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Koh H. Extending the purview of risk perception attitude (RPA) framework to understand health insurance-related information seeking as a long-term self-protective behavior. J Am Coll Health 2023; 71:496-506. [PMID: 35184698 DOI: 10.1080/07448481.2021.1895807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/21/2020] [Revised: 12/24/2020] [Accepted: 02/21/2021] [Indexed: 06/14/2023]
Abstract
Objective: The purpose of this study is to examine the roles of risk perceptions and efficacy beliefs play in predicting emerging adults' health insurance information seeking behavior based on the risk perception attitude (RPA) framework. In addition, the current study tests a role of worry to elucidate an underlying mechanism of their health insurance information seeking behavior. Participants: A total of 694 participants was recruited from a large public university in Southwest, USA. Methods: Participants completed an online survey questionnaire. Results: Efficacy beliefs influenced health insurance-related information seeking behavior. An intriguing finding is that there were significant differences in worry across the attitudinal groups posited in the RPA framework, which is consistent with findings in prior literature. Conclusions: Information about health insurance helps individuals make good decisions for their health in a long-term perspective, which is the primary interest of the RPA framework and the current study. The findings would provide resources for designing effective communication materials to help human beings improve their well-being and prepare for their well-ending. This communication effort would contribute to ensuring public health safety, reducing health disparities, and enhancing a society's well-being.
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Affiliation(s)
- Hyeseung Koh
- Austin Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, Austin, Texas, USA
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2
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Gibson BI. The portion of goods that falleth to me: Parental rights, children's rights, and medical decisions after COVID-19. Fam Court Rev 2022; 60:590-601. [PMID: 35937974 PMCID: PMC9347711 DOI: 10.1111/fcre.12657] [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] [Indexed: 06/15/2023]
Abstract
The advent and perpetuation of the COVID-19 pandemic has served to highlight issues in American law that have long gone unaddressed. Prominent among them are the issues involving parents, the government, and the medical decisions of children. This article examines the current state of American law involving parental rights, children's rights, and the government's role in medical decisions of children and proposes a uniform act as a solution to the discrepancy and unpredictability in this area of American law.
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Affiliation(s)
- B. Isaac Gibson
- University of Louisville Louis D. Brandeis School of LawLouisvilleKentuckyUSA
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3
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Strough J, Stone ER, Parker AM, Bruine de Bruin W. Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel. Med Decis Making 2022; 42:326-340. [PMID: 34961398 PMCID: PMC8923988 DOI: 10.1177/0272989x211067223] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender. METHODS Participants (N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends' approval of risky health care decisions, and their empathy. RESULTS We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions. LIMITATIONS Hypothetical scenarios may not adequately represent emotional processes in health care decision making. CONCLUSIONS Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making. HIGHLIGHTS People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients.Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments.Understanding the power of perceived social norms in shaping surrogates' decisions may help physicians to engage surrogates in shared decision making.Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.
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Affiliation(s)
- JoNell Strough
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Eric R Stone
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | | | - Wändi Bruine de Bruin
- Sol Price School of Public Policy, Dornsife Department of Psychology, Schaeffer Center for Health Policy and Economics, Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
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Schöngut-Grollmus N, Energici MA, Zuñiga N. COVID-19 and Dispositions of the Chilean Healthcare System: Sociomedical Networks in Care Decisions of Chronic Illnesses. Front Sociol 2021; 6:666758. [PMID: 34447806 PMCID: PMC8383208 DOI: 10.3389/fsoc.2021.666758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
This article is an empirical work on decision-making processes in the case of persons with chronic illnesses in the COVID19 pandemic context, regarding their medical care and self-care. Medical decisions are processes that guide the production of a health diagnosis or treatment, using the available information, where the patients' preferences are often incorporated. This article tackles the impact of the pandemic on chronically ill patients' medical decisions when the care system has been significantly altered by it. Considering that health decisions are importantly embedded in social and economic conditions, the pandemic affects a precarious care system and constrains individual possibilities. Chile has a weak support infrastructure for caregivers and a health care system that promotes private health and a low-quality public health system. Hence, the pandemic is an adverse context for chronically ill patients and it alters the conditions in which medical decisions are taken. We performed 10 interviews with chronically ill patients who took responsibility for their own health decisions: five patients diagnosed with common chronic diseases and five patients diagnosed with rare chronic diseases. After Reflexive Thematic Analysis, the results show that the Chilean health system is extremely precarious and that not many alternatives are or have been offered to chronically ill patients in the COVID19 context.
