Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.ConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

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Doctors’ perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional survey of the UK physicians

BMJ Open ◽

10.1136/bmjopen-2017-017856 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017856 ◽

Cited By ~ 7

Author(s):

Tom Bourne ◽

Bavo De Cock ◽

Laure Wynants ◽

Mike Peters ◽

Chantal Van Audenhove ◽

...

Keyword(s):

Online Survey ◽

Well Being ◽

Adverse Outcomes ◽

Perceived Support ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Final Sample ◽

Perception Of Support ◽

The Uk

ObjectiveHow adverse outcomes and complaints are managed may significantly impact on physician well-being and practice. We aimed to investigate how depression, anxiety and defensive medical practice are associated with doctors actual and perceived support, behaviour of colleagues and process issues regarding how complaints investigations are carried out.DesignA survey study. Respondents were classified into three groups: no complaint, recent/current complaint (within 6 months) or past complaint. Each group completed specific surveys.SettingBritish Medical Association (BMA) members were invited to complete an online survey.Participants95 636 members of the BMA were asked to participate. 7926 (8.3%) completed the survey, of whom 1780 (22.5%) had no complaint, 3889 (49.1%) had a past complaint and 2257 (28.5%) had a recent/current complaint. We excluded those with no complaints leaving 6144 in the final sample.Primary outcomes measuresWe measured anxiety and depression using the Generalised Anxiety Disorder Scale 7 and Physical Health Questionnaire 9. Defensive practice was assessed using a new measure for avoidance and hedging.ResultsMost felt supported by colleagues (61%), only 31% felt supported by management. Not following process (56%), protracted timescales (78%), vexatious complaints (49%), feeling bullied (39%) or victimised for whistleblowing (20%), and using complaints to undermine (31%) were reported. Perceived support by management (relative risk (RR) depression: 0.77, 95% CI 0.71 to 0.83; RR anxiety: 0.80, 95% CI 0.74 to 0.87), speaking to colleagues (RR depression: 0.64, 95% CI 0.48 to 0.84 and RR anxiety: 0.69, 95% CI 0.51 to 0.94, respectively), fair/accurate documentation (RR depression: 0.80, 95% CI 0.75 to 0.86; RR anxiety: 0.81, 95% CI 0.75 to 0.87), and being informed about rights (RR depression 0.96 (0.89 to 1.03) and anxiety 0.94 (0.87 to 1.02), correlated positively with well-being and reduced defensive practice. Doctors worried most about professional humiliation following a complaint investigation (80%).ConclusionPoor process, prolonged timescales and vexatious use of complaints systems are associated with decreased psychological welfare and increased defensive practice. In contrast, perceived support from colleagues and management is associated with a reduction in these effects.

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EVIDENCE-BASED MEDICINE IN THE TIMES OF COVID-19: A CROSS-SECTIONAL SURVEY TO UNDERSTAND THE INDIAN PERSPECTIVE

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v5i5.794 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Karan B. Bhanushali ◽

Nikita Gupta ◽

Vinayak Mishra ◽

Heena Asnani

Keyword(s):

Decision Making ◽

Clinical Experience ◽

Evidence Based Medicine ◽

Online Survey ◽

Medical Literature ◽

Evidence Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Significant Difference ◽

