scholarly journals Professional decision making with digitalisation of patient contacts in a medical advice setting: a qualitative study of a pilot project with a chat programme in Sweden

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054103
Author(s):  
Åsa Cajander ◽  
Gustaf Hedström ◽  
Sofia Leijon ◽  
Marta Larusdottir
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Professional Knowledge ◽  
Pilot Project ◽  
Medical Advice ◽  
Patient Contact ◽  
Clinical Patient ◽  
Nurses And Physicians ◽  
Professional Judgement

ObjectivesPatient e-services are increasingly launched globally to make healthcare more efficient and digitalised. One area that is digitalised is medical advice, where patients asynchronously chat with nurses and physicians, with patients having filled in a form with predefined questions before the chat. This study aimed to explore how occupational professionalism and the possibility of professional judgement are affected when clinical patient contact is digitalised. The study’s overall question concerns whether and how the scope of the healthcare staff’s professional judgement and occupational professionalism are affected by digitalisation.Design and settingA qualitative study of healthcare professionals working in a pilot project with a chat programme for patients in a medical advice setting in Sweden.Participants and analysisContextual inquiries and 17 interviews with nurses (n=9) and physicians (n=8). The interviews were thematically analysed. The analysis was inductive and based on theories of decision making.ResultsThree themes emerged: (1) Predefined questions to patients not tailored for healthcare professionals’ work, (2) reduced trust in written communication and (3) reduced opportunity to obtain information through chat communication.ConclusionsThe results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system’s design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

scholarly journals Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053937
Author(s):  
Jane Noyes ◽  
Gareth Roberts ◽  
Gail Williams ◽  
James Chess ◽  
Leah Mc Laughlin
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Healthcare Professionals ◽  
Family Members ◽  
Shared Decision ◽  
Framework Analysis ◽  
Future Treatment ◽  
Modifiable Factors ◽  
Decision Making Processes

ObjectivesTo explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice.DesignCoproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations.SettingFive Welsh kidney services.Participants95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals).FindingsShared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors.ConclusionsShared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.

scholarly journals Experiences of Iranian women with prenatal diagnosis of fetal abnormalities: A qualitative study

2020 ◽  
Author(s):  
Fahimeh Ranjbar ◽  
Fatemeh Oskouie ◽  
Shahrzad Hashemi Dizaji ◽  
Maryam Gharacheh
Keyword(s):  
Decision Making ◽  
Prenatal Diagnosis ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Fetal Abnormalities ◽  
Economic Problems ◽  
Self Blame ◽  
Emotional Suffering ◽  
Conventional Content Analysis ◽  
Depth Interviews

Abstract Background: Women are more likely to be diagnosed with congenital anomalies. Following prenatal diagnosis of fetal abnormalities, women may be forced to make decisions about whether to continue a pregnancy with fetal abnormalities. This can be a dilemma for the women. The aim of the study was to explore women’s experiences of prenatal diagnosis of fetal abnormalities. Methods: A qualitative study was conducted in a referral women’s hospital in Tehran, Iran in 2018. Participants were a purposeful sample of 15 women with prenatal diagnosis of fetal abnormalities. Data were collected by individual, in-depth interviews. The conventional content analysis approach was used to analyze the data. Results: Two main themes “emotional suffering” and “decision-making challenge” were extracted from the participants’ experiences. Emotional suffering consisted of subthemes “sense of guilt”, “self-blame”, “questioning of God”, “commiseration” and “projection”. Decision making challenge included subthemes “distrust”, “possible cure”, “dark future”, “economic problems”, “stereotypical beliefs”, “coercion” and “lack of support”. Conclusions: The experience of prenatal diagnosis of fetal abnormalities was associated with emotional suffering and challenges in decision-making to continue or terminate the pregnancy. Strategies need to be employed to improve women’s autonomy in decision-making. Healthcare professionals should be trained in communication skills to provide appropriate counseling to support women with diagnosis of fetal anomalies.

scholarly journals Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals’ perspectives

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042497
Author(s):  
Annabel Nash ◽  
Tom Kingstone ◽  
Saeed Farooq ◽  
Jessica Tunmore ◽  
Carolyn A Chew-Graham
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Side Effects ◽  
Qualitative Study ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Mental Health Nurses

ObjectivesThe side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI).DesignA qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants’ views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison.SettingsParticipants recruited through primary care and one mental health trust in the West Midlands.ParticipantsInterviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.ResultsAwareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this.ConclusionsThis study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

Perceptions and experiences of older patients and healthcare professionals regarding shared decision-making in pulmonary rehabilitation: A qualitative study

2021 ◽  
pp. 026921552110102
Author(s):  
Yuyu Jiang ◽  
Jianlan Guo ◽  
Pingping Sun ◽  
Zhongyi Chen ◽  
Fenglan Liu ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Perceived Stress ◽  
Thematic Analysis ◽  
Pulmonary Rehabilitation ◽  
Older Patients ◽  
Healthcare Professionals ◽  
Knowledge Gap ◽  
Shared Decision

