Deprescribing in Psychiatry

2019 ◽  
pp. 3-22
Author(s):  
Swapnil Gupta ◽  
Rebecca Miller ◽  
John D. Cahill
Keyword(s):  
Decision Making ◽  
Geriatric Medicine ◽  
Patient Relationship ◽  
Doctor Patient Relationship

This chapter introduces the concept of deprescribing in psychiatry, along with the rationale for its importance. Emerging from geriatric medicine, the reduction or stopping of medications in psychiatry goes beyond deciding which, when, and how to decrease a medication to also encompass psychological and social considerations. Settings for deprescribing, along with the involved ethics, are also touched upon. Deprescribing is placed in the context of recovery-oriented care as a broad-ranging intervention encompassing the complexity of decision-making and the doctor–patient relationship. The chapter sets the foundation for the rest of the book, laying out the rationale, structure, and goals of the text.

scholarly journals Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Jennifer Wrede-Sach ◽  
Isabel Voigt ◽  
Heike Diederichs-Egidi ◽  
Eva Hummers-Pradier ◽  
Marie-Luise Dierks ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Older Patients ◽  
Self Determination ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Good Doctor ◽  
Patient Decision Making

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

1992 ◽  
Vol 1 (1) ◽  
pp. 11-31 ◽  
Author(s):  
David C. Thomasma
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Ethics Committee ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patient Decision Making ◽  
Deontological Ethics ◽  
Ethical Discussion ◽  
Patient Decision

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.

Decision of palliative chemotherapy in late-stage cancer: The doctor-patient relationship and the decision-making process as seen by an oncologist.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 48-48
Author(s):  
Florian Scotte ◽  
Marie Pechard ◽  
Ivan Krakowski ◽  
Christophe Tournigand ◽  
marcel-Louis Viallard
Keyword(s):  
Decision Making ◽  
Late Stage ◽  
Palliative Chemotherapy ◽  
Specific Treatment ◽  
Decision Making Process ◽  
Patient Relationship ◽  
University Hospitals ◽  
Doctor Patient Relationship ◽  
Medical Progress ◽  
Late Stage Cancer

48 Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. Methods: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists. Results: The study are consistent with the literature showing that factors are in favor of treatment continuation: the patient's age, his desire to continue treatment and his life expectancy. The decision making process of chemotherapy discontinuation is marked by uncertainties, personal representations of the doctor and subjectivity in front of the objective facts that could make this decision difficult. The working conditions in cancer care and the valuation of the chemotherapy prescription can impact the decision. The constant medical progress in oncology make more complex the decision of stopping specific treatments. This study showed the singularity of the doctor-patient relationship in oncology. This can explain the difficulty to stop chemotherapy. Conclusions: The oncologist can use the collegiality which are necessary for decision to limit specific treatment. The objective is to propose the adequate care to the patient in all its dimensions. Some actions can be proposed to improve our practice: early use of palliative care for patients, analysis of practices and training to deal with uncertainty and the limits of possibilities in clinical practice.

scholarly journals Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

2018 ◽  
Vol 111 (11) ◽  
pp. 407-413 ◽  
Author(s):  
Andreas Fontalis ◽  
Efthymia Prousali ◽  
Kunal Kulkarni
Keyword(s):  
Decision Making ◽  
Legal Aspects ◽  
Hippocratic Oath ◽  
Moral Issue ◽  
Assisted Dying ◽  
Patient Relationship ◽  
Current Position ◽  
Doctor Patient Relationship ◽  
Moral Principles ◽  
Constitutional Right

Summary Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship, which is fundamentally based on trust, mutual respect and the premise of ‘first do no harm’. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor–patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer

2018 ◽  
Vol 49 (3) ◽  
pp. 364-375 ◽  
Author(s):  
Nuworza Kugbey ◽  
Kwaku Oppong Asante ◽  
Anna Meyer-Weitz
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Cross Sectional ◽  
Patient Relationships

Decreased quality of life is a major challenge among women living with breast cancer due to treatment effects and other psychosocial comorbidities. However, shared decision making and doctor–patient relationship have been linked to improved quality of life, but the mechanism linking shared decision making and quality of life is poorly understood. This study therefore examined both the direct and indirect influences of shared decision making on quality of life through doctor–patient relationship among 205 women living with breast cancer in Ghana with a mean age of 52.49 years. Using a cross-sectional design, participants were administered questionnaires which measured quality of life, doctor–patient relationship, and shared decision making. Results showed that shared decision making had significant indirect influence on overall quality of life via doctor–patient relationships ( b = 4.69, 95% confidence interval = [0.006, 9.555]). Shared decision making had a significant effect on doctor–patient relationships ( b = 7.63, t = 6.76, p < .001) but no significant direct effect on quality of life ( b = 2.72, t = 0.510, p = .61). Findings suggest that shared decision making results in improved doctor–patient relationships which probably lead to better quality of life among women living with breast cancer. These findings underscore the need for increased patient involvement in medical decisions to improve interpersonal relationships and consequently quality of life.

Redefining The Doctor-Patient Relationship in the Era of Artificial Intelligence – Modern Medicine’s Dilemma

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 150-150
Author(s):  
Roxana Elena Rusu ◽  
◽  
Beatrice Gabriela Ioan ◽  
◽  
◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Patient Relationship ◽  
Ethical Aspects ◽  
Medical Field ◽  
Doctor Patient Relationship ◽  
Diverse Background ◽  
Therapeutic Recommendations ◽  
Triangular Relationship ◽  
The Right

"Nowadays, the traditional relationship between doctors and patients is changed by the artificial intelligence (AI) and its involvement in the medical act – ranging from diagnosis to therapeutic recommendations or personalized treatment. The balance in this triangular relationship is hard to find especially in a digitalized world, in which patients have access to unfiltered information that may lead to inaccurate self-diagnosis. When it comes to the diverse background of a disease, only a doctor will be able to draw the right conclusion. It is hard to imagine that AI will soon be able to recognize problems such as domestic violence or mental illness. Ultimately, this means that AI is only a means to an end and the responsibility of any taken decision lies with the doctor. Doctors are more than decision making machines and the emotional intelligence cannot be replaced, but the advantages of using AI in the medical field are widely recognized and ultimately the goal is to ensure the best care for the patient. The purpose of this paper is to point out ethical aspects that rise from the involvement of AI in the doctor-patient relationship and to describe the new roles of the doctor and the patient in the era of AI. "

The internet—A useful communication tool but no replacement for the doctor-patient relationship

2001 ◽  
Vol 120 (5) ◽  
pp. A735-A735
Author(s):  
C STREETS ◽  
J PETERS ◽  
D BRUCE ◽  
P TSAI ◽  
N BALAJI ◽  
...  
Keyword(s):  
The Internet ◽  
Patient Relationship ◽  
Communication Tool ◽  
Doctor Patient Relationship
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