scholarly journals Discharge against medical advice (DAMA) in paediatrics: An approach to promote safety and ethics

2019 ◽  
Vol 25 (1) ◽  
pp. 12-15
Author(s):  
Aifric Kavanagh ◽  
Olivia Ostrow ◽  
Randi Zlotnik Shaul
Keyword(s):  
Decision Making ◽  
Medical Advice ◽  
Informed Decision ◽  
Best Interests ◽  
Informed Decision Making ◽  
Process Map ◽  
Against Medical Advice ◽  
Professional Obligations ◽  
Discharge Against Medical Advice ◽  
Reference Tool

Abstract Requests for discharge against medical advice are often challenging for clinicians to navigate, especially when the patient is a child. An informed, standardized approach to managing situations where children and their families are requesting to leave against medical advice is essential to maximizing safety and ethics for patients and staff, yet such situations are often not handled this way. Paediatric discharge against medical advice (DAMA) requests are best managed when clinicians ensure the patient’s best interests are met, understand and act upon their professional obligations, and engage in guided discussion with patients and families that involves both shared and informed decision-making strategies. A process map can capture these criteria and readily provide clinicians with a bedside reference tool when managing paediatric DAMA requests.

Disputes about the Withdrawal of Treatment: The Role of the Courts

2004 ◽  
Vol 32 (4) ◽  
pp. 701-707 ◽  
Author(s):  
Loane Skene
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Medical Advice ◽  
Treatment Regime ◽  
Best Interests ◽  
Against Medical Advice ◽  
Turn On ◽  
Limited Success ◽  
Withdrawal Of Treatment

It is commonly said that patients (or their representatives) have no right to demand that treatment must be continued when medical carers believe it is “futile” to continue it. There are certainly many judicial statements to this effect, some of which are quoted in this paper. However, there are various ways that courts can intervene, even if they do not order directly that treatment must be provided or continued. First, patients or their representatives may argue the process of decision making was unfair or that they were unfairly discriminated against when treatment has been refused. To date, these arguments have met with limited success so far as enabling patients to have treatment provided or continued against medical advice. More recently, however, some patients have challenged the lawfulness of a proposed treatment regime by advancing human rights arguments, based in turn on a broader aspect of patients’ “best interests” than best medical interests.

scholarly journals Going Beyond Panaceas: The Diversity of Land Observatory Forms in Africa

Land ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 70 ◽  
Author(s):  
Quentin Grislain ◽  
Jeremy Bourgoin ◽  
Ward Anseeuw ◽  
Perrine Burnod ◽  
Eva Hershaw ◽  
...  
Keyword(s):  
Decision Making ◽  
Participant Observation ◽  
Video Conferencing ◽  
Analytical Framework ◽  
Informed Decision ◽  
Informed Decision Making ◽  
Information Production ◽  
Dynamic Data ◽  
Ex Post ◽  
Ex Ante

In recent decades, mechanisms for observation and information production have proliferated in an attempt to meet the growing needs of stakeholders to access dynamic data for the purposes of informed decision-making. In the land sector, a growing number of land observatories are producing data and ensuring its transparency. We hypothesize that these structures are being developed in response to the need for information and knowledge, a need that is being driven by the scale and diversity of land issues. Based on the results of a study conducted on land observatories in Africa, this paper presents existing and past land observatories on the continent and proposes to assess their diversity through an analysis of core dimensions identified in the literature. The analytical framework was implemented through i) an analysis of existing literature on land observatories, ii) detailed assessments of land observatories based on semi-open interviews conducted via video conferencing, iii) fieldwork and visits to several observatories, and iv) participant observation through direct engagement and work at land observatories. We emphasize that the analytical framework presented here can be used as a tool by land observatories to undertake ex-post self-evaluations that take the observatory’s trajectory into account, or in the case of proposed new land observatories, to undertake ex-ante analyses and design the pathway towards the intended observatory.

scholarly journals A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial

2021 ◽  
Vol 22 ◽  
Author(s):  
Daniëlle N. Zijlstra ◽  
Jean W.M. Muris ◽  
Catherine Bolman ◽  
J. Mathis Elling ◽  
Vera E.R.A. Knapen ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Structural Equation ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Informed Decision ◽  
Equation Modeling ◽  
Informed Decision Making

Abstract Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

scholarly journals Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Asseel Albayati ◽  
Steven Douedi ◽  
Abbas Alshami ◽  
Mohammad A. Hossain ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Advice ◽  
Preventive Strategies ◽  
Against Medical Advice ◽  
Cause Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Discharge Against Medical Advice ◽  
Leaving Against Medical Advice

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.

scholarly journals Research use at the Ministry of Health in Burkina Faso: the decision-makers’ perspective

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christian Dagenais
Keyword(s):  
Decision Making ◽  
Knowledge Transfer ◽  
Burkina Faso ◽  
Informed Decision ◽  
Communication Strategy ◽  
Decision Makers ◽  
Research Use ◽  
Informed Decision Making ◽  
Ministry Of Health ◽  
Policy Makers

Abstract Background Despite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning. Method Individual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author. Results The results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence. Conclusions The conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

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