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Skjevik EP, Schei E, Boudreau JD, Tjølsen A, Ringberg U, Fuks A, Kvernenes M, Ofstad EH. What makes mentors thrive? An exploratory study of their satisfaction in undergraduate medical education. BMC Med Educ 2024; 24:372. [PMID: 38575953 PMCID: PMC10996132 DOI: 10.1186/s12909-024-05344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/23/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Mentoring medical students with varied backgrounds and individual needs can be challenging. Mentors' satisfaction is likely to be important for the quality and sustainability of mentorships, especially in programs where the mentor has responsibility for facilitating a group of mentees. However, little is known about what influences mentors' satisfaction. The aim of this study was to measure mentors' self-reported satisfaction with the mentoring experience and to explore associations between satisfaction and its putative factors. METHODS An online survey was sent out to all physician mentors in each of the three mentorship programs (UiT The Arctic University of Norway, the University of Bergen, and McGill University, graduation years 2013-2020, n = 461). Data were analyzed by descriptive statistics, dimension reduction, and linear regression. RESULTS On a scale from 1 to 5, mean mentor satisfaction score at two Norwegian and one Canadian medical school was 4.55 (95% CI 4.47, 4.64). In a multilevel multivariate regression analysis, two predictors were significantly associated with mentors' satisfaction: (1) the perception that students found the group meetings valuable (β = 0.186, 95% CI 0.021, 0.351, p = 0.027) and (2) mentors' perceived rewards (β = 0.330, 95% CI 0.224, 0.437, p < 0.001). Perceived rewards included experiencing gratifying relationships with students, and mentors' perception of self-development. CONCLUSIONS In this study, mentors appeared to be highly satisfied with their mentoring functions. Our findings suggest that mentors' overall satisfaction is closely linked to their experiences of fulfilling mentor-student relationships and personal and professional development. Interestingly, and perhaps contrary to commonly held assumptions, we found no association between mentor satisfaction and financial compensation. Furthermore, satisfaction was not associated with the provision of pre-assigned topics for discussions for mentor group meetings. We propose that the mentors' experienced psycho-social rewards, and their competence in establishing well-functioning group dynamics, should be areas of focus for faculty development.
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Affiliation(s)
- Elise Pauline Skjevik
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, 9037, Norway.
| | - Edvin Schei
- Department of Global Public Health and Primary Care, Faculty of Medicine, The University of Bergen, Bergen, Norway
| | - J Donald Boudreau
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- University of Notre Dame, Sydney, Australia
| | - Arne Tjølsen
- Department of Biomedicine and Center for Medical Education, Faculty of Medicine, The University of Bergen, Bergen, Norway
| | - Unni Ringberg
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, 9037, Norway
| | - Abraham Fuks
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Monika Kvernenes
- Department of Clinical Medicine, Center for Medical Education, Faculty of Medicine, The University of Bergen, Bergen, Norway
| | - Eirik H Ofstad
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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Valestrand EA, Hokstad LM, Schei E, Ofstad EH, Stenfors T, Kvernenes M. The liminal landscape of mentoring-Stories of physicians becoming mentors. Med Educ 2023; 57:1020-1027. [PMID: 37183266 DOI: 10.1111/medu.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/28/2023] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION This study explores narratives of physicians negotiating liminality while becoming and being mentors for medical students. Liminality is the unstable phase of a learning trajectory in which one leaves behind one understanding but has yet to reach a new insight or position. METHODS In this study, we analysed semi-structural interviews of 22 physician mentors from group-based mentoring programmes at two Norwegian and one Canadian medical school. In a dialogical narrative analysis, we applied liminality as a sensitising lens, focusing on informants' stories of becoming a mentor. RESULTS Liminality is an unavoidable aspect of developing as a mentor. Which strategies mentors resort to when facing liminality are influenced by their narrative coherence. Some mentors thrive in liminality, enjoying the possibility of learning and developing as mentors. Others deem mentoring and the medical humanities peripheral to medicine and thus struggle with integrating mentor and physician identities. They may contradict themselves as they shift between their multiple identities, resulting in rejection of the learning potentials that liminality affords. CONCLUSION Mentors with integrated physician and mentor identities can embrace liminality and develop as mentors. Those mentors with contradicting dialogues between their identities may avoid liminality if it challenges their understanding of who they are and make them experience discomfort, confusion and insufficiency while becoming a mentor. Support of the mentoring role from the clinical culture may help these physicians develop internal dialogues that reconcile their clinician and mentor identities.