Based Medicine

Introduction: During the COVID-19 pandemic, there is a tremendous amount of literature published regularly. In a country like India, historically, where there is a paternalistic approach to practicing medicine, there is a lot of hindrance to evidence-based medicine (EBM). Doctors have always weighed one's clinical experience superior over any other form of decision-making. This system of practice has made decision-making difficult for the physicians during this pandemic as COVID-19 is a reasonably new disease entity and the physicians lack enough 'prior experience' dealing with such a situation. Our survey tries to address the common barriers to evidence-based medical practices especially during the COVID-19 pandemic in India. We also try to explore the various source of information used by the doctors. Methods: It is a descriptive cross-sectional survey. The questions were provided in multiple-choice question format. An online survey comprising of 10 questions entitled “Hurdles faced by physicians to assimilate evidence-based guidelines on COVID-19” was made using Google Forms (Google Inc, California, US) and circulated through email to medical practitioners in the Ghatkopar (Mumbai, India) Medical Association's register from 17th June 2020 to 1st September 2020. Results: Our survey collected 213 responses, out of which 80.3% (n=171) of doctors were involved in care, counseling, or management of COVID-19 patients. The most opted primary sources for evidence-based information during this pandemic were teachings of/discussions with medical colleagues (71.4%, n=152), followed by online webinars (59.6%, n= 127) and social media (41.8%, n=89). When questioned about the main obstacles faced by them to obtain evidence-based information, the responses were as follows: Overload of medical literature (53.5%, n=114), limited access to quality resources (40.8%, n=87), unfamiliarity with the bio-statistics analysis (39%, n= 83), difficulty in locating relevant medical literature (38%, n=81), unfamiliarity with the research methodology (37.1%, n=79), lack of time (30%, n=64). Our respondents' perspective concerning EBM attributes: 57.3% (n=122) think evidence-based practice takes their clinical experience into account. 93.4% (n=199) of them have shown an interest in broadening their skills. There was no significant difference between doctors' attitudes with less than 10 years and more than 10 years of experience (chi-square value = 0.857, p = 0.65). Conclusion: Our survey results highlight the balance maintained between evidence-based medicine and experience-based medicine by Indian physicians. They identify the importance of EBM while acknowledging its shortcomings. They realize the significance of developing their repertoire to understand, appraise, and practice EBM. Keywords: EBM, COVID-19

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Advance care planning participation by people with dementia: a cross-sectional survey and medical record audit

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002550 ◽

2021 ◽

pp. bmjspcare-2020-002550

Author(s):

Jamie Bryant ◽

Marcus Sellars ◽

Amy Waller ◽

Karen Detering ◽

Craig Sinclair ◽

...

Keyword(s):

Advance Care Planning ◽

Aged Care ◽

Residential Aged Care ◽

Health Record ◽

Care Planning ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Substitute Decision Maker ◽

People With Dementia ◽

Advance Care

ObjectivesTo describe among individuals with dementia: (1) self-reported awareness of, and engagement in, advance care planning; (2) presence of advance care planning documentation in the health record and (3) concordance between self-reported completion of advance care planning and presence of documentation in the health record.MethodsAn Australian prospective multicentre audit and cross-sectional survey. Individuals diagnosed with dementia who were able to speak English and were judged by a healthcare provider as having decision-making capacity were recruited from self-selected hospitals, residential aged care facilities and general practices across Australia.ResultsFifty-two people with dementia completed surveys and were included. Overall, 59.6% of participants had heard about advance care planning and 55.8% had discussed advance care planning with someone, most often a family member (48.1%). While 38.5% of participants had appointed a medical substitute decision maker, only 26.9% reported that they had written down their values and preferences for future care. Concordance between self-reported completion of advance care planning and presence of documentation in the health record was low (56.8%, κ=0.139; 57.7%, κ=0.053).ConclusionEffective models that promote discussion, documentation and accessible storage of advance care planning documents for people with dementia are needed.

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Awareness and Attitudes towards Advance Care Directives (ACDs): An Online Survey of Portuguese Adults

Healthcare ◽

10.3390/healthcare9060648 ◽

2021 ◽

Vol 9 (6) ◽

pp. 648

Author(s):

Carlos Laranjeira ◽

Maria dos Anjos Dixe ◽

Luís Gueifão ◽

Lina Caetano ◽

Rui Passadouro ◽

...

