Shared Decision Making in High Risk Settings: Frail Patients' Perceptions of Preoperative Goal Clarification Consultation By Palliative Care Specialists

2021 ◽  
Vol 233 (5) ◽  
pp. S98-S99
Author(s):  
Tiffany P. Pellathy ◽  
Keri L. Rodriguez ◽  
Kristina L. Hruska ◽  
Kayla A. Kennedy ◽  
Daniel E. Hall
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
High Risk ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Frail Patients

High-risk surgery among older adults: Not-quite shared decision-making

Surgery ◽  
2021 ◽  
Author(s):  
Ana C. De Roo ◽  
Crystal Ann Vitous ◽  
Samantha J. Rivard ◽  
Michaela C. Bamdad ◽  
Sara M. Jafri ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
High Risk ◽  
Shared Decision Making ◽  
Shared Decision

Shared Decision-Making in Palliative Care: A Maternalistic Approach

2021 ◽  
Vol 11 (2) ◽  
pp. 211-220
Author(s):  
Laura Specker Sullivan ◽  
Mary Adler ◽  
Joshua Arenth ◽  
Shelly Ozark ◽  
Leigh Vaughan
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Shared Decision

SHARED DECISION MAKING IN ONCOLOGY AND PALLIATIVE CARE

2020 ◽  
Author(s):  
Paul A Glare
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Cognitive Biases ◽  
Treatment Options ◽  
Care Plan ◽  
Treatment Modalities ◽  
Shared Decision ◽  
Human Decision ◽  
Based Medicine

Background: Cancer raises many questions for people afflicted by it. Do I want to have genetic testing? Will I comply with screening recommendations? If I am diagnosed with it, where will I have treatment? What treatment modalities will I have? Will I go on a clinical trial? Am I willing to bankrupt my family in the process of pursuing treatment? Will I write an advance care plan? Will I accept hospice if I have run out of available treatment options? Most of these questions have more than one correct answer, and the evidence for the superiority of one option over another is either not available or does not allow differentiation. Often the best choice between two or more valid approaches depends on how individuals value their respective risks and benefits; “preference-based medicine” may be more important than “evidence-based medicine.” There are various models for eliciting preferences, but applying them can raise a number of challenges. Objectives: To present the concepts, the value, the strategies, the quandaries, and the potential pitfalls of Shared Decision Making in Oncology and Palliative Care. Method: Narrative review. Results: Some challenges to practicing preference-based medicine in oncology and palliative care include: some patients don’t want to participate in shared decision making (SDM); the whole situation needs to be addressed, not just part of it; but are some topics out of bounds? Cognitive biases apply as much in SDM as any other human decision making, affecting the choice; how numerically equivalent data are framed can also affect the outcome; conducting SDM is also important at the end of life. Conclusions: By being aware of the potential pitfalls with SDM, clinicians are more able to facilitate the discussion so that the patients’ choices truly reflect their informed preferences, at a time when stakes and emotions are high.

scholarly journals Predictors of ACP competency among Chaplains by Service Line

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 779-779
Author(s):  
Soyeon Cho ◽  
Jung Kwak ◽  
Brian Hughes ◽  
George Hands ◽  
Moon Lee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Positive Attitude ◽  
Online Survey ◽  
Special Care ◽  
Hierarchical Regression ◽  
Shared Decision ◽  
Team Members ◽  
Significant Difference

Abstract Healthcare chaplains have key roles in palliative care including facilitating advance care planning (ACP). However, little is known about chaplains’ competency in ACP. We conducted an online survey with board-certified healthcare chaplains recruited from three major professional chaplains’ organizations. We explored correlates of chaplains’ competency in ACP facilitation among two groups of chaplains, general and special care (SC) chaplains (chaplains in oncology, intensive care, or palliative units) because SC chaplains are generally more involved in palliative care. The final sample included 481 chaplains with 89.8% reporting ACP as an important part of their work and 71.3% reporting to help patients complete advance directives. There was no significant difference in ACP competency between general chaplain group (n=240; M=39.61, SD=7.0) and SC chaplain group (n=241; M=40.65, SD=5.87). Hierarchical regression analyses revealed differences between the groups. General chaplains who practiced longer as a chaplain (b=1.02, p<.000), were more engaged in ACP facilitation (b=1.06, p<.05), had more positive attitude toward ACP (b=4.04, p<.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p<.000) were more competent in ACP facilitation. In the SC chaplain group, higher competency was associated with more positive attitude towards ACP (b=2.58, p <.05), and a higher level of participation in shared decision-making (b=1.05, p <.000). Overall, these findings suggest that healthcare chaplains, both general and special care, are competent and actively involved in ACP facilitation. Further systematic studies are warranted to examine the effects of chaplains facilitating ACP on patient and healthcare system outcomes.

scholarly journals Core Outcome Measures for Palliative and End-of-Life Research After Severe Stroke: Mixed-Method Delphi Study

Stroke ◽  
2021 ◽  
Author(s):  
Bruce Mason ◽  
Kirsty Boyd ◽  
Fergus Doubal ◽  
Mark Barber ◽  
Marian Brady ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Outcome Measures ◽  
Service Users ◽  
Shared Decision ◽  
Potential Outcome ◽  
Stakeholder Workshop

Background and Purpose: Stroke is the second commonest cause of death worldwide and a leading cause of severe disability, yet there are no published trials of palliative care in stroke. To design and evaluate palliative care interventions for people with stroke, researchers need to know what measurable outcomes matter most to patients and families, stroke professionals, and other service providers. Methods: A multidisciplinary steering group of professionals and laypeople managed the study. We synthesized recommendations from respected United Kingdom and international consensus documents to generate a list of outcome domains and then performed a rapid scoping literature review to identify potential outcome measures for use in future trials of palliative care after stroke. We then completed a 3-round, online Delphi survey of professionals, and service users to build consensus about outcome domains and outcome measures. Finally, we held a stakeholder workshop to review and finalize this consensus. Results: We generated a list of 36 different outcome domains from 4 key policy documents. The rapid scoping review identified 43 potential outcome measures that were used to create a shortlist of 16 measures. The 36 outcome domains and 16 measures were presented to a Delphi panel of diverse healthcare professionals and lay service users. Of 48 panelists invited to take part, 28 completed all 3 rounds. Shared decision-making and quality of life were selected as the most important outcome domains for future trials of palliative care in stroke. Additional comments highlighted the need for outcomes to be feasible, measurable, and relevant beyond the initial, acute phase of stroke. The stakeholder workshop endorsed these results. Conclusions: Future trials of palliative care after stroke should include pragmatic outcome measures, applicable to the evolving patient and family experiences after stroke and be inclusive of shared decision-making and quality of life.

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