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Affiliation(s)
| | - María-Alejandra Energici
- Affect and Subjectivity Lab, Faculty of Psychology, Universidad Alberto Hurtado, Santiago, Chile
| | - Natalia Zuñiga
- Magíster en Psicología Social, Faculty of Psychology, Universidad Alberto Hurtado, Santiago, Chile
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5
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Rajna P. [Decisional collisions between evidence and experience based medicine in care of people with epilepsy]. Ideggyogy Sz 2020; 73:223-229. [PMID: 32750238 DOI: 10.18071/isz.73.0223] [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] [Indexed: 11/07/2022]
Abstract
Background - Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose - To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods - Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results - There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology - including genetic background -, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion - Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions.
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Affiliation(s)
- Péter Rajna
- Rosszullétek Elme- és Ideggyógyászati Szakrendelés, Budapest
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Abstract
According to many of its proponents, shared decision making ("SDM") is the right way to interpret the clinician-patient relationship because it respects patient autonomy in decision-making contexts. In particular, medical ethicists have claimed that SDM respects a patient's relational autonomy understood as a capacity that depends upon, and can only be sustained by, interpersonal relationships as well as broader health care and social conditions. This paper challenges that claim. By considering two primary approaches to relational autonomy, this paper argues that standard accounts of SDM actually undermine patient autonomy. It also provides an overview of the obligations generated by the principle of respect for relational autonomy that have not been captured in standard accounts of SDM and which are necessary to ensure consistency between clinical practice and respect for patient autonomy.
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Affiliation(s)
- Jonathan Lewis
- Institute of Ethics, Dublin City University, Dublin, Ireland
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7
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Abstract
Prior research found that "1-in-X" ratios led to higher and less accurate subjective probability than "N-in-X*N" ratios or other formats, even though they featured the same mathematical information. It is unclear, however, whether the effect transfers into health decisions, and the practical significance of the effect is undetermined. Based on previous findings and risk communication theories, we hypothesized that the 1-in-X effect would occur and transfer into relevant decisions. We also tested whether age, gender, and education differences would moderate the 1-in-X effect on decision making. We conducted 3 well-powered experiments ( n = 1912) using a sample from the general adult UK population to test our hypotheses, estimated the effect, and excluded a possible methodological explanation for such a transfer. In hypothetical scenarios, participants decided whether to travel to Kenya given the chance of contracting malaria (experiment 1) and whether to take recommended steroids given the side effects (experiments 2 and 3). Across the experiments, we replicated a small to medium 1-in-X effect on the perceived probability (Hedge's g = -0.36; 95% confidence interval [CI], -0.47 to -0.24; z = -6.18; P < 0.001) and found a small effect on subsequent decisions (odds ratio = 1.32; 95% CI, 1.10-1.59; z = 2.99; P = 0.003). The perceived probability fully mediated the effect of the ratio format on decision. Age, gender, and education did not moderate the 1-in-X effect on decision. We argue that a high prevalence of 1-in-X ratios in medical communication makes these small changes clinically relevant. Therefore, to communicate information accurately, 1-in-X ratios should not be used or at least used cautiously in medical communication.