Keyword(s):

Online Survey ◽

Sociodemographic Factors ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Positive Attitudes ◽

Advance Care Directives ◽

Advance Care ◽

Advance Decisions ◽

Eol Care

(1) Background: Evidence shows that facilitated advance decisions can increase the number of meaningful and valid Advance Care Directives (ACDs) and improve the quality of care when End-Of-Life (EOL) is near. Little is known about the awareness and attitudes of Portuguese adults towards ACDs. The present study aims to assess the knowledge, attitudes, and preferences of a sample of Portuguese adults regarding EOL care decisions and ACDs. (2) Methods: A total of 1024 adults were assessed with an online cross-sectional survey collecting information on sociodemographic factors, knowledge, attitudes and preferences regarding advance decisions and EOL care. (3) Results: Participants had a mean age of 40.28 ± 11.41 years. Most were female and had a professional background related to healthcare. While 76.37% of participants had heard of ACDs, only a small percentage (2.34%) had actually ever made an ACD. Knowledge levels were weakly correlated with attitudes regarding ACDs (r = −0.344; p < 0.01). (4) Conclusions: Participants lacked a comprehensive understanding about ACDs, but revealed positive attitudes towards their use and usefulness. Further research can inform efforts to improve ACD engagement in this population. The discussion about ACDs should be part of health promotion education with a focus on planning for a comfortable and peaceful death.

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Junior Medical Officers’ Knowledge of Advance Care Planning and Substitute Decision Making For People With Dementia: A Cross Sectional Survey

10.21203/rs.3.rs-604590/v1 ◽

2021 ◽

Author(s):

Jamie Bryant ◽

Amy Waller ◽

Alison Bowman ◽

Rob Pickles ◽

Carolyn Hullick ◽

...

Keyword(s):

Decision Making ◽

Advance Care Planning ◽

Public Hospitals ◽

Care Planning ◽

Correct Order ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Legal Validity ◽

People With Dementia ◽

Advance Care

Abstract Background For the benefits of advance care planning (ACP) to be realised during a hospital admission, the treating team must have accurate knowledge of the law pertaining to ACP. Aims To determine in a sample of Junior Medical Officers (JMOs): (1) knowledge of the correct order to approach people as substitute decision makers if a patient does not have capacity to consent to treatment; (2) knowledge of the legal validity of advance care directives (ACDs) when making healthcare decisions for persons with dementia, including the characteristics associated with higher knowledge; and (3) barriers to enacting ACDs. Methods A cross-sectional survey was conducted at five public hospitals in New South Wales, Australia. Interns, residents, registrars, and trainees on clinical rotation during the recruitment period were eligible to participate. Consenting participants completed an anonymous pen-and-paper survey. Results A total of 118 JMOs completed a survey (36% return rate). Fifty-five percent of participants were female and 56.8% were aged 20–29 years. Seventy-five percent of JMOs correctly identified a Guardian as the first person to approach if a patient did not have decision-making capacity, and 74% correctly identified a person’s spouse or partner as the next person to approach. Only 16.5% identified all four persons in the correct order, and 13.5% did not identify any in the correct order. The mean number of correct responses to the questions assessing knowledge of the legal validity of ACDs was 2.6 (SD = 1.1) out of a possible score of 6. Only 28 participants (23.7%) correctly answered four or more knowledge statements correctly. None of the explored variables were significantly associated with higher knowledge of the legal validity of ACDs. Uncertainty about the currency of ACDs and uncertainty about the legal implications of relying on an ACD when a patient’s family or substitute decision maker disagree with it were the main barriers to enacting ACDs. Conclusion JMOs knowledge of the legal validity of ACDs for persons with dementia without capacity and the substitute decision-making hierarchy is limited. There is a clear need for targeted education and training to improve knowledge in this area for this cohort.

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The Use of Evidence in Humanitarian Response Decision-Making

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19000852 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s33-s33

Author(s):

Dell Saulnier ◽

Claire Allen ◽

Anneli Eriksson ◽

Ben Heaven Taylor

Keyword(s):

Decision Making ◽

Online Survey ◽

Field Experience ◽

Good Practice ◽

Poor Quality ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Humanitarian Response ◽

