scholarly journals Healthcare providers' perceptions of the challenges and opportunities to engage Chinese migrant women in contraceptive counselling: a qualitative interview study

Sexual Health ◽  
2020 ◽  
Vol 17 (5) ◽  
pp. 405
Author(s):  
Hankiz Dolan ◽  
Mu Li ◽  
Deborah Bateson ◽  
Rachel Thompson ◽  
Chun Wah Michael Tam ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Migrant Women ◽  
Care Needs ◽  
Contraceptive Counselling ◽  
Qualitative Interview Study ◽  
Professional Interpreting

Background In Australia, there are many culturally and linguistically diverse communities and Chinese migrants make up one of the largest. Yet, little is known about healthcare providers’ (HCPs) unique experiences in providing contraceptive care for Chinese migrant women. There is minimal research into the HCPs’ perceptions of challenges or opportunities in engaging Chinese migrant women in informed and shared decision-making processes during contraceptive counselling. The aim of this study is to explore HCPs’ experiences of providing contraceptive care for Chinese migrant women, their perceptions of women’s care needs when choosing contraceptive methods, as well as their own needs in supporting women’s decision-making. Methods: Semi-structured interviews were conducted with 20 HCPs in Sydney, Australia who had substantial experience in providing contraceptive services to Chinese women who were recent migrants. Transcribed audio-recorded data were analysed using thematic analysis. Results: Four main themes were identified, including: ‘Are you using contraception?’: the case for being proactive and opportunistic; ‘Getting the message across’: barriers to communication; ‘Hormones are unnatural?’: women favouring non-hormonal methods; and ‘Word of mouth’: social influence on contraceptive method choice. Conclusions: In order to facilitate informed choice and shared decision-making with Chinese migrant women during contraceptive counselling, broader health system and community-level strategies are needed. Such strategies could include improving HCPs’ cultural competency in assessing and communicating women’s contraceptive needs; providing professional interpreting services and translated materials; and improving women’s health literacy, including their contraceptive knowledge and health system awareness.

scholarly journals “All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Isabelle Scholl ◽  
Sarah Kobrin ◽  
Glyn Elwyn
Keyword(s):  
Decision Making ◽  
Health System ◽  
Shared Decision Making ◽  
Cancer Care ◽  
The United States ◽  
System Level ◽  
Shared Decision ◽  
Qualitative Interview Study ◽  
The Usa ◽  
System Characteristics

Abstract Background Despite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care. Methods We conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content. Results The dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation. Conclusion Cancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.

Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes

2021 ◽  
pp. bmjspcare-2020-002857
Author(s):  
Erin Denney-Koelsch ◽  
Denise Cote-Arsenault
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Parental Decision ◽  
Parental Decision Making ◽  
Case Comparison ◽  
Theme Identification ◽  
Iterative Coding

ObjectivesWhen parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby.MethodsThis study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents’ experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison.ResultsThirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents’ experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk–benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets.ConclusionFor shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents’ subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.

scholarly journals Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study

2013 ◽  
Vol 27 (3) ◽  
pp. 214-222 ◽  
Author(s):  
France Légaré ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
Kimberley Fraser ◽  
Sophie Desroches ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Home Care ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Shared Decision

P002 IBD PARTNERSHIPS: UNDERSTANDING PATIENTS VS. CLINICIANS PERSPECTIVES OF IBD TREATMENT OPTIONS TO IMPROVE SHARED DECISION-MAKING

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Sandra Zelinsky ◽  
Catherine Finlayson
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Treatment Decisions ◽  
Research Approach ◽  
Shared Decision ◽  
Rural And Urban

Abstract Background The patient is the only constant in the care journey, the person who experiences both processes and the outcomes of care. There is an international shift towards including patients as equal partners in research. Co-producing research with Inflammatory Bowel Disease (IBD) patients to understand their values, needs and priorities when making treatment decisions will potentially improve shared decision-making between IBD patients and their Healthcare Providers (HCPs). To facilitate this process patients and HCPs must have a common understanding of expected medication benefits, risks and the potential impact on quality of life. The information available to facilitate this conversation must be aligned and reflect the priorities that IBD Patients and Healthcare Providers consider when making treatment decisions. Both parties can then share information and work towards an agreement to what treatment plan should be implemented. Aims To understand what matters most to IBD patients when making treatment decisions by conducting a qualitative patient-led peer to peer study which will inform the development of an IBD patient and HCP survey. Methods IBD patients (≥ 18 years of age) were recruited through the IBD clinic at the University of Calgary and via social media. Focus groups were held in three separate provinces (British Columbia, Alberta and Ontario) in both rural and urban locations. The focus groups were facilitated by a Patient Engagement Researcher to alleviate any potential power dynamics and to create a safe space for IBD patients to share their perspectives. A participatory action research approach was used to encourage co-production with participants throughout the focus groups. The focus groups were audio recorded. Flip charts and sticky notes were used for brainstorming and prioritization exercises. All audio and written data were transcribed. Thematic analysis was used to identify emerging themes and patient priorities. Results A total of 21 participants attended the focus groups from both rural and urban locations. Participant diversity ranged in ethnicity and age. Most of the participants were female (18 females and 3 males) of which 4 were biologic naïve and 17 were biologic exposed. The Top 5 IBD Patient Priorities when making treatment decisions are 1) Risks(more serious/long term) 2) Education(Support/Evidence Based Information/Resources) 3) Side Effects(short term/less serious) 4) Efficacy 5) Impact(Quality of Life/ Lifestyle/Logistics). Conclusions Co-producing research ‘with’ and ‘by’ IBD patients helped to generate priorities that matter most to patients when making treatment decisions. The patient priorities will help in the development of an IBD Patient and HCP survey. The results from the two surveys will be compared to understand patient vs. HCP perspectives.

scholarly journals The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

2020 ◽  
Vol 77 (1) ◽  
pp. 296-307
Author(s):  
Danique W. Bos‐van den Hoek ◽  
Maureen Thodé ◽  
Irene P. Jongerden ◽  
Hanneke W. M. Van Laarhoven ◽  
Ellen M. A. Smets ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Qualitative Interview ◽  
Interview Study ◽  
Hospital Nurses ◽  
Shared Decision ◽  
Qualitative Interview Study

scholarly journals Principles of shared decision-making within teams

2015 ◽  
Vol 25 (8) ◽  
pp. 1631-1636 ◽  
Author(s):  
Jeffrey P. Jacobs ◽  
Gil Wernovsky ◽  
David S. Cooper ◽  
Tom R. Karl
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Shared Decision Making ◽  
Risk Model ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

AbstractIn the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of “A+ personality” individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital.Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making.An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors.The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels:• SDM Level 1 Decision: “We disagree but it really does not matter, so do whatever you desire!”• SDM Level 2 Decision: “We disagree and I believe it matters, but I am OK if you do whatever you desire!!”• SDM Level 3 Decision: “We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!”SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.

scholarly journals Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Bridget Russell ◽  
Patricia Wilson ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Social Care ◽  
Realist Synthesis ◽  
Shared Decision ◽  
Care Needs ◽  
Health And Social Care ◽  
Multiple Health

scholarly journals Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis

2018 ◽  
Vol 6 (28) ◽  
pp. 1-84
Author(s):  
Frances Bunn ◽  
Claire Goodman ◽  
Bridget Russell ◽  
Patricia Wilson ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Family Carers ◽  
Care Needs ◽  
Programme Theory ◽  
Complex Needs ◽  
Need Support ◽  
Multiple Health

BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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