Compassion and Responsibility

This chapter explores how responsibility, fault, and desert matter for the content of compassion with particular reference to the idea of rationing by fault, shared decision-making, and recent UK law regarding the relationship between responsibility, risk, and consent. Conceptual clarity is sought through exploring how tragedy differs from Christian theology by deploying the contrasting categories of the ‘undeserving sick’, the ‘obstinate sick’ and the ‘sad sick’, as applied to clinical communication, pastoral discretion, and mercy. The chapter considers what may be learnt for the interrelation of responsibility with compassion from the Book of Job. This analysis deepens the earlier account of second-person relatedness and compassion, by considering the category of ‘remonstration’. This is then applied to practice through a discussion of the constraints on certain forms of public and preventive healthcare. The chapter concludes by drawing on ecclesiological motifs to describe how compassionate relationships can persevere over time.

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

Journal of Medical Ethics ◽

10.1136/medethics-2018-105118 ◽

2018 ◽

Vol 45 (3) ◽

pp. 156-160 ◽

Cited By ~ 26

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 ◽

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.

Two Training-Load Paradoxes: Can We Work Harder and Smarter, Can Physical Preparation and Medical Be Teammates?

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2016-0321 ◽

2017 ◽

Vol 12 (s2) ◽

pp. S2-50-S2-54 ◽

Cited By ~ 14

Author(s):

Tim J. Gabbett ◽

Rod Whiteley

Keyword(s):

Decision Making ◽

Injury Risk ◽

Early Stage ◽

Support Staff ◽

Training Load ◽

Shared Decision ◽

The Relationship ◽

And Training ◽

Physical Preparation

The authors have observed that in professional sporting organizations the staff responsible for physical preparation and medical care typically practice in relative isolation and display tension as regards their attitudes toward training-load prescription (much more and much less training, respectively). Recent evidence shows that relatively high chronic training loads, when they are appropriately reached, are associated with reduced injury risk and better performance. Understanding this link between performance and training loads removes this tension but requires a better understanding of the relationship between the acute:chronic workload ratio (ACWR) and its association with performance and injury. However, there remain many questions in the area of ACWR, and we are likely at an early stage of our understanding of these parameters and their interrelationships. This opinion paper explores these themes and makes recommendations for improving performance through better synergies in support-staff approaches. Furthermore, aspects of the ACWR that remain to be clarified—the role of shared decision making, risk:benefit estimation, and clearer accountability—are discussed.

The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study (Preprint)

10.2196/preprints.26721 ◽

2020 ◽

Author(s):

Richard Huan Xu ◽

Ling-Ming Zhou ◽

Eliza Lai-Yi Wong ◽

Dong Wang

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Regression Models ◽

Well Being ◽

Shared Decision ◽

Background Characteristics ◽

Cross Sectional ◽

Ehealth Literacy ◽

High Level ◽

BACKGROUND Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. OBJECTIVE This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being. METHODS The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics. RESULTS A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables. CONCLUSIONS This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM. CLINICALTRIAL

The relationship between health literacy and perceived shared decision making in patients with breast cancer

Patient Education and Counseling ◽

10.1016/j.pec.2018.09.017 ◽

2019 ◽

Vol 102 (2) ◽

pp. 360-366 ◽

Cited By ~ 8

Author(s):

Hsiu-Nien Shen ◽

Chia-Chen Lin ◽

Tammy Hoffmann ◽

Chia-Yin Tsai ◽

Wen-Hsuan Hou ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Health Literacy ◽

Shared Decision Making ◽

Shared Decision ◽

THE 4‘E’ FRAMEWORK FOR EFFECTIVE CLINICAL COMMUNICATION AND SHARED DECISION-MAKING

10.1142/9789813147423_0002 ◽

2021 ◽

pp. 7-8

Author(s):

Han Yee Neo

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Shared Decision ◽

Clinical Communication

Participation in Decision Making and Affective Trust Among the Teaching Staff: A 2-Year Cross-Lagged Structural Equation Modeling During Implementation Reform

International Journal of Educational Reform ◽

10.1177/1056787919877857 ◽

2019 ◽

Vol 29 (1) ◽

pp. 77-97 ◽

Cited By ~ 2

Author(s):

Rima’a Da’as

Keyword(s):

Decision Making ◽

Structural Equation ◽

Interpersonal Skills ◽

Equation Modeling ◽

Teaching Staff ◽

Affective Trust ◽

Organizational Reform ◽

Participation In Decision Making ◽

The Relationship ◽

The research investigated whether teachers’ participation in decision-making (PDM) contributes to the development of affective trust during school reform over time, or vice versa. A model including principals’ interpersonal skills was tested during implementation of the organizational reform. Teachers ( n = 1,482) from 113 Israeli elementary schools participated in the first measurement, and 1,390 teachers from 106 of these schools participated in the second measurement. A cross-lagged design for 2 years showed that PDM leads to affective trust over time. Furthermore, PDM mediated the relationship between principals’ interpersonal skills and affective trust over time.