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Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, Essex, UK
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, Essex, UK
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Su SH, Wu LM. [The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors]. Hu Li Za Zhi 2018; 65:32-42. [PMID: 29564855 DOI: 10.6224/jn.201804_65(2).06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. RESULTS Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p < .01), and whether the patient had signed a currently valid advance healthcare directive (Eta = .223, p = .002). Furthermore, a significantly negative correlation was found between these intentions and length of stay in the ICU (r = -.263, p < .01). Patient age, whether the patient had signed a currently valid advance healthcare directive, and length of stay in the ICU were all predictive factors for the behavioral intentions underlying the medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.
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Affiliation(s)
- Szu-Huei Su
- MSN, RN, Instructor, Department of Nursing, Chang Jung Christian University, Taiwan, ROC
| | - Li-Min Wu
- PhD, RN, Associate Professor, School of Nursing, College of Nursing, Kaohsiung Medical University, Taiwan, ROC.
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Roen K, Hegarty P. Shaping parents, shaping penises: How medical teams frame parents' decisions in response to hypospadias. Br J Health Psychol 2018; 23:967-981. [PMID: 30054962 DOI: 10.1111/bjhp.12333] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/23/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Psychological research provides insights into how parents approach medical decisions on behalf of children. The medical decision of concern here is the surgical alteration of a hypospadic penis, whose urethral opening does not appear at the tip. Hypospadias surgery is routinely carried out in infancy, despite criticism by international organizations concerned about children's rights. The focus of this study is on the framing of hypospadias surgery. OBJECTIVES The objective was to examine how health professionals frame hypospadias and hypospadias surgery in medical and non-medical ways. DESIGN This was a qualitative study designed to build on the experimental research of Streuli et al. who investigated how medical versus non-medical information affects decision-making about non-essential childhood genital surgery. METHODS Semi-structured interviews were undertaken with 32 health professionals. Theoretically informed thematic analysis was used to examine how health professionals talk about hypospadias surgery and about supporting parents to make treatment decisions. RESULTS The analysis suggests that medical professionals' engagement with parents underestimates the effect of framing in influencing parental decisions about hypospadias surgery. Some psychological specialists in this area are actively framing hypospadias in ways that enable some parents to choose a non-medical pathway. Psychologically informed ways of talking about a child's genital difference focus on psychological qualities, including affect, well-being, and unconditional positive regard. CONCLUSIONS The best interests of children with hypospadias may well be served when psychological pathways are highlighted, providing opportunities to support the flourishing of children whose genital appearance raises the question of medical intervention. Statement of Contribution What is already known on this subject? Framing significantly affects medical decision-making in ways that people typically fail to perceive. Parents frequently consent to non-essential hypospadias (penile) surgery for their sons, despite the risks and ethical concerns. What does this study add? Medical teams could do more to consider framing when counselling parents about their son's hypospadias. Psychological specialists can help parents to frame their son's penile difference in terms of well-being and love. The best interests of children with hypospadias may be served by highlighting psychological care pathways.
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Affiliation(s)
- Katrina Roen
- Department of Psychology, University of Oslo, Norway
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10
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Brown JL. Communication pitfalls of traditional history and physical write-up documentation. Adv Med Educ Pract 2016; 8:37-41. [PMID: 28096709 PMCID: PMC5207202 DOI: 10.2147/amep.s120525] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND An unofficial standardized "write-up" outline is commonly used for documenting history and physical examinations, giving oral presentations, and teaching clinical skills. Despite general acceptance, there is an apparent discrepancy between the way clinical encounters are conducted and how they are documented. METHODS Fifteen medical school websites were randomly selected from search-engine generated lists. One example of a history and physical write-up from each of six sites, one teaching outline from each of nine additional sites, and recommendations for documentation made in two commonly used textbooks were compared for similarities and differences. RESULTS Except for minor variations in documenting background information, all sampled materials utilized the same standardized format. When the examiners' early perceptions of the patients' degree of illness or level of distress were described, they were categorized as "general appearance" within the physical findings. Contrary to clinical practice, none of the examples or recommendations documented these early perceptions before chief concerns and history were presented. DISCUSSION An examiner's initial perceptions of a patient's affect, degree of illness, and level of distress can influence the content of the history, triage decisions, and prioritization of likely diagnoses. When chief concerns and history are shared without benefit of this information, erroneous assumptions and miscommunications can result. CONCLUSION This survey confirms common use of a standardized outline for documenting, communicating, and teaching history-taking and physical examination protocol. The present outline shares early observations out of clinical sequence and may provide inadequate context for accurate interpretation of chief concerns and history. Corrective actions include modifying the documentation sequence to conform to clinical practice and teaching contextual methodology for sharing patient information.
