The Obligation of Listening: Caring for Patients With Chronic Dysphagia Through Illness Narratives

2020 ◽  
Vol 5 (1) ◽  
pp. 231-235
Author(s):  
Jinxu Bridget Xia
Keyword(s):  
Decision Making ◽  
Chronic Conditions ◽  
Chronic Care ◽  
The United States ◽  
Illness Narratives ◽  
Narrative Approach ◽  
Psychosocial Needs ◽  
Patient Centered ◽  
Treatment Plans ◽  
Provision Of Care

Purpose Chronic conditions affect the lives of thousands of people in the United States. Dysphagia is a symptom that co-occurs with many chronic conditions. This presents unique challenges to speech-language pathologists (SLPs) who work with patients that are physically and psychosocially burdened by chronic dysphagia. Clinical decisions in chronic care are characterized by context-dependent complexities. There is a theoretical framework in bioethics called narrative ethics , which suggests that engaging with patients' illness narratives informs patient-centered decision making and that exploring contexts is essential to provision of care. Conclusion Using a narrative approach in decision making in chronic dysphagia helps contextualize the symptoms and supports clinicians to form individualized treatment plans that better suit patients' health care and psychosocial needs.

scholarly journals Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making (Preprint)

2019 ◽  
Author(s):  
Thomas H Wieringa ◽  
Manuel F Sanchez-Herrera ◽  
Nataly R Espinoza ◽  
Viet-Thi Tran ◽  
Kasey Boehmer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decision Aids ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Patient Centered ◽  
Patient Goals ◽  
Minimally Disruptive Medicine ◽  
Workload Capacity

UNSTRUCTURED About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

2020 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Implementation of a Shared Decision-Making Tool for Osteoarthritis Treatment to Reduce Decisional Conflict

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 186-186
Author(s):  
Yashika Watkins ◽  
Rose Gonzalez ◽  
Charla Johnson ◽  
Ravneet Kaur
Keyword(s):  
Physical Activity ◽  
Decision Making ◽  
Shared Decision Making ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Shared Decision ◽  
Patient Centered ◽  
Chronic Knee Pain ◽  
Co Morbidity

Abstract Shared decision making is a key component of patient centered care where clinical evidence and the patient’s preference and values are considered. Physical activity and weight loss are often recommendations in the treatment plan, especially in mild to moderate stage of osteoarthritis (OA). Movement is Life (MIL) created an innovative SDM tool to provide a framework for patient-centered discussions. The tool leverages an underlying Markov Model and represents the likely pain, activity levels, and lost productivity at three future time points. By comparing the patient’s likely progression depending on treatment choices compared to doing nothing, the patient has an illustration of future state. A pilot of N=108 women, ages 45-64, with chronic knee pain for at least three months and at least one co-morbidity (obesity, hypertension, diabetes) were randomized to a control (n=54) or intervention (n=54) arm of the study at eight centers across the United States. Results showed the demographic profiles were similar between the groups. At one-month, n=47 control and n=50 intervention patients returned for evaluation. Self-reported level of physical activity increased in the intervention group (56% vs 34%, p = 0.0229). Qualitative feedback from the intervention group indicated high satisfaction with use of the tool. Both groups reported a high likeliness to recommend the provider to a friend or family member. Inclusion of the SDM tool added an average of one minute to the patient counseling time over the control group. The quasi script provides a consistent communication pathway and may reduce disparities by addressing unconscious bias.

scholarly journals Analyzing dialogue moves in chronic care communication

2020 ◽  
Vol 9 (2) ◽  
pp. 167-198
Author(s):  
Fabrizio Macagno ◽  
Sarah Bigi
Keyword(s):  
Decision Making ◽  
Diabetes Care ◽  
Chronic Care ◽  
Common Ground ◽  
Personal Information ◽  
Effective Communication ◽  
Statistical Analyses ◽  
Patient Centered ◽  
Medical Interviews ◽  
General Goal

Abstract Dialogue moves are a pragmatic instrument that captures the most important categories of “dialogical intentions.” This paper adapts this tool to the conversational setting of chronic care communication, characterized by the general goal of making reasoned decisions concerning patients’ conditions, shared by the latter. Seven mutually exclusive and comprehensive categories were identified, whose reliability was tested on an Italian corpus of provider-patient encounters in diabetes care. The application of this method was illustrated through explorative analyses identifying possible correlations between the dialogical structure of medical interviews and one of the indicators of personalized decision-making, namely the specificity of the recommendations given by the provider (“customization”). The statistical analyses show a significant correlation between the exchange of personal information and very specific and customized recommendations for change. It suggests how the creation of common ground, exceeding the boundaries of the paternalistic or patient-centered models, can lead to highly effective communication.

