Patient contribution in the medical decision-making process

1991 ◽  
Vol 17 (2) ◽  
pp. 166
Author(s):  
J. Creplet
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process

Incorporating patient preferences and priorities into end-of-life care.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 41-41
Author(s):  
Eric Rackow ◽  
Afua Ofori ◽  
Wendy Rodkey ◽  
Roy A. Beveridge
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
End Of Life Care ◽  
Medical Decision Making ◽  
Case Managers ◽  
Readiness For Change ◽  
Medical Decision ◽  
Decision Making Process ◽  
Life Care

41 Background: Patients with advanced illness often face painful conversations and difficult decisions. A program was deployed to help patients identify, communicate, and incorporate their personal preferences and priorities into decisions about their care. The program was assessed by measuring movement along the readiness for change continuum. Methods: Patients residing in the home and participating in a chronic care program were referred by their case managers based on clinical conditions and whether the patient appeared to be in their last 12 months of life. Counseling sessions with patients or family caregiver/s were designed to move participants toward the following actions: be fully informed about their medical situation, describe their detailed quality of life priorities, articulate a self-defined medical decision making process, effectively communicate to their family and physicians, and implement and repeat the aforementioned steps. After 5 months (Sept-2014 to Feb-2015), movement along the readiness for change continuum (pre-contemplation, contemplation, preparation, action, maintenance, and advocacy) was reported. Results: Of the 427 patients referred, 33 could not be reached, 116 were ineligible, 50 declined or did not engage. Of the 228 participants, 191 (84%) moved at least one step in readiness for change continuum over the 5-month period. In Nov-2014, 13% of participants were in action, maintenance, or advocacy, which increased to 19% by Feb-2015. The largest observed movement to action, maintenance, or advocacy was in defining quality of life priorities: 2% Nov-2014 to 21% Feb-2015. The least movement to action, maintenance, or advocacy was observed in articulating a self-defined medical decision making process: 3% Nov-2014 to 16% Feb-2015. Case managers reported discomfort in referring members based on their assessment of length of life. Early surveys show high levels of satisfaction. Conclusions: A very high percentage of patients progressed in incorporating their preferences and priorities into end of life care as measured by the readiness to change continuum. This program is currently expanding and the referral process is changing from case manager to algorithm based identification referrals.

scholarly journals Application of a computerized medical decision-making process to the problem of digoxin intoxication

1984 ◽  
Vol 4 (3) ◽  
pp. 571-576 ◽  
Author(s):  
Keith S. White ◽  
Alan Lindsay ◽  
T. Allan Pryor ◽  
Wayne F. Brown ◽  
Kevin Walsh
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Digoxin Intoxication

scholarly journals The role of non-medical factors in physicians’ decision-making process in a pediatric telemedicine service

2019 ◽  
Vol 26 (2) ◽  
pp. 1152-1176 ◽  
Author(s):  
Motti Haimi ◽  
Shuli Brammli-Greenberg ◽  
Yehezkel Waisman ◽  
Nili Stein ◽  
Orna Baron-Epel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Medical Decisions ◽  
Telemedicine Service ◽  
Medical Factors ◽  
Complex Process ◽  
Clinical Scenarios

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.

Education for the Next Frontier in Patient Safety: A Longitudinal Resident Curriculum on Diagnostic Error

2016 ◽  
Vol 32 (6) ◽  
pp. 625-631 ◽  
Author(s):  
Emily Ruedinger ◽  
Maren Olson ◽  
Justin Yee ◽  
Emily Borman-Shoap ◽  
Andrew P. J. Olson
Keyword(s):  
Decision Making ◽  
Medical Education ◽  
Medical Decision Making ◽  
Diagnostic Error ◽  
Medical Decision ◽  
Decision Making Process ◽  
Education Programs ◽  
Cognitive Error ◽  
Error Mitigation ◽  
Second Victim

Diagnostic error is a common, serious problem that has received increased attention recently for its impact on both patients and providers. Presently, most graduate medical education programs do not formally address this topic. The authors developed and evaluated a longitudinal, multimodule resident curriculum about diagnostic error and medical decision making. Key components of the curriculum include demystifying the medical decision-making process, building skills in critical thinking, and providing strategies for diagnostic error mitigation. Special attention was paid to avoiding the second victim effect and to fostering a culture that supports constructive, productive feedback when an error does occur. The curriculum was rated by residents as helpful (96%), and residents were more likely to be aware of strategies to reduce cognitive error (27% pre vs 75% post, P < .0001) following its implementation. This article describes the development, implementation, and effectiveness of this curriculum and explores generalizability of the curriculum to other programs.

Adolescent Involvement in the Medical Decision Making Process

1999 ◽  
Vol 30 (4) ◽  
pp. 3-9 ◽  
Author(s):  
Lisa Harrison ◽  
Brandon Hunt
Keyword(s):  
Decision Making ◽  
Healthcare Professional ◽  
Medical Decision Making ◽  
Ethical Dilemmas ◽  
Medical Decision ◽  
Rehabilitation Counselors ◽  
Decision Making Process ◽  
Reasoning Ability ◽  
Rehabilitation Counselor ◽  
Consent To Medical Treatment

Many adolescents reach full cognitive development by age 15. Age 18, however, has been designated the age when adolescents may give consent to medical treatment. When the reasoning ability of the adolescent has reached maturation, but the law does not afford the adolescent the ability to utilize his or her reasoning ability, conflicts may arise. Parents may wish one set of treatments for their child and the child may wish for a different type of treatment. When the adolescent is the client of a rehabilitation counselor or healthcare professional, ethical dilemmas may also arise. Supporting the adolescent will support his or her autonomy, however, it may concurrently stifle beneficence or nonmaleficence. This paper addresses issues relevant when dealing with adolescents and informed medical consent. These issues include legal, ethical, and familial implications. Guidelines to assist rehabilitation counselors are also offered.

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