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Affiliation(s)
- Eivind A Valestrand
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Leif Martin Hokstad
- Educational Development Unit, Department of Education and Lifelong Learning, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Medical Simulation Centre, St. Olav University Hospital, Trondheim, Norway
| | - Edvin Schei
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik H Ofstad
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- The Medical Clinic, Nordland Hospital, Bodø, Norway
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics (LIME), Division for learning, Karolinska Institutet, Solna, Sweden
| | - Monika Kvernenes
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
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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 Educ Couns 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Skjeflo EW, Nymo SH, Djupen SM, Hammervold R, Ofstad EH. En tenåringsjente med stort tablettinntak i suicidal hensikt. Tidsskriftet 2022; 142:21-0620. [DOI: 10.4045/tidsskr.21.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Skjevik EP, Boudreau JD, Ringberg U, Schei E, Stenfors T, Kvernenes M, Ofstad EH. Group mentorship for undergraduate medical students-a systematic review. Perspect Med Educ 2020; 9:272-280. [PMID: 32820416 PMCID: PMC7550430 DOI: 10.1007/s40037-020-00610-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Mentoring has become a prevalent educational strategy in medical education, with various aims. Published reviews of mentoring report very little on group-based mentorship programs. The aim of this systematic review was to identify group-based mentorship programs for undergraduate medical students and describe their aims, structures, contents and program evaluations. Based on the findings of this review, the authors provide recommendations for the organization and assessment of such programs. METHODS A systematic review was conducted, according to PRISMA guidelines, and using the databases Ovid MEDLINE, EMBASE, PsycINFO and ERIC up to July 2019. Eight hundred abstracts were retrieved and 20 studies included. Quality assessment of the quantitative studies was done using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS The 20 included studies describe 17 different group mentorship programs for undergraduate medical students in seven countries. The programs were differently structured and used a variety of methods to achieve aims related to professional development and evaluation approaches. Most of the studies used a single-group cross-sectional design conducted at a single institution. Despite the modest quality, the evaluation data are remarkably supportive of mentoring medical students in groups. DISCUSSION Group mentoring holds great potential for undergraduate medical education. However, the scientific literature on this genre is sparse. The findings indicate that group mentorship programs benefit from being longitudinal and mandatory. Ideally, they should provide opportunities throughout undergraduate medical education for regular meetings where discussions and personal reflection occur in a supportive environment.
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Affiliation(s)
| | - J Donald Boudreau
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Edvin Schei
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Monika Kvernenes
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik H Ofstad
- Institute of Social Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Han PKJ, Babrow A, Hillen MA, Gulbrandsen P, Smets EM, Ofstad EH. Uncertainty in health care: Towards a more systematic program of research. Patient Educ Couns 2019; 102:1756-1766. [PMID: 31227333 DOI: 10.1016/j.pec.2019.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To promote a more systematic approach to research on uncertainty in health care, and to explore promising starting points and future directions for this research. METHODS We examine three fundamental aspects of medical uncertainty that a systematic research program should ideally address: its nature, effects, and communication. We summarize key insights from past empirical research and explore existing conceptual models that can help guide future research. RESULTS A diverse body of past research on medical uncertainty has produced valuable empirical insights and conceptual models that provide useful starting points for future empirical and theoretical work. However, these insights need to be more fully developed and integrated to answer remaining questions about what uncertainty is, how it affects people, and how and why it should be communicated. CONCLUSION Uncertainty in health care is an extremely important but incompletely understood phenomenon. Improving our understanding of the many important aspects of uncertainty in health care will require a more systematic program of research based upon shared, integrative conceptual models and active, collaborative engagement of the broader research community. PRACTICE IMPLICATIONS A more systematic approach to investigating uncertainty in health care can help elucidate how the clinical communication of uncertainty might be improved.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, USA; Tufts University School of Medicine, Boston, USA.
| | - Austin Babrow
- School of Communication Studies, Ohio University, Athens, USA
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Center, Akershus University Hospital, Lørenskog, Norway
| | - Ellen M Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Bodø, Norway; Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Geessink NH, Ofstad EH, Olde Rikkert MGM, van Goor H, Kasper J, Schoon Y. Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients' and observers' perceptions. Patient Educ Couns 2018; 101:1767-1774. [PMID: 29933924 DOI: 10.1016/j.pec.2018.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify determinants of older patients' perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions. METHODS Patients' perceptions of involvement were constructed by the 9-item SDM questionnaire (SDM-Q-9) and a Visual Analogue Scale for Involvement (VAS-I). Observers' perceptions were constructed by the OPTION5, OPTION12, and MAPPIN'SDM. Convergent validities were calculated between the patient-sided and observer instruments using Spearman's correlation coefficient. Linear regression was used to identify determinants per criterion. RESULTS 58 CRC and 22 PC patients were included (mean age: 71.8 ± 5.2 years, 45.0% female). No significant correlations were found between the patient-sided and observer instruments. Patients' impression of involvement was influenced by patient characteristics such as quality of life and satisfaction, while observers' perceptions mainly referred to encounter characteristics such as the mean duration of consultations and general communication skills. CONCLUSION Due to evident differences in determinants, older CRC/PC patients' and observers' perceptions of involvement should both be collected in evaluating the quality of medical decision-making. PRACTICE IMPLICATIONS General communication skills should be integrated in SDM training interventions. New SDM measurement tools for patients are needed to sufficiently discriminate between the constructs of involvement and satisfaction.