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Affiliation(s)
- Jeffrey L Brown
- Department of Pediatrics, New York Medical College
- Departments of Pediatrics and Psychiatry, Weill Cornell Medical College, NY, USA
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11
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Affiliation(s)
- Silvia Riva
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Milan, Italy
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12
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Bolcic-Jankovic D, Lu F, Colten ME, McCarthy EP. Using Cognitive Testing to Develop Items for Surveying Asian American Cancer Patients and Their Caregivers as a Pathway to Culturally Competent Care. J Empir Res Hum Res Ethics 2016; 11:57-66. [PMID: 27106891 DOI: 10.1177/1556264616638965] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the results from cognitive interviews with Asian American patients and their caregivers. We interviewed seven caregivers and six patients who were all bilingual Asian Americans. The main goal of the cognitive interviews was to test a survey instrument developed for a study about perspectives of Asian American patients with advanced cancer who are facing decisions around end-of-life care. We were particularly interested to see whether items commonly used in White and Black populations are culturally meaningful and equivalent in Asian populations, primarily those of Chinese and Vietnamese ethnicity. Our exploration shows that understanding respondents' language proficiency, degree of acculturation, and cultural context of receiving, processing, and communicating information about medical care can help design questions that are appropriate for Asian American patients and caregivers, and therefore can help researchers obtain quality data about the care Asian American cancer patients receive.
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Affiliation(s)
| | - Fengxin Lu
- Beth Israel Deaconess Medical Center, Boston, USA
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13
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Leppin AL, Humeniuk KM, Fernandez C, Montori VM, Yost K, Kumbamu A, Geller G, Tilburt JC. Was a decision made? An assessment of patient-clinician discordance in medical oncology encounters. Health Expect 2015; 18:3374-81. [PMID: 25619877 DOI: 10.1111/hex.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision making is promoted to improve cancer care quality. Patients and clinicians may have different ideas about what constitutes a cancer care decision, which may limit the validity of self-reported measures of shared decision making. We sought to estimate the extent to which patients and clinicians agree on whether a cancer care decision was made during an outpatient encounter. METHODS We surveyed patients and clinicians immediately after an oncology encounter at a large, tertiary medical centre and calculated agreement in response to the single-item question, 'Was a specific decision about cancer care made during the appointment today?' Answer options were 'yes' and 'no'. Participants were 315 oncology patients, with any solid tumour malignancy and at any stage of management, and their clinicians (22 staff oncologists, nine senior fellows and five nurse practitioners). RESULTS Patients and clinicians reported having made a cancer care decision in 184 (58%) and 174 (55%) of encounters, respectively. They agreed on whether a cancer care decision was made in 213 (68%) of encounters (chance-adjusted agreement was 0.34); in 56 of the 102 discordant encounters, the patient reported making a decision while the clinician did not. We found no significant correlates with discordance. CONCLUSIONS Patients and clinicians do not always agree on whether a cancer care decision was made. As such, measures that ask patients and/or clinicians to evaluate a decision-making process or outcome may be methodologically insufficient when they do not explicitly orient respondents towards the thing they are being asked to assess.
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Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Kathleen Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ashok Kumbamu
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA
| | - Gail Geller
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jon C Tilburt
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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