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Najem C, Wijma AJ, Meeus M, Cagnie B, Ayoubi F, Van Oosterwijck J, De Meulemeester K, Van Wilgen CP. "It is something you live with, like an organ in your body" a qualitative study on the lived experiences of people suffering from chronic low back pain in Lebanon. Disabil Rehabil 2024:1-12. [PMID: 39087694 DOI: 10.1080/09638288.2024.2384620] [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: 10/19/2023] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE This paper aims to understand the distinctive biopsychosocial aspects and patient perspectives on chronic low back pain in Lebanon, an Arab country with a unique and rich cultural heritage. METHOD Qualitative, semi-structured interviews with 12 Lebanese patients purposefully sampled from various governorates. The interviews included participants from different geographic areas and religions. The data underwent analysis through an inductive thematic approach guided by a bounded relativist ontology, a subjectivist epistemology, and a descriptive phenomenological framework. The coding process was managed by computer-assisted qualitative data analysis software (QSR NVivo version 12.0). RESULTS The researchers identified and constructed two themes: (1) Chronic low back pain: understanding the impact, coping strategies, and communication patterns in lived experiences within the Lebanese context. This theme sheds light on the complexities of pain management and societal influences in Lebanon. (2) Explanatory model of patients living with chronic low back pain in Lebanon. This theme allowed an exploration of the multifaceted narratives of chronic low back pain. CONCLUSION This study found that Lebanese individuals attribute chronic low back pain to biomedical factors despite some recognizing psychosocial elements. It emphasizes the need to educate patients on the biopsychosocial model, facilitate better care, and dispel misconceptions.
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Affiliation(s)
- Charbel Najem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- L3S, Faculty of Public Health, Antonine University, Baabda, Lebanon
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
| | - A J Wijma
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - B Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - F Ayoubi
- L3S, Faculty of Public Health, Antonine University, Baabda, Lebanon
- Department of Physiotherapy, Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - J Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Research Foundation - Flanders (FWO), Brussels, Belgium
| | - K De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
| | - C P Van Wilgen
- Pain in Motion International Research Group, www.paininmotion.be, Brussels, Belgium
- Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Lawson McLean A, Lawson McLean AC. Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:374-382. [PMID: 38448671 PMCID: PMC11219368 DOI: 10.1007/s13187-024-02419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
The integration of shared decision-making (SDM) into undergraduate oncology education represents a critical evolution in medical pedagogy, reflecting the growing complexity and patient-centric focus of contemporary healthcare. This paper introduces a comprehensive pedagogical framework designed to embed SDM within the undergraduate medical curriculum, particularly in oncology, where the multiplicity of treatment options and their profound impact on patient life underscore the necessity of this approach. Grounded in a systematic literature review and aligned with established educational theories, this framework proposes twelve strategic approaches to cultivate future physicians proficient in both clinical acumen and patient-collaborative decision-making. The framework emphasizes real-world clinical experience, role-playing, case studies, and decision aids to deepen students' understanding of SDM. It advocates for the development of communication skills, ethical deliberation, and cultural competence, recognizing the multifaceted nature of patient care. The inclusion of patient narratives and evidence-based decision-making further enriches the curriculum, offering a holistic view of patient care. Additionally, the integration of digital tools within the SDM process acknowledges the evolving technological landscape in healthcare. The paper also addresses challenges in implementing this framework, such as curricular constraints and the need for educator training. It underscores the importance of continual evaluation and adaptation of these strategies to the dynamic field of medical education and practice. Overall, this comprehensive approach aims not only to enhance the quality of oncological care but also to prepare medical students for the complexities of modern medicine, where patient involvement in decision-making is both a necessity and an expectation.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Anna C Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
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Yoon S, Tan CM, Phang JK, Liu VX, Tan WB, Kwan YH, Low LL. Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study. JMIR Form Res 2024; 8:e51848. [PMID: 38573763 PMCID: PMC11027060 DOI: 10.2196/51848] [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: 08/14/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. OBJECTIVE This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. METHODS We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). CONCLUSIONS The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.
