scholarly journals Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent

2020 ◽  
Vol 96 (1141) ◽  
pp. 708-710
Author(s):  
Zachary R Paterick ◽  
Timothy Edward Paterick ◽  
Barb Block Paterick
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Outcomes ◽  
Healthcare Providers ◽  
Informed Choice ◽  
Standard Of Care ◽  
Fiduciary Duty ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Legal Principles

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic approaches. Informed choice, as part of a shared decision-making model, allows widespread give-and-take of ideas between the patient and physician. This sharing of ideas results in a partnership for decision-making and a responsibility for medical and surgical outcomes.Informed choice is indispensible to the patient education process that meets the desired outcome of any covenant—an offer of and acceptance of the proposed treatment. The covenant anchors a true patient–physician partnership with parity and equality in decision-making and medical/surgical outcomes.Medical informed choice flows from ethical and legal principles necessary to meet the acknowledged standard of care. This is codified by statute and fortified in general common law. This espouses a fiduciary relationship where the patient and physician understand and accede to the degree of autonomy the patient requests.The growth of an equal patient–physician relationship requires time. There is no alternative to the time variable when developing a physician–patient relationship. Despite physicians being under pressures to perform more clinical and administrative duties in less time in the corporate model of medicine, time remains the most critical variable when considering informed choice and shared decision-making. Videos, pamphlets and alternate healthcare providers cannot and should not substitute for physician time.

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes

2021 ◽  
pp. bmjspcare-2020-002857
Author(s):  
Erin Denney-Koelsch ◽  
Denise Cote-Arsenault
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Parental Decision ◽  
Parental Decision Making ◽  
Case Comparison ◽  
Theme Identification ◽  
Iterative Coding

ObjectivesWhen parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby.MethodsThis study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents’ experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison.ResultsThirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents’ experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk–benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets.ConclusionFor shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents’ subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.

scholarly journals Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study

2013 ◽  
Vol 27 (3) ◽  
pp. 214-222 ◽  
Author(s):  
France Légaré ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
Kimberley Fraser ◽  
Sophie Desroches ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Home Care ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Shared Decision

Shared decision-making and informed choice for the early detection of prostate cancer in primary care

2005 ◽  
Vol 96 (9) ◽  
pp. 1209-1210 ◽  
Author(s):  
Suzanne K. Steginga ◽  
Carole Pinnock ◽  
Claire Jackson ◽  
Tony Gianduzzo
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Early Detection ◽  
Shared Decision Making ◽  
Informed Choice ◽  
Shared Decision

P002 IBD PARTNERSHIPS: UNDERSTANDING PATIENTS VS. CLINICIANS PERSPECTIVES OF IBD TREATMENT OPTIONS TO IMPROVE SHARED DECISION-MAKING

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Sandra Zelinsky ◽  
Catherine Finlayson
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Treatment Decisions ◽  
Research Approach ◽  
Shared Decision ◽  
Rural And Urban

Abstract Background The patient is the only constant in the care journey, the person who experiences both processes and the outcomes of care. There is an international shift towards including patients as equal partners in research. Co-producing research with Inflammatory Bowel Disease (IBD) patients to understand their values, needs and priorities when making treatment decisions will potentially improve shared decision-making between IBD patients and their Healthcare Providers (HCPs). To facilitate this process patients and HCPs must have a common understanding of expected medication benefits, risks and the potential impact on quality of life. The information available to facilitate this conversation must be aligned and reflect the priorities that IBD Patients and Healthcare Providers consider when making treatment decisions. Both parties can then share information and work towards an agreement to what treatment plan should be implemented. Aims To understand what matters most to IBD patients when making treatment decisions by conducting a qualitative patient-led peer to peer study which will inform the development of an IBD patient and HCP survey. Methods IBD patients (≥ 18 years of age) were recruited through the IBD clinic at the University of Calgary and via social media. Focus groups were held in three separate provinces (British Columbia, Alberta and Ontario) in both rural and urban locations. The focus groups were facilitated by a Patient Engagement Researcher to alleviate any potential power dynamics and to create a safe space for IBD patients to share their perspectives. A participatory action research approach was used to encourage co-production with participants throughout the focus groups. The focus groups were audio recorded. Flip charts and sticky notes were used for brainstorming and prioritization exercises. All audio and written data were transcribed. Thematic analysis was used to identify emerging themes and patient priorities. Results A total of 21 participants attended the focus groups from both rural and urban locations. Participant diversity ranged in ethnicity and age. Most of the participants were female (18 females and 3 males) of which 4 were biologic naïve and 17 were biologic exposed. The Top 5 IBD Patient Priorities when making treatment decisions are 1) Risks(more serious/long term) 2) Education(Support/Evidence Based Information/Resources) 3) Side Effects(short term/less serious) 4) Efficacy 5) Impact(Quality of Life/ Lifestyle/Logistics). Conclusions Co-producing research ‘with’ and ‘by’ IBD patients helped to generate priorities that matter most to patients when making treatment decisions. The patient priorities will help in the development of an IBD Patient and HCP survey. The results from the two surveys will be compared to understand patient vs. HCP perspectives.