The Right ◽

Media Channels

Introduction:The need to use evidence in humanitarian settings is recognized, yet utilizing that evidence to make decisions about humanitarian response remains a challenge.Aim:To identify how, when, and why decision makers in humanitarian response use scientific, peer-reviewed evidence to make decisions.Methods:An online cross-sectional survey of fifteen open- and closed-ended questions on demographics, experience, and role in humanitarian response was developed by Evidence Aid (EA) and Karolinska Institutet (KI). The online survey was available on the EA website from August 2015 to October 2018. Participants were self-selected, recruited through social media channels and mailing lists of EA and KI. All respondents and responses were anonymized. Responses were analyzed with descriptive statistics and content analysis.Results:47 people responded, primarily working in Europe or North America with roles of humanitarian response director/manager, independent consultant, or policymaker. Personal assessment of the quality of information, trust in the source, and information that was contextually relevant or based on field experience were factors for deciding whether information should be considered evidence. Reasons for using evidence when making decisions included adhering to good practice to maximize impact and effectiveness of aid, reassurance that the right decisions were being made, personal or organizational values, and using evidence as a tool to protect beneficiaries and organizations from poor quality decisions and program content.Discussion:Using evidence for decision making was common practice during the process of designing implementing and evaluating humanitarian response content, yet reasons for use varied. The importance of evidence developed and validated from field experience and trust in the source reported by this sample suggests that strengthening collaborative efforts between decisionmakers and evidence generators could be one approach to improve evidence and evidence use in humanitarian response.

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Knowledge of, and attitudes to, shared decision-making in orthodontics in the UK

Journal of Orthodontics ◽

10.1177/1465312520941526 ◽

2020 ◽

Vol 47 (4) ◽

pp. 294-302

Author(s):

Sophy K Barber ◽

Fiona Ryan ◽

Susan J Cunningham

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Orthodontic Treatment ◽

Online Survey ◽

Free Text ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Treatment Providers ◽

The Uk

Objective: To establish UK orthodontic treatment providers’ knowledge of, and attitudes to, shared decision-making (SDM). SDM involves patients as equal partners in decisions about treatment. Design: Cross-sectional survey. Setting: Online survey across the UK. Population: Dentists and orthodontists providing orthodontic treatment in the UK. Methods: Potential participants were contacted through the British Orthodontic Society mailing lists. An online survey was developed to examine knowledge of, and attitudes to, SDM using a combination of evidence-based statements and free text boxes. Questions regarding previous training in SDM and preferences for further training were also included. Results: The survey was completed by 210 respondents, yielding an approximate response rate of 15%. Respondents were mainly consultants (34%) and specialist orthodontists (42%). SDM was well described in terms of the people involved in this process, how it is approached, the components and topics of discussion, and the overall purpose of SDM. Generally, there was consistency in attitudinal responses, with the largest variance in responses to questions about the professional–patient partnership, the interface between SDM and clinical guidelines, and accepting a decision that is discordant with the professional’s opinion. Fifty-one respondents reported having some previous teaching/training in SDM, with the majority (87%) indicating that they would like more training. Conclusion: Clinicians providing orthodontic treatment in the UK have a good understanding of the meaning of shared decision-making. Concerns raised about using SDM and knowledge gaps suggest there is value in providing SDM training for the orthodontic team and that orthodontic providers would welcome it.

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Treatment Decision Needs of Psoriasis Patients: Cross-sectional Survey

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2010.09049 ◽

2010 ◽

Vol 14 (5) ◽

pp. 233-239 ◽

Cited By ~ 15

Author(s):

Jerry Tan ◽

Dawn Stacey ◽

Karen Fung ◽

Benjamin Barankin ◽

Robert Bissonnette ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Online Survey ◽

Treatment Decision ◽

Treatment Decisions ◽

Shared Decision ◽

Medical Evidence ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Values

Background: Informed shared decision making is a mutual process engaging both doctor and patient and informed by best medical evidence and patient values and preferences. Objective: Our aim was to identify the needs of psoriasis patients in decisions on selecting treatment. Methods: Psoriasis subjects participated in an online survey on decisional role, postdecisional conflict, and treatment awareness. Results: Of 2,622 people invited to participate, 248 completed surveys. Their most recent treatment decision was either made by subjects alone (42%) or physicians alone (28%) or was shared (29%). Subjects perceived that their doctors lacked time to stay abreast of treatments, to provide counseling, and to access appropriate treatments. Deficiencies most frequently identified were information on options, clarification of values, access to physicians, and decision-making skills. Those with a body surface area (BSA) ≥ 3% more frequently indicated that having the skill or ability to make treatment decisions was important. Limitations: The limitations of this study include sampling, recall, and reporting bias. Percent BSA was not verified. Conclusions: The multiple deficiencies in support of psoriasis patients in treatment decisions may preclude informed shared decision making.