Community Oncology in an Era of Payment Reform

2014 ◽  
pp. e447-e452 ◽  
Author(s):  
John V. Cox ◽  
Jeffery C. Ward ◽  
John C. Hornberger ◽  
Jennifer S. Temel ◽  
Barbara L. McAneny
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Fee For Service ◽  
Shared Decision ◽  
Payment Reform ◽  
Patient Centered ◽  
Payment Schemes ◽  
Oncology Practice ◽  
Personalized Cancer

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim—to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions

10.2196/18223 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e18223
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

Background Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. Objective This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. Methods A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. Results A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. Conclusions The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making

10.2196/13763 ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. e13763
Author(s):  
Thomas H Wieringa ◽  
Manuel F Sanchez-Herrera ◽  
Nataly R Espinoza ◽  
Viet-Thi Tran ◽  
Kasey Boehmer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decision Aids ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Patient Centered ◽  
Patient Goals ◽  
Minimally Disruptive Medicine ◽  
Workload Capacity

About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

scholarly journals Patient and Caregiver Priorities for Outcomes in Peritoneal Dialysis

2018 ◽  
Vol 14 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Karine E. Manera ◽  
David W. Johnson ◽  
Jonathan C. Craig ◽  
Jenny I. Shen ◽  
Lorena Ruiz ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Shared Decision Making ◽  
The United States ◽  
Nominal Group ◽  
Shared Decision ◽  
Importance Score ◽  
Patient Centered

Background and objectivesThe absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices.Design, setting, participants, & measurementsPatients on PD and their caregivers were purposively sampled from nine dialysis units across Australia, the United States, and Hong Kong. Using nominal group technique, participants identified and ranked outcomes, and discussed the reasons for their choices. An importance score (scale 0–1) was calculated for each outcome. Qualitative data were analyzed thematically.ResultsAcross 14 groups, 126 participants (81 patients, 45 caregivers), aged 18–84 (mean 54, SD 15) years, identified 56 outcomes. The ten highest ranked outcomes were PD infection (importance score, 0.27), mortality (0.25), fatigue (0.25), flexibility with time (0.18), BP (0.17), PD failure (0.16), ability to travel (0.15), sleep (0.14), ability to work (0.14), and effect on family (0.12). Mortality was ranked first in Australia, second in Hong Kong, and 15th in the United States. The five themes were serious and cascading consequences on health, current and impending relevance, maintaining role and social functioning, requiring constant vigilance, and beyond control and responsibility.ConclusionsFor patients on PD and their caregivers, PD-related infection, mortality, and fatigue were of highest priority, and were focused on health, maintaining lifestyle, and self-management. Reporting these patient-centered outcomes may enhance the relevance of research to inform shared decision-making.

scholarly journals Chronic Care Model Strategies In The United States And Germany Deliver Patient-Centered, High-Quality Diabetes Care

2014 ◽  
Vol 33 (9) ◽  
pp. 1540-1548 ◽  
Author(s):  
Stephanie Stock ◽  
James M. Pitcavage ◽  
Dusan Simic ◽  
Sibel Altin ◽  
Christian Graf ◽  
...  
Keyword(s):  
United States ◽  
Diabetes Care ◽  
Chronic Care Model ◽  
Chronic Care ◽  
The United States ◽  
Care Model ◽  
Patient Centered ◽  
High Quality

Sources of practice variations in cardiology - The influence of clinical context, cost, physicians’ perceptions and practice considerations

2018 ◽  
Vol 6 (3) ◽  
pp. 492
Author(s):  
Veena Manja ◽  
Gordon Guyatt ◽  
Sandra Monteiro ◽  
Susan Jack ◽  
Satyanarayana Lakshminrusimha ◽  
...  
Keyword(s):  
Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Practice Variation ◽  
Free Text ◽  
Patient Centered ◽  
Local Hospital ◽  
Hospital Practice ◽  
Centered Care ◽  
Management Choice

Background: Practice variation is common and may represent variation in values and preferences in the setting of limited evidence regarding optimal care or indicate deficiencies in care. Methods: We administered a case-based survey to cardiologists in the United States and Canada. Participants selected their preferred management option and then rated the influence of 7 factors (safety, effectiveness, patient-centered care, efficiency, local hospital practice, medicolegal concerns and prior experience) on their decision using a scale of 1 (unimportant) to 7 (critically important). Follow-up questions explored knowledge and attitudes on healthcare costs. The relationship between management choice and perceived influence of each factor was examined using repeated measures ANOVA. Free text comments were analyzed using basic content analysis.Results: One hundred and six cardiologists completed the survey. Respondents rated safety (5.8), effectiveness (5.7) and patient-centered care (5.7) as important determinants irrespective of their management choice. Cardiologists frequently (range 19%-87%) chose options not recommended by clinical practice guidelines (CPG), with individual cardiologists sometimes choosing guideline-suggested options and sometimes not. Differences in ratings of factors between those who chose guideline-suggested options and those who did not varied based on the case. Respondents considered cost to be important in decision-making; however, they did not feel well informed and, consequently, seldom discussed this with patients.Conclusion: Cardiologists rate evidence-based practice as an important factor influencing their decision-making whether or not they make CPG-concordant choices. Sources of practice variation include case-context, local hospital practice and medicolegal concerns. Implementation strategies to improve high value patient-centered care should consider physicians’ perceptions of effectiveness of the management options. Successful strategies to improve patient-centered care will require engagement from physicians, particularly to understand how best to support their ability to counsel and involve patients when choosing treatment options and considering cost in these decisions. A deeper understanding of practice variation and its implications will require use of qualitative methods.

Sign in / Sign up

Export Citation Format

Share Document