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Affiliation(s)
- Noralie H Geessink
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Eirik H Ofstad
- Department of Internal Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, Nijmegen, the Netherlands
| | - Jürgen Kasper
- Faculty of Health Sciences, Department Health and Caring Sciences, The Arctic University of Norway, Tromsø, Norway; Medical Clinics, University Medical Center, Tromsø, Norway
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.
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Gulbrandsen P, Clayman ML, Beach MC, Han PK, Boss EF, Ofstad EH, Elwyn G. Shared decision-making as an existential journey: Aiming for restored autonomous capacity. Patient Educ Couns 2016; 99:1505-1510. [PMID: 27460801 DOI: 10.1016/j.pec.2016.07.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We describe the different ways in which illness represents an existential problem, and its implications for shared decision-making. METHODS We explore core concepts of shared decision-making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust, responsibility) to interpret and explain existing results and propose a broader understanding of shared-decision making for future studies. RESULTS Existential aspects of being are physical, social, psychological, and spiritual. Uncertainty and vulnerability caused by illness expose these aspects and may lead to dependency on the provider, which underscores that autonomy is not just an individual status, but also a varying capacity, relational of nature. In shared decision-making, power and trust are important factors that may increase as well as decrease the patient's dependency, particularly as information overload may increase uncertainty. CONCLUSION The fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue shared decision-making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. Hence, we propose that the aim of shared decision-making should be restoration of the patient's autonomous capacity. PRACTICE IMPLICATIONS In doing shared decision-making, care is needed to encompass existential aspects; informing and exploring preferences is not enough.
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Affiliation(s)
- Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Marla L Clayman
- American Institutes for Research, 10 S Riverside Plaza, Suite 600, Chicago, IL, USA
| | | | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eirik H Ofstad
- Department of Internal Medicine, Nordland Hospital, Bodø, Norway
| | - Glyn Elwyn
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
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Abstract
OBJECTIVE The medical literature lacks a comprehensive taxonomy of decisions made by physicians in medical encounters. Such a taxonomy might be useful in understanding the physician-centred, patient-centred and shared decision-making in clinical settings. We aimed to identify and classify all decisions emerging in conversations between patients and physicians. DESIGN Qualitative study of video recorded patient-physician encounters. PARTICIPANTS AND SETTING 380 patients in consultations with 59 physicians from 17 clinical specialties and three different settings (emergency room, ward round, outpatient clinic) in a Norwegian teaching hospital. A randomised sample of 30 encounters from internal medicine was used to identify and classify decisions, a maximum variation sample of 20 encounters was used for reliability assessments, and the remaining encounters were analysed to test for applicability across specialties. RESULTS On the basis of physician statements in our material, we developed a taxonomy of clinical decisions--the Decision Identification and Classification Taxonomy for Use in Medicine (DICTUM). We categorised decisions into 10 mutually exclusive categories: gathering additional information, evaluating test results, defining problem, drug-related, therapeutic procedure-related, legal and insurance-related, contact-related, advice and precaution, treatment goal, and deferment. Four-coder inter-rater reliability using Krippendorff's α was 0.79. CONCLUSIONS DICTUM represents a precise, detailed and comprehensive taxonomy of medical decisions communicated within patient-physician encounters. Compared to previous normative frameworks, the taxonomy is descriptive, substantially broader and offers new categories to the variety of clinical decisions. The taxonomy could prove helpful in studies on the quality of medical work, use of time and resources, and understanding of why, when and how patients are or are not involved in decisions.
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Affiliation(s)
- Eirik H Ofstad
- The Research Centre, Akershus University Hospital, Lorenskog, Norway
| | - Jan C Frich
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Edvin Schei
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Richard M Frankel
- Indiana University School of Medicine, VA HSR&D Center of Excellence, Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lorenskog, Norway
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Ofstad EH, Frich JC, Schei E, Frankel RM, Gulbrandsen P. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study. Patient Educ Couns 2014; 97:216-22. [PMID: 25176608 DOI: 10.1016/j.pec.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/24/2014] [Accepted: 08/04/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. METHODS Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. RESULTS Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. CONCLUSION Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. PRACTICE IMPLICATIONS In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them.
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Affiliation(s)
- Eirik H Ofstad
- The Research Center, Akershus University Hospital, Lorenskog, Norway.
| | - Jan C Frich
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Edvin Schei
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Richard M Frankel
- Indiana University School of Medicine, VA HSR&D Center of Excellence, Roudebush VA Medical Center, Indianapolis, USA
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lorenskog, Norway; The Research Center, Akershus University Hospital, Lorenskog, Norway
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