scholarly journals Dialysis or conservative care for frail older patients: ethics of shared decision-making

2013 ◽  
Vol 28 (11) ◽  
pp. 2717-2722 ◽  
Author(s):  
S. Muthalagappan ◽  
L. Johansson ◽  
W. M. Kong ◽  
E. A. Brown
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Conservative Care

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.

scholarly journals Challenges of Shared Decision Making in Older Patients with COVID ‐19

2020 ◽  
Author(s):  
Abhay Dhand ◽  
Leanne Forman ◽  
Rathnamitreyee Vegunta ◽  
Wilbert S. Aronow ◽  
Christopher Nabors
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision

Expert and patient consensus on a dynamic model for shared decision-making in frail older patients

2016 ◽  
Vol 99 (6) ◽  
pp. 1069-1077 ◽  
Author(s):  
Marjolein H.J. van de Pol ◽  
Cornelia R.M.G. Fluit ◽  
Joep Lagro ◽  
Yvonne H.P. Slaats ◽  
Marcel G.M. Olde Rikkert ◽  
...  
Keyword(s):  
Decision Making ◽  
Dynamic Model ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision

Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care

2018 ◽  
Vol 35 (10) ◽  
pp. 1330-1336 ◽  
Author(s):  
Nebras. Abu Al Hamayel ◽  
Sarina R. Isenberg ◽  
Susan M. Hannum ◽  
Joshua Sixon ◽  
Katherine Clegg. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Quality Improvement ◽  
Access To Care ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Coordination Of Care ◽  
Serious Illness

Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients’ perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study. Participants: Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative. Methods: We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. Results: We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Conclusions: Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

scholarly journals Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

2020 ◽  
Vol 40 (3) ◽  
pp. 279-288
Author(s):  
Eleonore V. Grant ◽  
Jenny Summapund ◽  
Daniel D. Matlock ◽  
Victoria Vaughan Dickson ◽  
Sohah Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Comparative Method ◽  
Patient Specific ◽  
Shared Decision ◽  
Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

Leveraging the Preoperative Clinic to Engage Older Patients in Shared Decision Making About Complex Surgery

2016 ◽  
Vol 7 (2) ◽  
pp. 30-32
Author(s):  
Sushila Murthy ◽  
David Lerner Hepner ◽  
Zara Cooper ◽  
Houman Javedan ◽  
Lauren Jan Gleason ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Complex Surgery

Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients’ and observers’ perceptions

2018 ◽  
Vol 101 (10) ◽  
pp. 1767-1774 ◽  
Author(s):  
Noralie H. Geessink ◽  
Eirik H. Ofstad ◽  
Marcel G.M. Olde Rikkert ◽  
Harry van Goor ◽  
Jürgen Kasper ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision

scholarly journals Shared decision making with frail older patients: Proposed teaching framework and practice recommendations

2016 ◽  
Vol 38 (4) ◽  
pp. 482-495 ◽  
Author(s):  
Marjolein H. J. van de Pol ◽  
Cornelia R. M. G. Fluit ◽  
Joep Lagro ◽  
Yvonne Slaats ◽  
Marcel G. M. Olde Rikkert ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Practice Recommendations
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