Health Decisions and Decision Support for Women

2001 ◽  
Vol 19 (1) ◽  
pp. 307-324 ◽  
Author(s):  
MARILYN L. ROTHERT ◽  
ANNETTE M. O’CONNOR
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Cochrane Review ◽  
Informed Choice ◽  
Shared Decision ◽  
Patient Decision ◽  
Key Issues ◽  
Conceptual Overview

Women are more likely to live longer with chronic illness and have a longterm relationship with their health care provider; this requires a situation in which patients and providers have a role in managing illness. In this chapter, the authors provide a conceptual overview of decision making along with key issues: historical concepts related to patients and providers, consumerism, informed choice/consent, patient rights, shared decision making, patient involvement, as well as an overview of models of patient/provider partnerships. This review builds on the work of O’Connor et al. (1999), which resulted in a Cochrane review of decision aids and focuses the examination of patient decision aids that support women’ decisions regarding health treatment or screening. The authors conclude with a look to the future and recommendations for research in the area of shared decision making and health care decision aids.

scholarly journals Principles of shared decision-making within teams

2015 ◽  
Vol 25 (8) ◽  
pp. 1631-1636 ◽  
Author(s):  
Jeffrey P. Jacobs ◽  
Gil Wernovsky ◽  
David S. Cooper ◽  
Tom R. Karl
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Shared Decision Making ◽  
Risk Model ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

AbstractIn the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of “A+ personality” individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital.Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making.An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors.The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels:• SDM Level 1 Decision: “We disagree but it really does not matter, so do whatever you desire!”• SDM Level 2 Decision: “We disagree and I believe it matters, but I am OK if you do whatever you desire!!”• SDM Level 3 Decision: “We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!”SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.

scholarly journals Shared Decision Making For Children with Chronic Respiratory Failure- It Takes a Village and a Process

2020 ◽  
Author(s):  
Katharine Kevill ◽  
Grace Ker ◽  
Rina Meyer
Keyword(s):  
Decision Making ◽  
Respiratory Failure ◽  
Shared Decision Making ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Chronic Respiratory Failure ◽  
Shared Decision ◽  
Medical Specialties ◽  
Key Questions

Background and objectives: Shared decision making (SDM) prior to non-urgent tracheostomy in a child with chronic respiratory failure (CRF) is recognized as the standard of care, but has proven challenging to implement in practice. We hypothesize that utilization of the microsystem model for analysis of the complex ecosystem in which SDM occurs will yield insights that enable formation of a reproducible, measurable SDM process. Methods: Retrospective chart review of a case series of children with CRF in whom a SDM process was pursued. The process included a palliative care consult, a validated decision aid and 12 key questions designed to elucidate information integral to an informed decision. Investigators reviewed a single hospital admission for each child, focusing on the 3 core elements of a medical microsystem- the patient, the providers, and information. Results: 29 patients who met inclusion criteria ranged in age from 0 to 19 years (median 1.7) and remained in the hospital from 10 to 316 days (median 38). Patients were medically complex with multiple and varied respiratory diagnoses, multiple and varied comorbidities, and varying psychosocial environments. 14/29 children received tracheostomies. Each child encountered a mean of 6.2 medical specialties, 1.9 surgical specialties and 8.5 non-physician led services. Answers to 12 key questions were not documented systematically and often not found. Conclusion: A unique SDM microsystem is formed around each child but not optimally utilized. Explicit recognition of these microsystems would enable team formation and an SDM process comprised of measurable steps and communication patterns.

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

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 ◽  
The Relationship

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.

scholarly journals Practitioners’ views on shared decision-making implementation: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259844
Author(s):  
Anshu Ankolekar ◽  
Karina Dahl Steffensen ◽  
Karina Olling ◽  
Andre Dekker ◽  
Leonard Wee ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Shared Decision ◽  
Implementation Success ◽  
Patient Decision ◽  
Interview Format ◽  
Major Shift

Introduction Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners’ perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes. Methods We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis. Results Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools. Conclusions Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.

Sign in / Sign up

Export Citation Format

Share Document