Cross-Cultural Interactions and Shared Decision Making

2021 ◽  
pp. 141-164
Author(s):  
Sabrina F. Derrington ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Cultural Differences ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Cultural Humility ◽  
Shared Decision ◽  
Care Providers ◽  
Implicit Biases ◽  
Culturally Different

Authentic shared decision making depends on the quality of interpersonal interactions and communication, which can be profoundly influenced by cultural differences. The concept of culture itself is multidimensional and dynamic, including race, ethnicity, language, religion, socioeconomic status, geography, family traditions, perceptions of illness and death, and the culture of medicine itself. Cultural differences between health care providers and patients and families intersect and overlap in important ways. Shared decision making can be derailed when providers hold assumptions and implicit biases about culturally different patients and families. This chapter explores the interplay between culture and shared decision making, highlighting cases in which cultural differences may impact decision making and suggesting recommendations for optimizing cultural humility in all aspects of communication and shared decision making.

scholarly journals Shared decision-making in food allergy management

2020 ◽  
Vol 2 (1) ◽  
pp. 124-127
Author(s):  
Meera Patrawala ◽  
Gerald Lee ◽  
Brian Vickery
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Food Allergy ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aids ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

scholarly journals A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

2018 ◽  
Author(s):  
Colleen A. McHorney ◽  
Lindsey T. Murray ◽  
Dayo Jagun ◽  
Jennifer Whiteley ◽  
Miriam Kimel ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Of Care ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Quantitative Measure ◽  
Shared Decision ◽  
Care Providers ◽  
Clinician Communication

BACKGROUND Shared decision making (SDM) is a process in which health care providers and patients relate to and influence each other as they collaborate in making decisions about patients’ health care. Hypothesized as a means to improve quality of care, successful applications of SDM in routine cancer care have not been widely documented. OBJECTIVE The objective of this study was to examine the literature to determine if elements of SDM implementation between cancer patients and their clinicians were more or less successful at improving the quality of care and health outcomes. METHODS A systematic literature search of SDM approaches and outcomes in cancer care was conducted using PubMed and EMBASE. An integrative model for SDM was used to classify elements included in SDM intervention studies and the resulting outcomes. RESULTS From 1,018 unique publications, 23 articles meeting eligibility criteria were included. Only three studies addressed elements of patient-clinician interaction as part of the study objectives. Interventions included decision aid (DA) evaluation (n=22) and clinician communication training (n=1). SDM elements commonly included were: defining/explaining the problem (n=23); presenting options (n=19); discussing pros and cons (n=17); assessing patient priorities and preferences (n=17); clinician knowledge and recommendations (n=15); and making or deferring treatment decisions (n=12). The most frequently-measured outcomes were patient-reported outcomes including treatment preference or decision (n=12), decisional conflict (n=10), patient satisfaction (n=10), patient participation (n=9), and patient knowledge (n=7). No clear patterns demonstrating relationships between SDM elements and outcomes were identified. Information on how patients and clinicians utilized DA information to promote SDM was limited. CONCLUSIONS Evaluation of SDM in cancer care has been increasing. However, the term “SDM” was generally applied to studies that focused on the development and/or evaluation of DAs which limited the current analyses to a review of SDM elements as part of the DAs. Most studies did not include a qualitative or quantitative measure of SDM specific to patient-clinician communication and interaction. Instead, there was an underlying assumption that SDM occurred organically with DA implementation. Without a qualitative or quantitative measure of SDM, identification of successful SDM elements and their relationships to patient outcomes remains unclear. Additional research is warranted on SDM implementation and measurement in real-world cancer care settings.

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Oswald Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Diabetic Clinic ◽  
Participation In Decision Making

Abstract Background Patients’ participation in decision making regarding their treatment play an important role in treatment outcome through improvement in self-care and adherence to treatment. There is scarcity of information regarding shared decision making in sub-Saharan Africa. This study was conducted to assess participation of patients and health care providers in decision-making process in the diabetic clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania.Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working in the diabetic clinic at Muhimbili National Hospital. Data was collected using interview guide with open ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software. Results Several themes were identified in this study including some form of participation in decision making of patients, use of decision aids in the clinic and belief and values regarding patients’ engagement in decision making. Several factors were identified as barriers to shared decision making as noted from participants interview, these included lack of time, literacy level, beliefs and values. Decision aids were reported to be important for improving patient’s knowledge and subsequently their involvement in decisions that were made although it was also noted that these were not prepared by the health care providers in the clinic and they were not adequately provided.Conclusion Some form of participation in decision making was observed in the diabetic clinic at Muhimbili national Hospital, and barriers identified for shared decision-making included time, literacy, beliefs and values.

Shifts in allergy practice in a COVID-19 world: Implications of pre–COVID-19 national health care provider and patient surveys of treatments for nasal allergies

2021 ◽  
Author(s):  
Tonya Winders ◽  
Lawrence DuBuske ◽  
Don A. Bukstein ◽  
Eli O. Meltzer ◽  
Dana Wallace ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Nasal Allergy ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Surveys

Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available.Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools.Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management.Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness.Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment.SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home–administered SLIT-tablets over SCIT.

Listening to Haitian Women and their Health Care Providers: Insight into Shared Decision-making After Cesarean Section

2021 ◽  
Vol 32 (2) ◽  
pp. 931-947
Author(s):  
Somphit Chinkam ◽  
Kathryn Mezwa ◽  
Kimberly Ashley Pierre ◽  
Courtney Steer-Massaro ◽  
Ivan Herbey ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cesarean Section ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Haitian Women ◽  
Insight Into

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Osward Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Patient Beliefs

Abstract Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods:This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.

Shared decision-making in chronic lymphocytic leukemia: Preferences and perceptions of patients, providers, and navigators.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 221-221
Author(s):  
Gabrielle Betty Rocque ◽  
Emily Van Laar ◽  
Uma Borate ◽  
Karina I. Halilova ◽  
Pamela M. Peters ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Lymphocytic Leukemia ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
College Education ◽  
Active Role ◽  
Treatment Decisions ◽  
Lymphocytic Leukemia ◽  
Shared Decision ◽  
Care Providers

221 Background: In recent years, new treatments for chronic lymphocytic leukemia (CLL) with excellent response rates and varying toxicity profiles have emerged. In the setting of multiple available options, shared decision-making is critical. Developing strategies to enhance shared decision-making requires better understanding of how patients and providers make treatment decisions. Methods: Patients with CLL and health care providers within the University of Alabama at Birmingham Health System Cancer Community Network were to assess how treatment decisions are made. Results: Forty-four patients with CLL completed telephone-based surveys. The median age was 69 years old. Thirty percent had completed ≤12 years of education, 20% had some college education. Seventy-three percent of patients preferred an active or shared role in decision-making (27% preferring to make decision, 23% making decision with physician input, and 45% a shared role). Only 2% of patients preferred the doctor select the treatment. Despite >50% preferring an active role, only 20.5% perceived having an active role (Table 1). Thirty-three lay patient navigators, 26 oncologists, and 28 nurses (RN)/advanced care providers (ACP) completed web-based surveys. Navigators and nurses perceived a greater patient role in decision-making than physicians, who perceived that decisions were most often shared. Conclusions: Patients and providers have differing perceptions of their roles in decision-making in CLL treatment. Patients desire higher levels of participation in decision-making than they perceive that they receive, suggesting an opportunity for education of patients and providers to improve shared decision-making. [Table: see text]

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