Guidelines (short version) of the French Otorhinolaryngology – Head and Neck Surgery Society (SFORL) on patient pathway organization in ENT: The therapeutic decision-making process

Autoimmune and inflammatory disorders of the central nervous system can result in significant morbidity and mortality. Through the recognition of syndromes using diagnostic biomarkers, the clinician is now able to use immune suppressive therapies to improve outcomes. However, the therapeutic decision-making process is complex. The clinician has to balance the risk of disease, with the risk of treatment side effects. To achieve this balance, it is important to understand the natural history of disease, the risk of residual disability, the risk of relapse, and risk of a fatal outcome. It is also important to have some understanding of the pathological processes, as some of the entities have more reversible processes, whereas others have destructive processes. This review will assess the dynamic nature of this decision-making process, and compare some of the more severe diseases such as neuromyelitis optica, anti-N-methyl-D-aspartate receptor encephalitis and opsoclonus myoclonus ataxia syndrome, with disorders with more favourable outcomes such as Sydenham chorea and post-infectious cerebellar ataxia.

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Empowering Patients in the Therapeutic Decision-Making Process: A Glance Into Behçet's Syndrome

Frontiers in Medicine ◽

10.3389/fmed.2021.769870 ◽

2021 ◽

Vol 8 ◽

Author(s):

Diana Marinello ◽

Federica Di Cianni ◽

Alessandra Del Bianco ◽

Irene Mattioli ◽

Jurgen Sota ◽

...

Keyword(s):

Decision Making ◽

Psychological Status ◽

Care Process ◽

Decision Making Process ◽

Behçet’S Syndrome ◽

Therapeutic Decision ◽

Behçet's Syndrome ◽

Behcet’S Syndrome ◽

Therapeutic Decision Making ◽

Behcet's Syndrome

Behçet's syndrome (BS) represents a challenging condition, characterized by a variable spectrum of disease profile and associated with a significant limitation of the daily activities as well as a potential negative impact on relationships and psychological status. Considering also the complexity of the therapeutic management of BS, that often includes biological off-label treatments, the participation in the therapeutic decision-making process of the BS patients is essential to ensure the integration of the care process into the life of the patient. For this reason, the empowerment of BS patients represents a crucial need and the present work is aimed at fully exploring all the potential variables implicated in the BS patient empowerment, also highlighting major points to consider and concrete actions to be planned in the immediate future in order to implement a pragmatic facilitation of the patients' empowerment.

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Health emergencies and interoceptive sensibility modulate the perception of non-evidence-based drug use: Findings from the COVID-19 outbreak

PLoS ONE ◽

10.1371/journal.pone.0256806 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256806

Author(s):

Gerardo Salvato ◽

Daniela Ovadia ◽

Alessandro Messina ◽

Gabriella Bottini

Keyword(s):

Decision Making ◽

Individual Characteristics ◽

Decision Making Process ◽

Evidence Based ◽

Care Providers ◽

Therapeutic Decision ◽

Therapeutic Approaches ◽

Experimental Drugs ◽

Therapeutic Decisions ◽

Therapeutic Decision Making

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants’ interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.

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