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Affiliation(s)
| | - Chao Min Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jie Kie Phang
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Venice Xi Liu
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Wee Boon Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | | | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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Muishout G, El Amraoui A, Wiegers GA, van Laarhoven HWM. Muslim Jurisprudence on Withdrawing Treatment from Incurable Patients: A Directed Content Analysis of the Papers of the Islamic Fiqh Council of the Muslim World League. JOURNAL OF RELIGION AND HEALTH 2024; 63:1230-1267. [PMID: 36446918 DOI: 10.1007/s10943-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them.
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Affiliation(s)
- George Muishout
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Gerard Albert Wiegers
- Department of History, European Studies and Religious Studies, Amsterdam School for Historical Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Wilma Marlies van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [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: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Schladitz K, Weitzel EC, Löbner M, Soltmann B, Jessen F, Pfennig A, Riedel-Heller SG, Gühne U. Experiencing (Shared) Decision Making: Results from a Qualitative Study of People with Mental Illness and Their Family Members. Healthcare (Basel) 2023; 11:2237. [PMID: 37628436 PMCID: PMC10454232 DOI: 10.3390/healthcare11162237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: There is a fundamental shift in healthcare toward shared decision making (SDM). This study explores SDM from the perspective of individuals affected by mental illness and their family members and investigates factors which promote and hinder the process. (2) Methods: We conducted N = 15 telephone interviews (n = 4 adults affected by mental illness, n = 5 family members, n = 6 both applicable, the majority reporting experiences with affective and anxiety disorders). Data were recorded, transcribed, and analyzed according to procedures established by Mayring. (3) Results: Individuals affected by mental illness and their family members have a strong desire to be involved in treatment decisions and to participate in finding a diagnosis. Often these stakeholders are denied the opportunity to participate; sometimes enabling behaviors impede participation. The stigmatization of mental illnesses is a major barrier. There are also structural barriers to SDM within the healthcare system. Peer support, self-help associations, and psychosocial counseling services are important to empowering individuals and promoting SDM. (4) Conclusions: SDM has the potential to improve the quality of mental healthcare. Barriers can be mitigated and new approaches for interventions in the psychiatric sector have been identified. This study has also shown the importance of understanding SDM as a process that should begin at the diagnostic phase.
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Affiliation(s)
- Katja Schladitz
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Elena C. Weitzel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Köln, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Medizinische Fakultät Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
| | - Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, Leipzig University, 04103 Leipzig, Germany; (E.C.W.); (M.L.); (S.G.R.-H.); (U.G.)
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Van Bostraeten P, Aertgeerts B, Bekkering G, Delvaux N, Haers A, Vanheeswyck M, Vandekendelaere A, Van der Auwera N, Dijckmans C, Ostyn E, Soontjens W, Matthysen W, Schenk N, Mertens L, Jaeken J, Agoritsas T, Vermandere M. Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care. BMC Med Inform Decis Mak 2023; 23:97. [PMID: 37217915 DOI: 10.1186/s12911-023-02186-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners' (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care. METHODS We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis. RESULTS Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source. CONCLUSIONS This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training. TRIAL REGISTRATION The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
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Affiliation(s)
- Pieter Van Bostraeten
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium.
| | - Bert Aertgeerts
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Geertruida Bekkering
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Nicolas Delvaux
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Anna Haers
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Matisse Vanheeswyck
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Alexander Vandekendelaere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Niels Van der Auwera
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Charlotte Dijckmans
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Elise Ostyn
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Willem Soontjens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Wout Matthysen
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Noémie Schenk
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Lien Mertens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Jasmien Jaeken
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Thomas Agoritsas
- Division General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mieke Vermandere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. PATIENT EDUCATION AND COUNSELING 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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Sellaiah V, Merlo F, Malacrida R, Albanese E, Fadda M. Physician-reported characteristics, representations, and ethical justifications of shared decision-making practices in the care of paediatric patients with prolonged disorders of consciousness. BMC Med Ethics 2023; 24:19. [PMID: 36882830 PMCID: PMC9993525 DOI: 10.1186/s12910-023-00896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to "share" meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians' experiences of SDM in the management of paediatric patients with prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians' SDM approaches, representations, and ethical justifications for engaging in SDM. METHODS We used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis. RESULTS We found that participants followed three main decision-making approaches: the "brakes" approach, characterized by maximized family's decisional freedom, though conditional to physician's judgment regarding the medical appropriateness of a treatment; the "orchestra director" approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the "sunbeams" approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians' virtues to guide the decision-making process. CONCLUSION Our results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient's autonomy as its only moral foundation.
