experiences are common, and often with negative emotional consequences. DISCUSSION Adolescent preferences for involvement in the decision-making process are situational and individualistic. Healthcare professionals can encourage involvement by ensuring that adolescents are informed of treatment options, and aware of the value of their contribution. Future research should explore adolescent perceived barriers and facilitators to SDM. PRACTICAL IMPLICATIONS Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.
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Affiliation(s)
- Amber Jordan
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Fiona Wood
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Victoria Shepherd
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
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Schrag A, Khan K, Hotham S, Merritt R, Rascol O, Graham L. Experience of care for Parkinson's disease in European countries: a survey by the European Parkinson's Disease Association. Eur J Neurol 2018; 25:1410-e120. [DOI: 10.1111/ene.13738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Schrag
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - K. Khan
- Department of Clinical Neurosciences; Institute of Neurology; University College London; London UK
| | - S. Hotham
- Centre for Health Services Studies; University of Kent; Canterbury UK
| | - R. Merritt
- Centre for Health Services Studies; University of Kent; Canterbury UK
- University of Surrey; Guildford UK
| | - O. Rascol
- Départements de Pharmacologie Clinique et de Neurosciences; Centre Hospitalo-Universitaire de Toulouse and INSERM; Centre d'Investigation Clinique CIC1436; Centre Expert Parkinson, NeuroToul COEN Centre of Excellence in Neurodegeneration; Université de Toulouse; Toulouse France
| | - L. Graham
- European Parkinson's Disease Association; Sevenoaks UK
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Amateis AL, Boesel CL, Ehnert BP, Evans AS, Hurst KE, Marek KL, Sullivan AC, Zalewski KR, Huddleston WE. The need for mapping personal goals to exercise dosage in community-based exercise programs for people with Parkinson’s disease. Physiother Theory Pract 2018; 35:1250-1258. [DOI: 10.1080/09593985.2018.1476942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Allison L. Amateis
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Chelsea L. Boesel
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Bryan P. Ehnert
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Abby S. Evans
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katheryn E. Hurst
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katie L. Marek
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amanda C. Sullivan
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kathryn R. Zalewski
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Wendy E. Huddleston
- Department of Kinesiology: Integrative Health Care and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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"It Is Hard Work, But It Is Worth It": Patients and Spouses' Experiences of a Nursing Intervention to Promote Adjustment to Deep Brain Stimulation for Parkinson's Disease-A Feasibility Study. ANS Adv Nurs Sci 2018; 41:174-187. [PMID: 29727341 DOI: 10.1097/ans.0000000000000208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article evaluates the feasibility of a nursing intervention when adjusting to deep brain stimulation for Parkinson disease. Eight couples were included in the study. Main activities of the intervention were a diary and individualized meetings between nurses, patients, and spouses with a focus on everyday life and expectations to deep brain stimulation. All meetings were audio recorded and analyzed together with the content of the diary. The intervention was evaluated as feasible and experienced as meaningful. It supports the need for individualized care involving both patients and spouses and contributes to the development of an evidence-based nursing practice.
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Stern JM, Cendes F, Gilliam F, Kwan P, Ryvlin P, Sirven J, Smith B, Adomas A, Walter L. Neurologist-patient communication about epilepsy in the United States, Spain, and Germany. Neurol Clin Pract 2018; 8:93-101. [PMID: 29708182 DOI: 10.1212/cpj.0000000000000442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022]
Abstract
Background Effective communication between patients and their health care providers is recognized as critically important to improve the quality of health services for individuals with epilepsy. We aimed to describe in-office neurologist-patient conversations about epilepsy and focus on disease identification, shared decision-making, and care planning. Methods Transcripts and audio recordings of conversations between patients and neurologists in the United States, Spain, and Germany were analyzed linguistically in the topic areas of epilepsy identification and diagnosis, disease education, treatments, and care planning. Analyses included word-level assessments, topic switching, strategies of information elicitation, identification of topics discussed, quantification of questions asked, and assessment of types of questions asked. Results Conversations of 17 neurologists in the United States, 12 in Spain, and 6 in Germany, with 50, 20, and 16 patients, respectively, were analyzed. Neurologists tended to utilize an event-based, patient-friendly vocabulary to refer to seizures, and in the United States, they avoided using the term "epilepsy." Regardless of who initiated the treatment discussion, the neurologists in all 3 countries were unilaterally responsible for the treatment decision and choice of medication. When describing a new medication, neurologists most often discussed potential side effects but did not review potential benefits. Neurologists rarely defined seizure control and did not ask patients what seizure control meant to them. Conclusions We identified opportunities related to vocabulary, decision-making, and treatment goal setting that could be targeted to improve neurologist-patient communication about epilepsy, and ultimately, the overall treatment experience and outcomes for patients.