T236. A PROGRAM TO INCREASE THE APPROPRIATE USE OF LONG-ACTING ANTIPSYCHOTIC MEDICATIONS IN COMMUNITY SETTINGS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.796 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S322-S323

Author(s):

Dawn Velligan ◽

Martha Sajatovic

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Antipsychotic Medication ◽

Poor Adherence ◽

Shared Decision ◽

Appropriate Use ◽

Antipsychotic Medications ◽

Oral Antipsychotic ◽

Long Acting ◽

Abstract Background Antipsychotic medications are evidence-based treatments for schizophrenia that improve health outcomes and reduce costs. However, rates of non-adherence to oral antipsychotic medications can exceed 60%. We examined whether a simple checklist to identify individuals not receiving optimum benefit from current oral antipsychotic treatment (NOB Checklist) and The Multi-level Facilitation of Long-acting Antipsychotic Medication Program (MAP) could increase the appropriate use of long-acting injectable antipsychotic medication (LAI) in community clinics. Methods Two clinics in Texas and two in Ohio changed clinical procedures in one of two ways 1) NOB only clinics--providers used a five-item checklist to identify individuals with schizophrenia on oral antipsychotics who were Not receiving Optimum Benefit from current treatment and may therefore benefit from a switch to LAI. 2) MAP- providers used the NOB checklist AND received MAP; MAP is a novel behavior change intervention designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer for whom peer specialists showed a video describing shared decision making and how to make a choice between tablets and injections, and provided a balanced shared-decision making tool to assist them in choosing medication route,2) the provider who received academic detailing describing various LAI options, how to make good offers as part of a shared decision making dialogue, and important benefits of LAI including the ability to disentangle efficacy versus poor adherence and to help individuals with cognitive and practical problems that lead to poor adherence, and 3) the administrators who received information on how LAI could improve outcomes for individuals and clinic processes, how to encourage the use of LAI among providers and how to provide regular feedback to providers about prescribing practices. The primary outcome was the percentage of LAI versus oral antipsychotic medication prescribed to individuals with schizophrenia. Results Higher NOB checklist scores were associated with an increased provider likelihood of LAI offers and increased consumer acceptance of LAI. All clinics increased use of LAI over time. In Texas, where MAP was fully implemented, the MAP clinic had greater use of LAI over time (eventually reaching about 50% of all antipsychotic use) vs. the NOB only clinic. In Cleveland, the patient stakeholder curriculum was not delivered and there was no significant difference in LAI use between MAP and NOB clinics. Discussion The NOB checklist appears to be a useful tool to help identify patients who might be appropriate candidates for LAI and the full MAP program may help clinicians and consumers to work together to optimize the appropriate use of LAI in outpatient settings. Implementation must be customized for clinics and workflows to determine which parts of the MAP program are practical and appropriate. Participation of consumer stakeholders may be essential to delivery of the MAP Program.

Key components of shared decision making models: a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-031763 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031763 ◽

Cited By ~ 11

Author(s):

Hanna Bomhof-Roordink ◽

Fania R Gärtner ◽

Anne M Stiggelbout ◽

Arwen H Pieterse

Keyword(s):

Systematic Review ◽

Decision Making ◽

Healthcare Professional ◽

Shared Decision Making ◽

Treatment Options ◽

Healthcare Setting ◽

Shared Decision ◽

Eligibility Criteria ◽

Choice Awareness ◽

ObjectivesTo (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting.DesignSystematic review.Eligibility criteriaPeer-reviewed articles in English presenting a new or adapted model of SDM.Information sourcesAcademic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019.ResultsForty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment optionswas the most prominent component across models. Components present in >50% of models were:Make the decision (75%),Patient preferences (65%),Tailor information (65%),Deliberate (58%), Create choice awareness (55%), andLearn about the patient(53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time,Describe treatment optionsandMake the decisionare the two components which are present in most models in any time period.Create choice awarenessstood out for being present in a markedly larger proportion of models over time.ConclusionsThis review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key.Trial registrationPROSPERO registration CRD42015019740