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Affiliation(s)
- Vinurshia Sellaiah
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Federica Merlo
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland.,Sasso Corbaro Foundation, Bellinzona, Switzerland
| | | | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Marta Fadda
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland.
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Tallet A, Rey D, Casanova C, Lecourtois D, Bergeaud M, Bendiane MK, Mancini J. Physicians’ Opinion on Intraoperative Radiotherapy as a Therapeutic De-Escalation Option in Older Women with Early Breast Cancer. Curr Oncol 2023; 30:2812-2824. [PMID: 36975427 PMCID: PMC10047225 DOI: 10.3390/curroncol30030214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Background: Intraoperative radiotherapy (IORT) is a therapeutic de-escalation option in older women with low-risk early breast cancer (EBC). A qualitative study was implemented to describe EBC physicians’ points of view on IORT as a de-escalation option. Methods: Recorded face-to-face and telephone semi-structured interviews were conducted among diverse physicians from seven French comprehensive cancer centers. Interview transcripts were grouped as corpus to construct a typology. Thematic analysis was performed. Results: Positions toward IORT were contrasted between the 16 participating physicians. Five fully supported IORT as a de-escalation option, four were not in favor, and seven had a more reserved or neutral opinion. Points of divergence concerned treatment efficacy, treatment duration, side effects and sequelae, psychological impact, compliance with adjuvant endocrine therapy, logistical constraints, financial cost, and availability of other techniques of partial breast irradiation. Physicians in favor of IORT emphasized direct benefits for the patient, and those against pointed the lack of specific guidelines, risk of lost opportunity in older women with long life expectancy, and challenges of shared decision making. Conclusions: Despite national policies to preserve cancer patients’ quality of life and increase their participation in medical decision making, therapeutic de-escalation using IORT is not consensual among physicians. Further efforts are needed to promote patient-centered care.
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Affiliation(s)
- Agnès Tallet
- UNICANCER, Institut Paoli-Calmettes, Department of Radiation Oncology, 13009 Marseille, France
| | - Dominique Rey
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Clémence Casanova
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Delphine Lecourtois
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | | | - Marc-Karim Bendiane
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
| | - Julien Mancini
- Aix-Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Ligue 2019 Accredited Team, 13009 Marseille, France
- APHM, BIOSTIC, Hop Timone, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-34-87
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Sui W, Gong X, Qiao X, Zhang L, Cheng J, Dong J, Zhuang Y. Family members' perceptions of surrogate decision-making in the intensive care unit: A systematic review. Int J Nurs Stud 2023; 137:104391. [PMID: 36442321 DOI: 10.1016/j.ijnurstu.2022.104391] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND A better understanding of the perceptions of family members in making surrogate decisions for loved ones during intensive care is needed to inform the development of targeted supportive interventions. OBJECTIVE To examine and synthesize qualitative data on family members' perceptions of surrogate decision-making in the intensive care unit. DESIGN We conducted a systematic review and qualitative data synthesis. Eligible studies contained family members' quotes about surrogate decision-making experiences and perceptions in adult intensive care units, published in English or Chinese, in a peer-reviewed journal up to February 2022. Data sources included Embase, PubMed, ISI Web of Science, PsychINFO, CINAHL, Biomedical Literature Service System, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Journal. METHODS The searches yielded 5974 identified articles, of which 23 studies were included. At least two different reviewers independently assessed the study quality and extracted data into a Microsoft Excel spreadsheet. A thematic synthesis was performed by classifying all text units into one of the broad themes and subsequently analyzed to inductively develop the first-, second-, and third-order themes. Six family members with experience in intensive care unit surrogate decision-making contributed to the analysis. RESULTS The qualitative data synthesis resulted in five major themes. The following key new insights into family members' perceptions of surrogate decision-making in the intensive care unit were obtained: in individual systems, family members suffered from emotional distress and psychological stress; different cognitive styles emerged; some family members reshaped a new order of life in the disruption; in family