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Affiliation(s)
- John M Stern
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Fernando Cendes
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Frank Gilliam
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Patrick Kwan
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Philippe Ryvlin
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Joseph Sirven
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Brien Smith
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Aleksandra Adomas
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
| | - Lauren Walter
- David Geffen School of Medicine (JMS), University of California Los Angeles; University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN) (FC), Campinas, São Paulo, Brazil; University of Kentucky Epilepsy Center (EpiC) (FG), Lexington; University of Melbourne (PK), Parkville, Australia; Centre Hospitalier Universitaire Vaudois (PR), Lausanne, Switzerland; Mayo Clinic (JS), Scottsdale, AZ; Spectrum Health Medical Group (BS), Grand Rapids, MI; MicroMass Communications, Inc. (AA), Cary, NC; and Verilogue, Inc. (LW), Horsham, PA
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Racine E, Sattler S, Escande A. Free Will and the Brain Disease Model of Addiction: The Not So Seductive Allure of Neuroscience and Its Modest Impact on the Attribution of Free Will to People with an Addiction. Front Psychol 2017; 8:1850. [PMID: 29163257 PMCID: PMC5672554 DOI: 10.3389/fpsyg.2017.01850] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 10/04/2017] [Indexed: 12/18/2022] Open
Abstract
Free will has been the object of debate in the context of addiction given that addiction could compromise an individual's ability to choose freely between alternative courses of action. Proponents of the brain-disease model of addiction have argued that a neuroscience perspective on addiction reduces the attribution of free will because it relocates the cause of the disorder to the brain rather than to the person, thereby diminishing the blame attributed to the person with an addiction. Others have worried that such displacement of free will attribution would make the person with a drug addiction less responsible. Using the paradigmatic literature on the seductive allure of neuroscience explanations, we tested whether neuroscience information diminishes attributions of free will in the context of addiction and whether respondent characteristics influence these attributions and modulate the effect of neuroscience information. We performed a large-scale, web-based experiment with 2,378 German participants to explore how attributions of free will in the context of addiction to either alcohol or cocaine are affected by: (1) a text with a neurobiological explanation of addiction, (2) a neuroimage showing effects of addiction on the brain, and (3) a combination of a text and a neuroimage, in comparison to a control group that received no information. Belief in free will was measured using the FAD-Plus scale and was, subsequent to factor analysis, separated into two factors: responsibility and volition. The investigated respondent characteristics included gender, age, education, self-reported knowledge of neuroscience, substance-use disorder (SUD), and having a friend with SUD. We found that attributions of volition (in the cocaine-subsample) were reduced in the text and neuroimage-treatment compared to the control group. However, respondent characteristics such as education and self-reported knowledge of neuroscience were associated with lower attributions of responsibility for both substances, and education was associated with lower attribution of volition for the alcohol sub-sample. Interaction analyses showed that knowledge of neuroscience was found to generally decrease attribution of responsibility. Further research on attribution of free will should consider the effects of context and respondent characteristics, which appeared surprisingly larger than those induced by experimental treatments.
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Biomedical Ethics Unit, Division of Experimental Medicine, Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada
| | - Sebastian Sattler
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Institute for Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Alice Escande
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Cognitive Science Program, McGill University, Montréal, QC, Canada
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Racine E, Bell E, Farlow B, Miller S, Payot A, Rasmussen LA, Shevell MI, Thomson D, Wintermark P. The 'ouR-HOPE' approach for ethics and communication about neonatal neurological injury. Dev Med Child Neurol 2017; 59:125-135. [PMID: 27915463 DOI: 10.1111/dmcn.13343] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/26/2022]
Abstract
Predicting neurological outcomes of neonates with acute brain injury is an essential component of shared decision-making, in order to guide the development of treatment goals and appropriate care plans. It can aid parents in imagining the child's future, and guide timely and ongoing treatment decisions, including shifting treatment goals and focusing on comfort care. However, numerous challenges have been reported with respect to evidence-based practices for prognostication such as biases about prognosis among clinicians. Additionally, the evaluation or appreciation of living with disability can differ, including the well-known disability paradox where patients self-report a good quality of life in spite of severe disability. Herein, we put forward a set of five practice principles captured in the "ouR-HOPE" approach (Reflection, Humility, Open-mindedness, Partnership, and Engagement) and related questions to encourage clinicians to self-assess their practice and engage with others in responding to these challenges. We hope that this proposal paves the way to greater discussion and attention to ethical aspects of communicating prognosis in the context of neonatal brain injury.
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Affiliation(s)
- Eric Racine
- Institut de recherches cliniques de Montréal, Montréal, Canada.,Université de Montréal, Montréal, Canada.,McGill University, Montréal, Canada
| | - Emily Bell
- Institut de recherches cliniques de Montréal, Montréal, Canada
| | - Barbara Farlow
- The DeVeber Institute for Bioethics and Social Research, Toronto, Canada.,Patients for Patient Safety Canada, Edmonton, Canada
| | - Steven Miller
- Hospital for Sick Children, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Antoine Payot
- Université de Montréal, Montréal, Canada.,CHU Sainte-Justine, Montréal, Canada
| | | | - Michael I Shevell
- McGill University, Montréal, Canada.,Montreal Children's Hospital, Montréal, Canada
| | - Donna Thomson
- NeuroDevNet/Kids Brain Health Network, Vancouver, Canada
| | - Pia Wintermark
- McGill University, Montréal, Canada.,Montreal Children's Hospital, Montréal, Canada
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