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Assessing public awareness of clubfoot and knowledge about the importance of early childhood treatment: a cross-sectional survey

BMC Pediatrics ◽

10.1186/s12887-019-1740-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Abdulmonem Alsiddiky ◽

Salman Alrwibaah ◽

Abdulrahman Alqahtani ◽

Abdulmalek Alnujidi ◽

Abdullah Alhomaidhi ◽

...

Keyword(s):

Social Media ◽

Early Childhood ◽

Online Survey ◽

Public Awareness ◽

Age Groups ◽

Public Knowledge ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Early Management ◽

Awareness Campaigns

Abstract Background Clubfoot is a treatable abnormality that can be managed with early intervention. However, there is a lack of public knowledge regarding clubfoot, which can delay treatment. This study aimed to assess the public awareness of clubfoot and knowledge regarding the importance of treatment in early childhood. Methods This cross-sectional survey spanned 6 months, from June through November 2018, and involved persons living in Saudi Arabia. To collect data on public awareness of clubfoot risk factors, treatment, and prognosis, a questionnaire was developed by orthopedic experts and disseminated online. The target population included people of both genders and all age groups from the general population, regardless of their knowledge of someone with clubfoot. Results By the end of the study period, 746 participants completed the online survey. In total, 520 of the respondents (69.7%) had never heard about clubfoot syndrome. Among the participants, 5.4% had a child with clubfoot syndrome and 4.6% were aware of clubfoot because they had an affected child. The top resource accessed by respondents for obtaining knowledge about clubfoot was social media channels (38.4%), followed by obtaining knowledge from relatives and friends (19.9%). The most reported perceived cause of clubfoot was hereditary and genetic disorders (58.4%), followed by neurological disorders (39.9%). Conclusions Results show that there is low public knowledge of clubfoot which may be attributed to a lack of awareness campaigns. We recommend increasing awareness regarding clubfoot through social media platforms and public campaigns in key locations, such as malls, as this may encourage people to seek early treatment. This is important because early management of clubfoot is less invasive and with regular follow-up, leads to better patient outcomes.

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Testing the Strain Theory of Suicide – The Moderating Role of Social Support

Crisis ◽

10.1027/0227-5910/a000604 ◽

2020 ◽

Vol 41 (2) ◽

pp. 82-88 ◽

Cited By ~ 1

Author(s):

Bob Lew ◽

Ksenia Chistopolskaya ◽

Yanzheng Liu ◽

Mansor Abu Talib ◽

Olga Mitina ◽

...

Keyword(s):

Social Support ◽

Suicidal Behavior ◽

Online Survey ◽

Perceived Social Support ◽

Strain Theory ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Psychological Strains ◽

Moderating Role

Abstract. Background: According to the strain theory of suicide, strains, resulting from conﬂicting and competing pressures in an individual's life, are hypothesized to precede suicide. But social support is an important factor that can mitigate strains and lessen their input in suicidal behavior. Aims: This study was designed to assess the moderating role of social support in the relation between strain and suicidality. Methods: A sample of 1,051 employees were recruited in Beijing, the capital of China, through an online survey. Moderation analysis was performed using SPSS PROCESS Macro. Social support was measured with the Multidimensional Scale of Perceived Social Support, and strains were assessed with the Psychological Strains Scale. Results: Psychological strains are a good predictor of suicidality, and social support, a basic need for each human being, moderates and decreases the effects of psychological strains on suicidality. Limitations: The cross-sectional survey limited the extent to which conclusions about causal relationships can be drawn. Furthermore, the results may not be generalized to the whole of China because of its diversity. Conclusion: Social support has a tendency to mitigate the effects of psychological strains on suicidality.

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