systems, the family as a whole was closely connected with each other; and in medical systems families perceived asymmetry in relationships with clinicians, many factors influencing trust, the necessity for role-specific mediators and issues with operations and environments not being sufficiently humanized. CONCLUSION This qualitative synthesis showed that individuals' emotions and cognition underwent complex processes during surrogate decision-making. The family as a whole, with disparate functional states, also faced different processes and outcomes under the crisis situation. At a broader level, the decision-making process reflected society's perceptions of the medical system. Future studies should use these insights to further explore and optimize the many aspects of surrogate decision support measures for families of critically ill patients and include the measurement of outcomes after interventions at multiple layers of the individual, family, and medical systems. REGISTRATION NUMBER The protocol was prospectively published on International Prospective Register of Systematic Reviews (PROSPERO)-CRD42022316687. TWEETABLE ABSTRACT Families of critically ill patients undergo a complex interactional process within the individual, family, and medical systems during surrogate decision-making.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
| | - Xiaoyan Gong
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
| | - Xiaoting Qiao
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Lixin Zhang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Junning Cheng
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Jing Dong
- School of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yiyu Zhuang
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China.
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Cahill S, Richardson H. Shared Decision Making and Reducing the Use of Low-Value Occupational Therapy Interventions. Am J Occup Ther 2022; 76:23277. [PMID: 35648116 DOI: 10.5014/ajot.2022.050065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Shared decision making (SDM), or the process by which clients actively work with health care professionals to make informed decisions about health care options, is critical to value-based, client-centered care and representing client preferences as part of the occupational therapy process. With the enactment of the Patient Protection and Affordable Care Act and the continued focus on patient-centered care models and quality indicators, occupational therapy practitioners must be prepared to engage in SDM. In this Health Policy Perspectives article, we provide considerations about how occupational therapy practitioners may use Choosing Wisely® recommendations to engage clients in SDM and provide high-quality evidence-based care.
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Affiliation(s)
- Susan Cahill
- Susan Cahill, PhD, OTR, FAOTA, is Director of Evidence-Based Practice, American Occupational Therapy Association, North Bethesda, MD;
| | - Hillary Richardson
- Hillary Richardson, MOT, OTR/L, is Practice Manager, Knowledge Translation, Evidence-Based Practice, and Practice Improvement, American Occupational Therapy Association, North Bethesda, MD
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16
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Institutionalizing Reflexivity for Sustainability: Two Cases in Health Care. SUSTAINABILITY 2021. [DOI: 10.3390/su132111712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unsustainability in health care comprises diminishing returns and misalignment between the health care regime and the needs of the population. To deal with complex sustainability problems, niche solutions can be collaboratively designed and implemented through reflexive methods. For second-order sustainability, however, the institutionalization of the reflexive element itself is also needed. This paper aims to provide insight into the possibilities of embedding reflexivity into institutions to support second-order sustainability by reporting on two consecutive participatory research programs that sought to address unsustainability in terms of misalignment and diminishing returns. The first case study reflexively monitored the system’s innovation toward an integrated perinatal care system. Reflection within the project and implementation was supported successfully, but for stronger embedding and institutionalization, greater alignment of the reflexive practices with regime standards was needed. Building on these lessons, the second case study, which was part of the IMI-PARADIGM consortium, collaboratively built a structured tool to monitor and evaluate “the return on engagement” in medicine development. To institutionalize reflexivity, the creation of “reflexive standards” together with regime actors appears to be most promising. Broader and deeper institutionalization of reflexive standards can be attained by building enforcement structures for reflexive standards in the collaborative process as part of the reflexive methodologies for addressing complex sustainability problems.
