The Decision-Making Process of Selection in the Clinical Pathway for COVID-19: The Recommendations for Older Patients

2020 ◽  
pp. 89-101
Author(s):  
Andrea Fabbo ◽  
Marilena De Guglielmo ◽  
Andrea Spanò
Keyword(s):  
Decision Making ◽  
Clinical Pathway ◽  
Older Patients ◽  
Decision Making Process

scholarly journals Management of Multiple Myeloma in Older Patients

2021 ◽  
pp. 69-81
Author(s):  
Jian Li ◽  
Henry Chan
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Literature Review ◽  
Treatment Efficacy ◽  
Older Patients ◽  
Recent Literature ◽  
Decision Making Process ◽  
Frailty Assessment ◽  
Disease Biology ◽  
Optimal Regimen

Multiple myeloma is a condition that affects predominantly the older population. There are now various approved chemotherapy regimens as a result of advances in treatment. Choosing the optimal regimen for older patients with myeloma remains a challenge because of frailty and a lack of head-to-head comparisons between backbone regimens. The purpose of this literature review is to summarise the recent literature on frailty assessment, disease biology, and treatment efficacy in the frontline and relapsed settings to aid the decision-making process.

scholarly journals Considerations and values in decision making regarding mechanical ventilation for older patients with severe to very severe COPD

2016 ◽  
Vol 11 (4) ◽  
pp. 140-148 ◽  
Author(s):  
Heidi Jerpseth ◽  
Vegard Dahl ◽  
Per Nortvedt ◽  
Kristin Halvorsen
Keyword(s):  
Decision Making ◽  
Mechanical Ventilation ◽  
Older Patients ◽  
Chronic Obstructive ◽  
Decision Making Process ◽  
Biomedical Data ◽  
Next Of Kin ◽  
Theoretical Understanding ◽  
District Hospitals ◽  
Severe Copd

Background The different considerations involved in decisions regarding whether or not to initiate mechanical ventilation for patients with severe chronic obstructive pulmonary disease (COPD) are challenging for health professionals. Aim To investigate the considerations and values that influences decision-making regarding mechanical ventilation in older patients (≥65-years-old) with severe to very severe COPD. Furthermore, it aims to elucidate how physicians involve their patient in decision-making process. Participants and setting Seven intensive care physicians and seven physicians working in the respiratory units at two university hospitals and two district hospitals in Norway. Methods This study had a qualitative design consisting of focus group interviews with 14 physicians. The data was analysed according to the interpretative contexts: self-understanding, critical common-sense understanding and theoretical understanding. Results Decisions regarding mechanical ventilation were mainly based on the physicians' own experiences, their perceptions of the patients' situation, and biomedical data. The patients were not involved in the decision-making and such decisions were only occasionally made in a multi-professional context. Conclusion To decide whether older patients with severe COPD should be treated with mechanical ventilation is both medically and ethically challenging for physicians. Decision making in this context seems to be mainly driven by a paternalistic attitude, since the physicians interviewed in our study, in general, make such decisions without involving either the patient, their next of kin or the nurses. There is a need for broader cooperation between health professional and for the involvement of patients in the decision-making process regarding mechanical ventilation in cases of late stage COPD.

scholarly journals Decision-Making Experience of Older Patients with Cancer in Choosing Treatment: A Qualitative Meta-Synthesis Study

2021 ◽  
Vol 23 (4) ◽  
pp. 418-430
Author(s):  
Eun Young Kim ◽  
Se Jin Hong
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Information Service ◽  
Treatment Decision ◽  
Science Research ◽  
Qualitative Studies ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
Patients With Cancer ◽  
Gains And Losses

Purpose: This study was conducted to analyze and synthesize the findings of qualitative studies related to the decision-making experience of older patients with cancer in choosing treatment.Methods: We used the seven steps of Noblit and Hare’s meta-ethnography to analyze and synthesize selected qualitative studies. Seven databases were used to search the literature that explored the decision-making experiences of older patients with cancer in choosing treatment: PubMed, CINAHL, Embase, Web of Science, Research Informations Sharing Service (RISS), Koreastudies Information Service System (KISS), and National Assembly Library.Results: The final 11 studies were included in the analysis. Three themes emerged as result of synthesizing: “Checking the feasibility of treatment in one’s own life”, “The constant weighing up the gains and losses of treatment”, and “Having meanings to life”.Conclusion: This study provides an in-depth understanding of treatment decision-making experiences of older patients with cancer and highlights the complex factors that influence their treatment decision-making process. This may contribute to the development of interventions that help older patients with cancer choose treatment during the decision-making process.

scholarly journals Reversals in Decisions About Life-Sustaining Treatment Among Terminally Ill Older Korean Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 246-246
Author(s):  
Suhyun Kim ◽  
Jung-Ja Choi
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Heart Diseases ◽  
Multivariate Logistic Regression Analysis ◽  
Tertiary Hospital ◽  
Decision Making Process ◽  
Code Status ◽  
Cardiopulmonary Disease ◽  
Terminal Stage ◽  
Life Sustaining Treatment

Abstract Purpose: The purpose of this study was to investigate the patterns and factors of reversals in decisions about life –sustaining treatment (LST) among older patients with terminal stage of chronic cardiopulmonary diseases. Methods: In a retrospective correlational descriptive study, data were collected using medical chart review from 124 deceased older patients with terminal stage of cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. Results: Primary decision makers were offspring (72.6%), spouse (13.7%), acquaintance (8.9%), and patients (4.8%), in order. While 31.5% of the reversed decisions were made toward higher intensity of LST, 21.9% were made toward lower intensity of LST, and 46.6% were made for each treatment without change of overall code status. The use of inotropic was the most frequently reversed LST treatment (47.5%), followed by CPR (30.6%), intubation (27.4%), ventilator therapy (24.2%), and hemodialysis (17.8%). Patients who had lung diseases (vs. heart diseases), were single, divorced or bereaved (vs. married), and had acquaintance as a primary decision maker (vs. patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. Conclusion: This study demonstrate the complex and turmoil situation of the LST decision making process among older patients with terminal stage of cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision making process.

AAC Decision-Making and Mobile Technology: Points to Ponder

2014 ◽  
Vol 23 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Mary Ann Abbott ◽  
Debby McBride
Keyword(s):  
Decision Making ◽  
Mobile Technology ◽  
Communication System ◽  
Augmentative And Alternative Communication ◽  
Evaluation Process ◽  
Decision Making Process ◽  
Alternative Communication ◽  
Ipod Touch ◽  
Feature Match

The purpose of this article is to outline a decision-making process and highlight which portions of the augmentative and alternative communication (AAC) evaluation process deserve special attention when deciding which features are required for a communication system in order to provide optimal benefit for the user. The clinician then will be able to use a feature-match approach as part of the decision-making process to determine whether mobile technology or a dedicated device is the best choice for communication. The term mobile technology will be used to describe off-the-shelf, commercially available, tablet-style devices like an iPhone®, iPod Touch®, iPad®, and Android® or Windows® tablet.

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