Relationship between dementia severity in older women and family caregivers’ preferences for shared decision making about breast cancer screening

Proceedings of IMPRS ◽

10.18060/25923 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Molly Frank ◽

Nicole Fowler

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Shared Decision Making ◽

Family Caregiver ◽

Standard Of Care ◽

Shared Decision ◽

Dementia Severity ◽

Background/Objective: Mammography is one of the most effective ways to diagnose breast cancer early; however, its perceived benefits are complicated by terminal conditions such as dementia. By undergoing mammography, women with dementia risk treatment complications and false-positive results, which can exacerbate psychological distress. The lack of a standard of care confounds the individual roles of the patient, family caregiver, and physician in the decision-making process. This study evaluates the relationship between dementia severity and family caregiver preferences for shared decision making. Methods: Data were gathered from the Decisions about Cancer screening in Alzheimer’s Disease trial, which uses the Dementia Severity Rating Scale (DSRS) and a revised version of the Control Preferences Scale (CPS) to assess family caregiver preferences for decision-making as a dyad (patient and caregiver) and triad (patient, caregiver, and physician). Two multinomial logistic regression models assessed the relationship between DSRS and CPS categories (active, passive, and collaborative), while controlling for the caregivers’ age, gender, education, relationship to patient, self-perceived income, and race. Both models used the “active” group as the baseline; however, Model 1 examined preferences as a dyad and Model 2 as a triad. Results: Model 1 found a statistically significant association between dementia severity and a collaborative approach (p<0.001), and between dementia severity and a passive approach (p=0.014). For every one-unit increase in DSRS score, the odds of being in the collaborative group decreased by 0.083 and the odds of being in the passive group decreased by 0.085. There was no statistically significant association between dementia severity and decision-making preferences in Model 2. Clinical Significance: The association between dementia severity and family caregiver decision-making preferences supports the need for a standard of care regarding breast cancer screening in women with dementia.

QUEM ESTÁ NO COMANDO? NEUROCIÊNCIA, RESSONÂNCIA E DESAFIOS PARA A TEOLOGIA

Perspectiva Teológica ◽

10.20911/21768757v49n3p611/2017 ◽

2017 ◽

Vol 49 (3) ◽

pp. 611

Author(s):

Rudolf Von Sinner

Keyword(s):

Human Condition ◽

The Body ◽

Christian Theology ◽

Human Being ◽

Second Person ◽

Third Person ◽

Ancient Problem ◽

The One ◽

The Relationship ◽

The Brain

RESUMO: A relação entre corpo e alma ou entre corpo, alma e espírito é um problema antigo da antropologia, inclusive na teologia cristã. A questão continua em pauta hoje diante de novas descobertas e teorias nas neurociências. Praticamente migrou para a discussão da relação entre cérebro e mente. Hoje é consenso bastante amplo que quem comanda o corpo é o cérebro. Se aceitarmos isto, quem está no comando do cérebro? Sou eu, em primeira pessoa, minha alma, minha mente? Ou seria “ele”, em terceira pessoa, nosso próprio cérebro me determinando? E como ficaria na segunda pessoa – o ser humano como estando em relação a Deus a quem o chama de “tu”? Querendo superar preconceitos contra uma neurociência determinista e uma teologia despreocupada com a ciência – e estas próprias posições, onde são defendidas –, o presente artigo procura tratar da condição humana em sua liberdade sempre precária e tolhida. Recorrendo à abordagem neurobiológica e psiquiátrica de Joachim Bauer, argumenta pela importância das relações do ser humano com o outro, com Deus e com o mundo, numa forma de ressonância (Hartmut Rosa). ABSTRACT: The relationship between body and soul or between body, soul and spirit is an ancient problem of anthropology, and also of Christian theology. In view of present day discoveries and new neuroscientific theories, the issue poses itself afresh. It practically migrated to the discussion of the relationship between brain and mind. Today, there is ample consensus that it is the brain that is in charge of the body. If we accept that, then who is in charge of the brain? Is it me, in the first person, my soul, my mind? Or is it “him”, in the third person, our own brain that determines me? And how about the second person – the human being in its relationship with God whom it calls “you”? Striving to overcome prejudices against a deterministic neuroscience, on the one hand, and a theology indifferent to science – and, indeed, such positions, wherever they are held – the present article seeks to deal with the human condition in its freedom, always precarious and restrained. Referring to neurobiological and psychiatric insights from Joachim Bauer, it argues for the importance of the relationship of the human being with the other, with God and with the world, in a form of resonance (Hartmut Rosa).