scholarly journals Ethical Issues in Dysphagia Management

2020 ◽  
Vol 41 (03) ◽  
pp. 257-265
Author(s):  
Paula Leslie ◽  
Dominika Lisiecka
Keyword(s):  
Decision Making ◽  
Family Caregivers ◽  
Clinical Judgment ◽  
Information Disclosure ◽  
Ethical Issues ◽  
Shared Decision ◽  
Ethical Reflection ◽  
Ethical Challenges ◽  
Swallowing Problems

AbstractDysphagia management is complex and requires balancing individuals' preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one's own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia; the influence of culture on decision-making about eating and feeding; the importance of information disclosure and respect for individuals' refusal of recommendations; and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind to ensure compassionate and competent care of the person with eating, drinking, or swallowing problems and their family caregivers.

scholarly journals Experiences of bereaved family caregivers with shared decision making in palliative cancer treatment: a qualitative interview study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sanne P. C. van Oosterhout ◽  
Daisy J. M. Ermers ◽  
Floor K. Ploos van Amstel ◽  
Carla M. L. van Herpen ◽  
Yvonne Schoon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Family Caregivers ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patients With Cancer ◽  
Qualitative Interview Study ◽  
Bereaved Family ◽  
Life Prolongation

Abstract Background Patients with incurable cancer face complex medical decisions. Their family caregivers play a prominent role in shared decision making processes, but we lack insights into their experiences. In this study, we explored how bereaved family caregivers experienced the shared decision making process. Methods We performed a qualitative interview study with in-depth interviews analysed with inductive content analysis. We used a purposive sample of bereaved family caregivers (n = 16) of patients with cancer treated in a tertiary university hospital in the Netherlands. Results Four themes were identified: 1. scenarios of decision making, 2. future death of the patient 3. factors influencing choices when making a treatment decision, and 4. preconditions for the decision making process. Most family caregivers deferred decisions to the patient or physician. Talking about the patient’s future death was not preferred by all family caregivers. All family caregivers reported life prolongation as a significant motivator for treatment, while the quality of life was rarely mentioned. A respectful relationship, close involvement, and open communication with healthcare professionals in the palliative setting were valued by many interviewees. Family caregivers’ experiences and needs seemed to be overlooked during medical encounters. Conclusions Family caregivers of deceased patients with cancer mentioned life prolongation, and not quality of life, as the most important treatment aim. They highly valued interactions with the medical oncologist and being involved in the conversations. We advise medical oncologists to take more effort to involve the family caregiver, and more explicitly address quality of life in the consultations.

Ethics of the Psychotherapeutic Alliance, Shared Decision Making and Consensus on Therapy Goals

2019 ◽  
Author(s):  
Stella Reiter-Theil ◽  
Charlotte Wetterauer
Keyword(s):  
Decision Making ◽  
Problem Solving ◽  
Shared Decision Making ◽  
Assisted Suicide ◽  
Ethical Issues ◽  
Medical Patient ◽  
Shared Decision ◽  
Ethical Challenges ◽  
Therapy Goals ◽  
Psychotherapeutic Alliance

The ethics of the psychotherapeutic alliance (a), shared decision making (b), and consensus on therapy goals (c) is discussed in the context of a legal overview in three German-speaking countries. Particular ethical challenges are identified in different settings. Clinical Ethics Support (CES) has gained importance beyond acute medical patient care, but is still new in psychotherapy. Three examples present ethical issues underlying the basic concepts of psychotherapy (a, b, and c) that often go unnoticed or remain implicit. Addressing ethical questions in a practical psychotherapy context may lead to acknowledging more complexity than expected. At the same time, meta-level ethical reflection can help to coordinate previously diverging interests and efforts and remove obstacles towards problem-solving. Complexity as well as problem solving will be illustrated by referring to problems with confidentiality concerning sexual abuse, coercion in treating dependency disorders, and responding to wishes of assisted suicide.

scholarly journals SHARED DECISION MAKING IN DEMENTIA CARE PLANNING: INVOLVING FAMILY CAREGIVERS

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 667-667
Author(s):  
M. Vernooij-Dassen ◽  
E. Mariani ◽  
Y. Engels ◽  
R. Chattat
Keyword(s):  
Decision Making ◽  
Family Caregivers ◽  
Shared Decision Making ◽  
Dementia Care ◽  
Care Planning ◽  
Shared Decision

Optimizing patient adherence to stroke rehabilitation: A mixed method telerehabilitation trial (Preprint)

2021 ◽  
Author(s):  
Isabelle Gaboury ◽  
Michel Tousignant ◽  
Hélène Corriveau ◽  
Matthew Menear ◽  
Guylaine Le Dorze ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Rehabilitation ◽  
Patient Adherence ◽  
Interprofessional Collaboration ◽  
Interdisciplinary Collaboration ◽  
Control Group ◽  
Shared Decision ◽  
The Impact

BACKGROUND Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration to normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration to normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured on clinicians. METHODS In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will entail 220 patients to receive stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation) versus face-to-face, standard of care (n = 110 patients). RESULTS Results: Our Research Ethics Board has approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS This study will contribute to minimize both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practices guidelines regarding telecare services and the provision of telerehabilitation, including recommendations regarding effective interdisciplinary collaboration regarding stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT04440215

Improving the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic

2021 ◽  
pp. JDNP-D-20-00078
Author(s):  
Sybilla Myers ◽  
Christopher Kennedy
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Cognitive Theory ◽  
Well Being ◽  
Mobile App ◽  
Shared Decision ◽  
Patient Centered ◽  
The Social

BackgroundPerceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.Local ProblemNo standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual’s likelihood of long-term success.MethodsDuring the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.InterventionsThe four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.ResultsAmong 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.ConclusionsThe SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Shared Decision Making ◽  
Vital Signs ◽  
Ambulance Service ◽  
Guidance Document ◽  
Shared Decision ◽  
Clinical Guidance ◽  
Decision Making Model

<p><strong>Introduction</strong></p><p>Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.</p><p><strong>Results</strong></p><p>31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.</p><p><strong>Conclusion</strong></p><p>Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.</p>

Exploring Shared Decision Making Between Family Caregivers, Persons With Disorders of Consciousness, and Rehabilitation Therapists in Acute Care

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512510247p1-7512510247p1
Author(s):  
Jennifer Weaver ◽  
Trudy Mallinson ◽  
Leslie Davidson ◽  
Christina Papadimitriou ◽  
Ann Guernon ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Caregivers ◽  
Shared Decision Making ◽  
Research Study ◽  
Medical Model ◽  
Clinical Encounter ◽  
Disorders Of Consciousness ◽  
Observational Research ◽  
Shared Decision ◽  
Clinical Encounters

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This qualitative, observational research study explored treatment encounters between patients with disorders of consciousness, rehabilitation practitioners, and family to understand how treatment decisions occurred. The data showed shared decision making (SDM) occurring as a process, meaning that not all five principles of SDM occur in one clinical encounter but rather unfold across multiple clinical encounters. We delineate differences in SDM between rehabilitation and the medical model. Primary Author and Speaker: Jennifer Weaver Contributing Authors: Trudy Mallinson, Leslie Davidson, Christina Papadimitriou, Ann Guernon, and Philip van der Wees

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