Objective: To understand the perceptions and experiences of older patients with chronic obstructive pulmonary disease (COPD) and healthcare professionals (HCPs) regarding shared decision-making in pulmonary rehabilitation (PR). Design: A qualitative study using single, semi-structured interviews, and thematic analysis. Setting: Face-to-face interviews were conducted in the Jiangnan University, in hospital and in patients’ homes. Participants: Twenty-two older patients with COPD and 29 HCPs. Methods: An initial codebook and semi-structured interview guide were developed based on the shared decision-making 3-circle conceptual model. Thematic analysis was used to analyze data. Results: The study identified 10 themes that describe the perceptions and experiences of patients and HCPs involved in PR decision-making: (1) patients’ confidence, (2) patients’ perceptions of the cost-benefit of decisions, (3) patients’ perceived stress about the consequences of decision-making, (4) HCPs’ perceived stress on shared decision-making, (5) cognitive biases of patients toward illness and rehabilitation, (6) shared decision-making as a knowledge gap, (7) the knowledge gap between patients and HCPs, (8) authority effect, (9) family support, (10) human resources. These themes were then divided into three groups according to their characteristics: (1) the feelings of the participants, (2) knowledge barriers, and (3) support from the social system. Conclusion: Patients and HCPs described their negative perceptions and experiences of participating in decision-making in PR. The implementation of shared decision-making in PR is currently limited; therefore, health education for patients and families should be strengthened and a training system for HCPs in shared decision-making should be established.

Perspectives on autonomy and advance decision-making: A qualitative study based on older people living with frailty and their carers

2020 ◽  
pp. 096853322092744
Author(s):  
Louise Bramley ◽  
Jane Seymour ◽  
Karen Cox ◽  
Jo Samanta
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Older People ◽  
Healthcare Professionals ◽  
Mental Capacity Act 2005 ◽  
Future Care ◽  
Advance Care ◽  
Using Data ◽  
Mental Capacity Act ◽  
And Coping

The Mental Capacity Act 2005, covering England and Wales, sets out formal tools to extend autonomy past the onset of incapacity that protect an individual’s right to retain autonomy in decision-making. Despite policy drivers who encourage healthcare professionals to support advance decision-making for future care, very few individuals living with frailty engage in doing so. In this article, we interrogate these issues using data from a qualitative study of older people living with frailty, which engages with how those living and coping with varying degrees of frailty experience their situation day to day and their perceptions of planning for incapacity and decision-making. After critically evaluating the viewpoints of older people living with frailty and their carers, we assess the significance of their perceptions for the contemporary debates surrounding autonomy and how they align with the policy perspectives and the clinical practice of advance care planning.

scholarly journals Beyond the “information deficit model” - understanding vaccine-hesitant attitudes of midwives in Austria: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Lehner ◽  
Janna Gribi ◽  
Kathryn Hoffmann ◽  
Katharina T. Paul ◽  
Ruth Kutalek
Keyword(s):  
Decision Making ◽  
Early Childhood ◽  
Qualitative Study ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Scientific Information ◽  
Vaccine Hesitancy ◽  
Theory Approach ◽  
Deficit Model ◽  
The Right

Abstract Background Healthcare workers are considered key stakeholders in efforts to address vaccine hesitancy. Midwives’ influence in advising expectant parents on early-childhood vaccinations is unquestioned, yet they remain an understudied group. The literature on midwives’ attitudes towards vaccinations is also inconclusive. We therefore conducted an explorative qualitative study on midwives’ vaccine-hesitant attitudes towards MMR (measles-mumps-rubella) vaccinations in Austria. Methods We conducted 12 in-depth interviews on their knowledge, concerns, and beliefs with midwives who self-identified as hesitant or resistant towards early-childhood MMR vaccinations. We analyzed the data using a grounded theory approach to distill common themes and meanings. Results Healthcare workers’ stewardship to address vaccine hesitancy is commonly framed in terms of the “information deficit model”: disseminate the right information and remedy publics’ information deficits. Our findings suggest that this approach is too simplistic: Midwives’ professional self-understanding, their notions of “good care” and “good parenthood” inflect how they engage with vaccine information and how they address it to their clients. Midwives’ model of care prioritized good counseling rather than sharing scientific information in a “right the wrong”-manner. They saw themselves as critical consumers of that information and as promoting “empowered patients” who were free, and affluent enough, to make their own choices about vaccinations. In so doing, they also often promoted traditional notions of motherhood. Conclusions Research shows that, for parents, vaccine decision-making builds on trust and dialogue with healthcare professionals and is more than a technical issue. In order to foster these interactions, understanding healthcare professionals’ means of engaging with information is key to understanding how they engage with their constituents. Healthcare workers are more than neutral resources; their daily praxis influenced by their professional standing in the healthcare system. Similarly, healthcare professionals’ views on vaccinations cannot be remedied with more information either. Building better and more diverse curricula for different groups of healthcare workers must attend to their respective roles, ethics of care, and professional beliefs. Taken together, better models for addressing vaccine hesitancy can only be developed by espousing a multi-faceted view of decision-making processes and interactions of healthcare workers with constituents.

A qualitative study of factors in nurses' and physicians' decision-making related to family presence during resuscitation

2017 ◽  
Vol 27 (1-2) ◽  
pp. e320-e334 ◽  
Author(s):  
Renee Twibell ◽  
Debra Siela ◽  
Cheryl Riwitis ◽  
Alexis Neal ◽  
Nicole Waters
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Family Presence ◽  
Nurses And Physicians
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