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Moleman M, Regeer BJ, Schuitmaker-Warnaar TJ. Shared decision-making and the nuances of clinical work: Concepts, barriers and opportunities for a dynamic model. J Eval Clin Pract 2021; 27:926-934. [PMID: 33164316 PMCID: PMC8359199 DOI: 10.1111/jep.13507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is considered the "final stage" that completes the implementation of evidence-based medicine. Yet, it is also considered the most neglected stage. SDM shifts the epistemological authority of medical knowledge to one that deliberately includes patients' values and preferences. Although this redefines the work of the clinical encounter, it remains unclear what a shared decision is and how it is practiced. AIM The aim of this paper is to describe how healthcare professionals manoeuvre the nuances of decision-making that shape SDM. We identify barriers to SDM and collect strategies to help healthcare professionals think beyond existing solution pathways and overcome barriers to SDM. METHODS Semi-structured interviews were conducted with 68 healthcare professionals from psychiatry, internal medicine, intensive care medicine, obstetrics and orthopaedics and 15 patients. RESULTS This study found that healthcare professionals conceptualize SDM in different ways, which indicates a lack of consensus about its meaning. We identified five barriers that limit manoeuvring space for SDM and contest the feasibility of a uniform, normative SDM model. Three identified barriers: (a) "not all patients want new role," (b) "not all patients can adopt new role," and (c) "attitude," were linked to strategies focused on the knowledge, skills and attitudes of individual healthcare professionals. However, systemic barriers: (d) "prioritization of medical issues" and (e) "lack of time" render such individual-focused strategies insufficient. CONCLUSION There is a need for a more nuanced understanding of SDM as a "graded" framework that allows for flexibility in decision-making styles to accommodate patient's unique preferences and needs and to expand the manoeuvring space for decision-making. The strategies in this study show how our understanding of SDM as a process of multi-dyadic interactions that spatially exceed the consulting room offers new avenues to make SDM workable in contemporary medicine.
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Affiliation(s)
- Marjolein Moleman
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
| | - Barbara J Regeer
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
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Abstract
PURPOSE OF REVIEW The aim of this study was to briefly summarize the contribution of the PREDIMED (PREvención con DIeta MEDiterránea) trial on cardiovascular evidence and examine in depth its groundbreaking trajectory.PREDIMED was conducted during 2003-2010 and represented the largest primary prevention trial ever testing the effects of changes in a complete food pattern (namely, the Mediterranean diet) on cardiovascular disease (CVD). Major contributions relied on the relevant changes in the food pattern attained by the behavioural intervention and their robust effect in reducing hard clinical end-points. Given some potential concerns, which were appropriately addressed with supporting analyses, this review is timely and relevant. RECENT FINDINGS PREDIMED has continued contributing to the existing literature with extensive, robust and abundant new evidence on the benefits of the Mediterranean diet, particularly on cardiovascular health, including recent studies using high-throughput metabolomic techniques. After robustly addressing some controversies, the conclusions of the original trial remained unaltered. SUMMARY The Mediterranean diet represents an effective and robust nutritional strategy against CVD in high cardiovascular risk populations. Recent findings from the PREDIMED have identified a metabolic signature of the Mediterranean diet that can objectively determine dietary adherence and predict CVD risk. This metabolomic signature opens up a new era for nutritional epidemiology and personalized nutrition.
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Affiliation(s)
- César I Fernández-Lázaro
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra
- IdiSNA, Navarra Institute for Health Research, Pamplona
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra
- IdiSNA, Navarra Institute for Health Research, Pamplona
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra
- IdiSNA, Navarra Institute for Health Research, Pamplona
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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